To obtain a Position working in the field of Health Insurance Billing Claims Processing, Billing, Claims Follow up, Claims Auditing and Denial Resolution
Raleigh Orthopedic ClinicOctober 2008 to May 2015Blue Cross Blue Shield Billing Specialist
Duties consisted of working in the Insurance module on claims with high dollar amounts as well as clearing older dates of service, while insuring current claims issues were followed up on or did not fall behind.
Processed claims into the BCBSNC and Medicaid (NC Tracks) data bases that did not submit electronically.
Resubmission of corrected claims for adjudication to the Insurance carriers.
Appealed denied claims
Submitted secondary claims with primary EOB's for payment
Wrote off balances to specific accounts when requested by our Physicians or Management.
Worked all inquiries from insurance carriers both in and out of state
Submitted monthly production progress reports
Phone resolutions with patients regarding their accounts
Placed calls to Insurance Companies for resolution on appeals, corrected, and denied claims.
Santa Barbara Regional Health AuthorityApril 2001 to September 2007Senior Claims Analyst
Interpreted State and Federal regulations to establish changes to policies that may impact IT and claims processing
Assisted IT staff on the development of IT systems which included new website program testing, electronic and on-line claim submissions, new authorization screens and procedure coding pricing screens
Wrote internal policies
Audit provider accounts
Perform quality assurance on the claims processing staff and monitored upper level provider accounts for Management
Provided back up to the Claims department, resolved problem provider calls, and assisted claims department with workload as needed.
Santa Barbara Regional Health AuthorityOctober 1995 to April 2001Internal Claims Auditor
Audited Provider Accounts for Accuracy.
Completed Finance Adjustment Requests, Reviewed and Implemented Special Handling Requests for Management.
Involved with the development and implementation of the new Access to Infants & Mothers (AIM), Healthy Families and In Home Supportive Services (IHSS) Programs.
Worked on Medicare/Medi-cal/Medicaid Claim sumissions
assisted Claims department with upper level provider calls and workload as needed.
Santa Barbara Regional Health AuthorityFebruary 1993 to October 1995Adjudication Supervisor
Supervised staff consisting of eight employees.
Performed all functions related to the Adjudication department including paperwork flow, issue resolution, charting of work flow progress, payroll, staffing issues and work scheduling.
Note: In October 1995, the Adjudication Supervisor position was eliminated and I returned to Internal Claims Auditor and assumed all duties of that position.
Santa Barbara Regional Health AuthorityMarch 1985 to February 1993Adjudication Specialist
Scheduled individual one on one training with providers and billing staff for review of billing and payment issues and complaint resolutions.
Other duties included special projects as assigned
Note: June 1, 1986, the contract for the Fiscal Intermediary ended and the program merged and became part of The Santa Barbara Regional Health Authority which continued the processing and payment of Medi-Cal Claims for the Santa Barbara Provider Community.
Education and Training
San Marcos High SchoolJune 1978High School DiplomaSanta Barbara, California
University of California at Santa Barbara
Supervisory Skills Training: Effective (12-15-93)
Developing Business Writing Skills (9-30-93/10-22-93)