1. 412 Norman Court
Des Plaines, Illinois 60016
(847) 321-5882
bmezzano@aol.com
Bonnie M. Mezzano
Experienced Health Care Claims Manager
Over 35 Years ofExperience as a Highly Skilled and Well-Seasoned Health Care Claims Leader; Proven Ability to
Manage Various Medical Insurance Lines of Business, Lead Teams to Success, Direct Resource for Special
Projects, Identify Work Flow Efficiencies, Create Operational Best Practices, Meet Industry Regulations and
Standards, and Oversee Quality Assurance. A Driving Force for Operational Transformations.
A Health Care Claims Manager professional with extensive experience in the complete operational claims processing
process. Results orientated individual with proven ability to direct departments and teams. Strong analytical, decision-
making, and interpersonal skills. Organized team leader who motivates teams to maximize productivity and improve
team chemistry. Proven communicator in any level of an organization, excellent customer service and ability to partner
with customers to achieve their goals, build strong business relationships, as well as managing vendors. Self-motivated
and welcomes any and all challenges.
Software: MS Office, SharePoint, MS Lync
Health Care Software: EZCap 6.2.4, RIMS, QuickCap
Claims Software: HCIM Symkey (Auto-Adjudication Assist), PCG Software Virtual Reporter (Claims Code
Editor), Claims, ClaimsShop (EZCAP interface) Pricing and Claims Code Editing System,
EncoderPro (APC,ASC and DRG stand-alone pricing), CMS pricers for DRG,
LTCH,SNF,HH and ESRD, 3M CORE GROUP APL pricing software (Medicaid)
March 1999 - Present
North American Medical Management of Illinois / Optum Collaborative Care, Hillside Illinois
Provides management services to medical groups seeking to maximize the opportunities of managed care.
 Strategic / TacticalPlanning
 Audits Management
 Team Building / Coaching
 Dispute Management
 Process Improvement
 Claims Processing
 Managed Care Business
 Solid Leadership Skills
 Staff Training / Development
 Policy / Program Development
 Claims Adjustment
 Staffing / Employee Relations
 Health Plan Business Lines
 Fraud Waste & Abuse
Professional Experience
Technical Expertise
Core Knowledge and Skill Areas Include

2. Director ofClaims (NAMM)/ Manager ofClaims (Optum) delivers overall management of the claims process that
aligns to the organization’s strategic goals, transformation initiatives, system refinement, and efficiencies in work flow
processes with financial savings. Reports to the Vice President of Operations, responsible for 16 direct reports, supporting
6 health plan payers, and 13 physician/hospital groups.
 Organizes and presides as Claims Representative over yearly delegated audits for the Health Plans
 Resource for all claims, claims process related functions, and claims workflows
 Provides Corporate and Internal reporting deliverables, including Health Plan and IPA claims statistics
 Assures claims deliverables comply with all regulatory requirements on the Health Plan, State,and Federal levels
 Writes and reviews reports to insure accurate claims payments and best practices for all clients
 Manages all claims related project including recoupments and fee schedule changes
 Excellent rapport with both internal and external clients, works equally well as a team leader or participant
 Involved in developing transition plans for both incoming and outgoing clients
 Works closely with Health Services and Provider Relations Departments to assure all client and business needs
are met
 Active participant in Fraud, Waste and Abuse initiatives including identifications and recoveries
 Meets all claims department claims processing metrics for turnaround time and accuracy
 In depth and hands on knowledge of the Managed Care Business and how it relates to Commercial, Medicare
Advantage and Medicaid clients
 Hands on involvement in all aspects of claims processing including EDI and claims auditing as needed
Selected Accomplishments:
 Successfully transitioned Claims System to Web based version including setup of auto adjudication rules, system
integrated facility pricing, and staff training.
 Implementation of ByteSize Solution for Health Plan web based claim process to convert paper claims into
Electronic, as automating responses to the Health Plan, resulting in 30% reduction in FTE’s.
 Automated generation and printing of misdirected claims, daily and weekly claims reports, and member denial
letters.
 Successfully passed all Health Plan audits within the last 16 years.
Additional related work experience and excellent references available upon request.
Bachelor of Science: Psychology
De Paul University-Chicago, Illinois
Education