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account receivable specialist resume example with 20+ years of experience

Jessica Claire
  • , , 609 Johnson Ave., 49204, Tulsa, OK 100 Montgomery St. 10th Floor
  • Home: (555) 432-1000
  • Cell:
  • resumesample@example.com
  • :
Professional Summary

Motivated medical billing and collection specialist with over 15 years of experience in healthcare management with a background in account receivables functions. Expertise in ICD-10, CPT, UB-04, and CMS/HCFA 1500 insurance claim forms. Excellent knowledge of health operation management and understanding of insurance contracts, denials, appeals, and EOBs. Expertise in Worker’s compensation claims and injury protection claims.

Expertise in quality control, reimbursements, and implementation improved processes to enhance the accuracy of business, billing, and collection department

Core Qualifications
  • Accounts Receivable
  • Compliance excellence
  • Collections and billing department management
  • CPT and Coding fluency
  • Credentialing
  • Bookkeeping
  • Strong negotiation, problem-solving, and conflict resolutions skills
  • Strong typing, ability to use computer software, excellent customer service, and communication skills.
  • Expert in denials and claims appeals
  • Expert with workers' compensation and personal injury protection claims
  • Posting charges, and payments
Experience
Account Receivable Specialist, 11/XXX4 to Current
CambrexEast Rutherford, NJ,


  • Legal account management (Medical/personal injury protection claims
  • Analyzes and processes workers’ compensation claims by investigating and gathering information to determine the exposure of the claim
  • Meet the team goals -ensure all claims are accurately transmitted daily
  • Complete follow-up on claims in a timely manner according to the guidelines
  • Resolve denied claims accurately and resolve any issue that could delay payment processing
  • Built and maintained close relationships with all healthcare provider representatives to insure proper claims processing
  • Audit current procedures to monitor and improve the efficiency of billing and collections operations
  • Analyze all assigned account delinquencies and account activity to ensure timely and accurate payments from appropriate payers
  • Knowledge of Workers’ Compensation law, rules, and regulations of the Florida Workers Compensation Legislation
  • Negotiates, settles, and authorizes payment for injury claims with both legal counsel for represented claimants and unrepresented parties
  • Following up with attorneys for settlement of injury claims
  • Ensure PIP payments logs, claims information policy, and payments information requested is provided within the timeline frame
Medical Representative, 07/XXX3 to 11/XXX4
Principia Biopharma Inc.Morristown, NY,
  • Recognized and resolved issues pertaining to contracts and improper billing procedures
  • Conduct regular audits of random claims for purposes of quality assurance
  • Management disputes
  • Stay up to date on local, state, and federal law changes in the insurance field
  • Review technical billing (UB04) and professional billing (1500) components provided by Client Hospital for accuracy


  • Utilize and understand electronic health record


  • Responsible for verifying and checking the eligibility of insurance plans and understanding mental health care coverage
  • Manage current A/R reports to reduce A/R and increase revenue
  • Coordinates and performs all aspects of accounts receivable collection and reprocessing of claims
  • Ability to decipher the proper ICD-10 and CPT coding classification system, place of service codes, and provider types
  • Post payer remittances to patient accounts


Account Manager, 01/2008 to 04/XXX3
Affiliated MonitoringWilmington, NC,
  • Training, developing, and performance management staff to meet performance standards
  • Determining staff schedules and ensuring operational standards are met
  • Monitoring and maintaining the office budget using spreadsheets and other tools
  • Organizing and overseeing supply purchases, equipment upgrades, and operations expenses
  • Manage current A/R reports to reduce A/R and increase revenue by assigning the appropriate staff
  • touching base with staff for the status of resolution and trending of the AR
  • Monitor staff time and attendance as well as time off request


  • Maintain current Insurance contracts to provide support to the billing staff on unpaid and underpayment claims according to provider contracts
  • keep current on billing chargers
  • Maintain knowledge of all billing department functions data entry, charge posting, payment posting, ERA, EDI filing, denials, patient communications, insurance appeals and follow-ups, end of days, etc
  • Communicate with staff to determine needs, goals, and necessary changes in systems or policies
  • Recommend various personnel actions including, but not limited to hiring, performance appraisals, promotions, transfers, and vacation schedules
  • Completing administrative functions including bank deposits, revenue posting, staff payroll, and invoice processing


Office Manager, 03/1996 to 01/2008
WesleylifeWest Des Moines, IA,
  • Evaluate and manage staff performance, recruit and office staff
  • Maintain all Insurance contracts to provide support to billing staff on unpaid claims and invoices, and keep current on all billing chargers
  • Responsible for revenue operations including managing revenue reporting and preparing recurring invoices
  • Negotiate settlements
  • Managing/overseeing collections and accounts receivable
  • Maintaining patient data according to regulations and company policies
  • Established protocol and follow processes to contact appropriate parties to retrieve proper payment
  • Analyze all assigned account delinquencies and account activity to ensure timely and accurate payments from appropriate payers
  • Resolve claims in a timely manner
  • Maintain all billing department functions data entry, charge posting, payment posting, ERA, EDI filing
  • Review all denials, insurance appeals, follow-ups, and months end reports
  • Make sure the office is comply with current HIPPA and OSHA guidelines to ensure the safety and privacy of the patients and employees
Education
Associate Degree: Health Management, Expected in to American Intercontinental University - ,
GPA:
Curriculum completed Business leadership, Business marketing

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Resume Overview

School Attended

  • American Intercontinental University

Job Titles Held:

  • Account Receivable Specialist
  • Medical Representative
  • Account Manager
  • Office Manager

Degrees

  • Associate Degree

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