- Montgomery Street, San Francisco, CA 94105
- (555) 432-1000
- resumesample@example.com
- Date of Birth:
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Aegon – Chicago, IL,
Process appeals from investigation to resolution according to CMS regulations and department policies and procedures, and within the timeliness standards. Collaborate with Appeals mJessicager and subject matter experts within the organization to obtain benefit and/or clinical opinions/interpretations of complex cases. Review inpatient and outpatient medical records for completeness and categorization of administrative or clinical appeal Coordinate with internal departments, external customers and delegated entities to gather additional documentation required to make an appropriate decision within the timeliness standards. Document all information related to the processing of appeals in Facets. Code diagnoses, procedures Remains current with the coding and processing of records to assure timely coding. Assures that the proper documentation is available in the medical record prior to coding. Enters codes for each provider and assures that the record is complete to assure that it is accurately abstracted. Follows through to assure the coding is finalized and a claim has been generated. Utilizes the available automated systems to achieve peak efficiency and accuracy
Logisticare, Inc. – , ,
- Performed billing for the pharmacy such as: dme billing, Medicare billing, private insurance billing, Chdp, Cmisp.
- Billed on Hcfa 1500 and ub04 forms with cpt codes.
- Answered multiple phone lines.
- Recorded and or redirected calls.
- Greeted and assisted customers.
- Translated written materials from English to Spanish.
- Maintained inventory.
- Filled prescriptions on specialized computer software for dispensing prescription.
- Preformed all round cashier duties.
Cleveland Clinic – , ,
- Performed billing for the pharmacy such as: dme billing, Medicare billing, private insurance billing, Chdp, Cmisp.
- Billed on Hcfa 1500 and ub04 forms with cpt codes.
- Answered multiple phone lines.
- Recorded and or redirected calls.
- Greeted and assisted customers.
- Translated written materials from English to Spanish.
- Maintained inventory.
- Filled prescriptions on specialized computer software for dispensing prescription.
- Preformed all round cashier duties.
Logisticare, Inc. – Southfield, MI, Responsible for financially securing the account, which includes Insurance Verification & Notification when not completed by PAS and securing the authorization number or written approval (TAR, etc.) concurrently throughout the patient stay. Complete Insurance Verification and initial Authorization request when insurance is discovered on Uninsured patients. The Patient Financial Assistant is responsible for providing timely insurance verification, authorization, CCS coordination, and the Medi-Cal TAR process for all inpatient accounts.
Blue Cross – City, STATE, Determines level of reimbursement based on established criteria, provider contract, plan and employer group provisions, for multiple products. Processes all claims eligible or ineligible for payment accurately and conforming to quality production standards and specifications. Documents provider claims/billing forms to support payments/decisions. Matches authorizations to claims, maintains current desk procedural and reference materials. Reviews appeals and complaints; researches any missing or required information. Responds to providers, members, or other company departments to process and resolve the claim issue. Identifies dual coverage, potential third party liability cases and reinsurance cases. Requests additional information that is relevant to savings/recovery.
Health Net – City, STATE, Assisted members with their billing questions and payments Changed their doctor for them Answered questions they may have in regards to their insurance plan Assisted them with their deductible Assisted providers with claims on how to bill their claim properly and correctly Verified that the claims were billed with the correct codes
Sutter Health – City, STATE,
Responsible for financially securing the account, which includes Insurance Verification & Notification when not completed by PAS and securing the authorization number or written approval (TAR, etc.) concurrently throughout the patient stay. Complete Insurance Verification and initial Authorization request when insurance is discovered on Uninsured patients. The Patient Financial Assistant is responsible for providing timely insurance verification, authorization, CCS coordination, and the Medi-Cal TAR process for all inpatient accounts.
EDS MEDICAL – City, STATE, Assisted members with their billing questions and payments Changed their doctor for them Answered questions they may have in regards to their insurance plan Assisted them with their deductible Assisted providers with claims on how to bill their claim properly and correctly Verified that the claims were billed with the correct codes
John F. Kennedy High School - Sacramento, CA
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School Attended
- John F. Kennedy High School
Job Titles Held:
- Lead/Appeals and Grievances
- Store Pharmacy Technician
- Store Pharmacy Technician
- Sutter Health Patient Financial Advocate
- Claims Examiner
- Claims Processor
- Patient Financial Advocate
- CLAIMS PROCESSOR
Degrees
- High School Diploma
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