Denial Resolution Specialist Bcbs (a R) (work From Home) resume example with 13+ years of experience
JessicaClaire
Montgomery Street, San Francisco, CA94105609 Johnson Ave., 49204, Tulsa, OK Home: (555) 432-1000 - Cell: - resumesample@example.com - -
Professional Summary
To work in a positive environment that utilizes my extensive experience. To contribute my focus on company success into quality team work by increasing responsibility and professionalism.
Licenses
Skill Highlights
COMPUTER SKILLS: PC and Macintosh Operating Systems, Microsoft Office, Outlook, SharePoint, Internet, Windows, AS400, Meditech, Excel, Passport, Artiva, and Kronos
Professional Experience
09/2010 to 03/2014
Denial Resolution Specialist BCBS (A/R) (Work From Home)Houston Medical Center – Warner Robins, GA,
Status and follow up with payers, vendors, and clearinghouse on open insurance claims and balances. Track and follow up on requests for refunds or recoupments in accordance with payer requirements.
Review, identify, and resolve payer denials and prepare payer appeals for denied claims and investigated claim formatting and claim issues and escalated to appropriate departments and file or re-file primary and secondary claims.
Performed web research and updated patient accounts as necessary by verifying patient's insurance coverage, insurance benefits, policy number, precertification requirements, and effective date of coverage.
Post payments, adjustments, and denial codes, follow-up with insurance carriers to maximize revenue, and review payment to ensure consistency with insurance policy terms. Ensure adjustments are posted timely and correctly for denied claims that need to be written off. Performed other duties that were assigned to me as well.
07/2008 to 06/2010
Patient Account RepresentativeComputershare Inc – Chicago, IL,
Responsible for the review and follow-up of outstanding accounts and adhering to productivity guidelines as established by the department supervisor.
Contact patients and insurance companies for collection of outstanding.
Resolve outstanding accounts, following policy/procedure in resolving, i.e. account write off, placement with collection agency, payment plan scheduling, and appeals with insurance companies etc.
Utilize/review reports to identify reimbursement problems with insurance companies.
Compose letters to insurance companies/patients to resolve reimbursement problems.
Telephone insurance companies to resolve contract issues regarding rates of payment.
Review bad address reports/returned statements and utilize resources to locate correct information.
02/2007 to 06/2008
Collection SpecialistHospital Corporation Of America (HCA) – City, STATE,
Monitor insurance claims by running appropriate reports and contacting insurance companies to resolve claims that are not paid in a timely manner.
Identify coding or billing problems from EOBs and work to correct the errors in a timely manner.
Identify problem accounts and escalate as appropriate and update the patient account record to identify actions taken on the account.
Work with patients and guarantors to secure payment on outstanding account balances.
03/2014 to Current
Patient Financial Specialist/Accounts ReceivaleVivere Health – City, STATE,
Analyzes information received and determines level of patient liability.
Communicates financial responsibility to the patients prior to the procedure.
Billing and rebilling claims accurately and timely per the payer and facility billing instructions. Working reports of accounts aged over 90 days monthly to resolve aged account balances per payer and general follow-up procedures. Notifying management of issues delaying payment on claims in a timely manner.
Following the system and reference procedures to ensure proper account status at all times. Proper adjustments being posted, proper financial class assigned, proper account documentation and billing status
Claim Status – Follow-up with payor prior to 35 days from last bill date for accurate and complete status of the claim per documented payor and claim follow-up procedures.
Billing/Rebilling claims – Billing and rebilling claims accurately and timely per the payor and facility billing instructions.
Maintaining accurate and up-to-date account information on system – Following the system and reference procedures to ensure proper account status at all times. Proper adjustments being posted, proper financial class assigned, proper account documentation and billing status.
Other duties as assigned, and in keeping with Vivere Health, LLC policies, procedures, compliance, standards of patient care and/or initiatives toward continuous improvement at the individual and organizational level.
Education and Training
Expected in 1996
High School Diploma: Standard Study Whites Creek Comprehensive High School - Whites Creek, TN GPA:
Whites Creek Comprehensive High School, Whites Creek, TN 1993-1996
Accomplishments
Responsible for the review and follow-up of outstanding accounts and adhering to productivity guidelines as established by the department supervisor
Contact patients and insurance companies for collection of outstanding
Resolve outstanding accounts, following policy/procedure in resolving, i.e. account write off, placement with collection agency, payment plan scheduling, and appeals with insurance companies etc
Work with patients and guarantors to secure payment on outstanding account balances
Member of National Honor Society
Professional Affiliations
of National Honor Society
Skills
Auto Insurance, Claims, Insurance Claims, A/r, Adjustments, Benefits, File, Payments, Post Payments, Accounts And, Collection, Patient Account, Scheduling, Telephone, Billing, Coding, Eobs, As400, Excel, Kronos, Meditech, Microsoft Office, Microsoft Sharepoint, Ms Office, Outlook, Passport, Sharepoint
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Resume Overview
School Attended
Whites Creek Comprehensive High School
Job Titles Held:
Denial Resolution Specialist BCBS (A/R) (Work From Home)