Auditor with management experience and exceptional people skills. Versed in Medical Claims and Medical Coding. I am looking to join a growing entrepreneurial organization as part of the Executive team. Experienced manager with excellent client and project management skills. Action-oriented with strong ability to communicate effectively with technology, executive, and business audiences.
Certified Coding Specialist American Academy of Professional Coders License
Knowledge of HMOs, personal and professional integrity
Sound decision making Research Abilities
Claims analysis and review specialist Staff training and development
In-depth claims knowledge
Training and development
Medical Manager Software
Managed care contract knowledge
Electronic Medical Record (EMR) software
Neurology billing expertise
CPT and HCPCS coding
Internal medicine billing
Strong planning skills
Strong work ethic
Team player with positive attitude
Coder/Collector March 2013 to CurrentUofL Physicians － Louisville, KY
Planned and executed Inmate Claim Procedures. Calculated figures such as discounts, percentage allocations and credits. Suggested process improvements to secure prompt and regular receipts for the organization.
Researched and resolved billing and invoice problems. Thoroughly investigated past due invoices and minimized number of unpaid accounts.
Demonstrated analytical and problem-solving ability by addressing barriers to receiving and validating accurate HCC information.
Resolved and clarified issues with patient accounts and collaborated with local clinics.
Applied payments, adjustments and denials into medical manager system.
Posted charges, payments and adjustments.
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.
Consistently informed patients of their financial responsibilities prior to services being rendered.
Remained up-to-date with all insurance requirements, including the details of patient financial responsibilities, fee-for-service and managed care plans.
Prepared and attached all required claims documentation including referrals, treatment plans or other required correspondence to reduce incidence of denials.
A/R Specialist May 2012 to January 2013PMRC － Jeffersonville, INCorresponded with operations staff to ensure key client deliverables and revenue goals were met.
Front Desk & Check In/Out Took copays & past due balances at check in counter.
Scheduled and Pre-cert MRI's, and made follow up appointments at check out.
I made daily reminder calls to the patients of their appointments & balance due.
Billed and collected on aging & current accounts.
Worked with a collection company to get paid due accounts off the books.
Answered phones and routed calls to Nurse's line.
Medicare Coordinator June 2011 to May 2012Kindred Healthcare via Randstad － Louisville, KY
Worked Special Projects as directed by my Supervisor.
Corrected claims in IVANS daily in order for the claims to pay in sequence for 13 Skilled Nursing Facilities.
Followed up and collected on past due claims.
Contact person for all Medicare claim issues for the Nursing Facilities email@example.com.
Central Billing Coordinator June 2010 to June 2011Senior Care － Louisville, KY
Corporate office of 19 Skilled Nursing Facilities and 43 Assisted Living Facilities Maintain AR accurate and prompt billing.
Post all cash receipts, file all adjustments, File all NO Pay bills to Medicare.
Process all refunds; File the Medicare Credit balance Report.
Send out Patient Statements; make sure all Administrators are following our collections and Bad Debt policies.
Analyze outstanding accounts Receivable and process old outstanding claims.
Technical Support June 2009 to June 2010ZirMed － Louisville, KY
Cross-trained and provided back-up for other customer service representatives when needed.
Extensive knowledge with the ZirMed system/ALL functions.
Answer incoming calls from customers, vendors, Intermediaries and payers, Assist customers with overall website inquires/Support Emails, communicate effectively with internal & external departments.
Handle escalate calls and issues for full resolution.
Participate in internal and external conference calls as well as face to face internal and customer meetings.
Investigate complex EDI issues and determine resolution.
Provider Claim Rep July 2008 to June 2009Passport Healthcare － Louisville, KY
Answer incoming calls from providers regarding managed care issues.
Review claims for reconsideration Supported providers in order to get their problems/issues.
Work appeals and correspondence review for reprocessing per the Medicaid/Medicare rules.
Claims Examiner March 2006 to June 2008Medplans － Louisville, KY
Paid claims daily that didn't make first pass.
Reviewed & Reworked claims that were paid incorrectly.
Priced claims per their individual contracts and per coding before paying.
Pay per performance.
Claims Auditor May 2000 to March 2006The Rawlings Group － Louisville, KY
Obtained relevant evidence and information regarding suspicious claims.
Identified and collected evidence and determined its value to a specific claim.
Reviewed clients systems to determine if claims were paid per coordination of benefits.
Revamped accounting quality system to prepare for important audits.
I communicated with Medicare, Patients, and Employers.
Was a Mentor for new employees.
Constructed training manuals and implementations of new clients.
Trained new employees.
Education and Training
Bachelor of Science : Business ManagementSullivan University － Louisville, KYBusiness Management