Account Representative Resume Example

Researched and resolved billing and claim problems. Reducing outstanding A/R for 2012 to current.

Monitored new trends and procedures as they applied to Medicare and CMS.

Diligently monitored claims and Accounts Receivable to confirm proper resolution.

Verified that CPT and ICD code used, were in compliance with established policies for NCCI edits and MUE's per CMS guidelines.

Kept abreast of advances in medicine, computerized diagnostic and treatment equipment, data processing technology, government regulations, health insurance changes and financing options.

Maintained accounts receivable documentation electronically and on paper.

Working with Medicare, Worker's Compensation, Liens, Medicare Replacement Plans.

• Demonstrated analytical and problem-solving ability by addressing barriers to receiving and validating accurate HCC information.
• Carefully reviewed medical records for accuracy and completion as required by insurance companies.
• Strictly followed all federal and state guidelines for release of information.
• Acquired insurance authorizations for procedures and tests ordered by the attending physician.
• Completed registration quickly and cordially for all new patients.
• Demonstrated knowledge of HIPAA Privacy and Security Regulations by appropriately handling patient information.
• Analyzed and interpreted patient medical and surgical records to determine billable services.
• Remained up-to-date with all insurance requirements, including the details of patient financial responsibilities, fee-for-service and managed care plans.
• Efficiently performed insurance verification and pre-certification and pre-authorization functions.
• Ensured the accuracy of public information and materials.

• Family Practice Office Manage and Collections of all patient and insurance claims for busy family practice with laboratory, x-ray, and physical medicine modalities as the only collector in the business office.
• Work practice Accounts Receivables for both patient and insurance balances.
• Post payments and adjustments.
• Intake and approval for Industrial claims.
• Management of all payment arrangements for patients.
• Review of denied and underpaid insurance claims for optimum reimbursement.
• Intake and triage of Motor Vehicle Accident patients.
• Prepping third party liens.
• Working with attorneys and third party adjusters to negotiate settlement of claims.
• Verification of insurance plans.
• Coverage for front office as needed.
• Back up to poster as needed.
• Ensured the accuracy of Patient information and billing.
• Actively maintained up-to-date knowledge of applicable state and Federal laws and regulations.
• Demonstrated analytical and problem-solving ability by addressing barriers to receiving and validating accurate HCC information.
• Carefully reviewed medical records for accuracy and completion as required by insurance companies.
• Assigned additional diagnosis codes based on specific clinical findings (laboratory, radiology and, pathology reports as well as clinical studies) in support of existing diagnoses.

• DME Company Supervision and Management of 55 employees.
• Managed Centralized Admissions/Call Center, Billing Department for Arizona region of National DME Provider.
• Successfully obtained objective of answering 80% of calls received in 20 seconds.
• Implemented new procedures for monitoring calls, to provide training and education, to increase professionalism of employees, and increase customer satisfaction.
• Implemented new procedures for auditing of patient files, to achieve compliance with Medicare, Medicaid, and JCHAO requirements.
• Implemented an employee morale committee to increase employee participation and satisfaction, and decrease employee turnover.
• Implemented adherence to policies and procedures, using employee rewards and recognition, progressive discipline, performance reviews, and one on one monthly review.
• Implemented employee goals for incoming calls, with goals for number of calls, patient satisfaction, and quality of call.
• Set goals for orders processed, ensuring insurance demographics.
• Provided thorough supervision for day-to-day operations of facility in accordance with set policies and guidelines.
• Organized and led weekly personnel meetings with team members.
• Diligently monitored the QA (Quality Assurance) program to improve performance and maintain high standards of care.
• Organized and led weekly personnel meetings with team members.
• Observed strict confidentiality and safeguarded all patient-related information.

• Oversaw Government billing of $2.5 million per month in account receivables.
• Supervised Cash Application Department for average weekly deposits of $1.5 million.
• Reduced unapplied as well as unidentified cash.
• Successfully resolved large backlog of refunds.
• Reorganized cash application department from a data-entry department to a cash resolution department.
• Carefully selected, developed and retained qualified staff, as well as trained new staff annually.
• Created annual goals, objectives and budget and made recommendations to reduce costs.
• Directed the installation of improved work methods and procedures to achieve agency objectives.
• Provided thorough supervision for day-to-day operations of facility in accordance with set policies and guidelines.

• Radiology Corporation Supervision and Management of seven employees.
• Managed the day to day workflow for collections department of a National Medical Company.
• Responsible for maximum reimbursement.
• Directly responsible for managing staff to successfully resolve A/R greater than 120 days and bring the DSO to Corporate guidelines.
• Successfully met cash goals monthly, above Corporate Guidelines.
• Daily auditing of employees production to ensure completion of company goals.
• Cross-trained in other departments, including coding and billing.
• Analyzed accounts for maximum reimbursement.
• Assigned Daily and Monthly goals.
• Strictly followed all federal and state guidelines for release of information.
• Thoroughly investigated past due invoices and minimized number of unpaid accounts.
• Posted charges, payments and adjustments.
• Submitted refund requests for claims paid in error.
• Carefully prepared, reviewed and submitted patient statements.
• Ensured timely and accurate charge submission through electronic charge capture, including the billing and account receivables (BAR) system and clearing house.
• Meticulously tracked and resolved underpayments.
• Remained up-to-date with all insurance requirements, including the details of patient financial responsibilities, fee-for-service and managed care plans.
• Performed full-cycle medical billing in a fast-paced medical billing company.
• Performed quality control of the data entry system to verify that claims and payments were posted correctly.

• Thoroughly investigated past due invoices and minimized number of unpaid accounts.
• Recorded and filed patient data and medical records.
• Demonstrated analytical and problem-solving ability by addressing barriers to receiving and validating accurate HCC information.
• Carefully reviewed medical records for accuracy and completion as required by insurance companies.
• Appropriately and correctly identified errors and re-filed denied/rejected claims as they were received from the Patient Account Representative.
• Added modifiers as appropriate coded narrative diagnoses and verified diagnoses.
• Analyzed and interpreted patient medical and surgical records to determine billable services.
• Thoroughly reviewed remittance codes from EOBS/AR's.
• Evaluated the accuracy of provider charges, including dates of service, procedures, level of care, locations, diagnoses, patient identification and provider signature.

• Billing and collection of Infusion therapy accounts for Medicare, Medicaid, and Tricare programs in 15 states.
• Effective appeals for Medicare denied claims.
• Prepared and attached all required claims documentation including referrals, treatment plans or other required correspondence to reduce incidence of denials.
• Meticulously tracked and resolved underpayments.
• Posted charges, payments and adjustments.
• Completed appeals and filed and submitted claims.
• Analyzed and interpreted patient medical and surgical records to determine billable services.
• Received, organized and maintained all coding and reimbursement periodicals and updates.
• Received and reviewed all updates from Medicare and Medicaid to keep abreast of all changes in Government programs.
• Accurately entered procedure codes, diagnosis codes and patient information into billing software.