Lead Purchased Referred Care Specialist Resume Example Muckleshoot Indian Tribe

LEAD PURCHASED REFERRED CARE SPECIALIST

Professional Summary

Energetic and organized Lead with over 20 years of customer service and 10 years billing experience. Self-motivated, hardworking, reliable and flexible; adapts easily and performs effectively under pressure and in change of environment. Personable with a positive attitude, interfaces well with patients, families, healthcare staff and outside contacts. Proficient knowledge of computer software and demonstrated ability to adapt to new equipment and technology. Excellent verbal, written, leadership, communication and training skills. Committed to top quality, efficient and detailed work, who demonstrates competent professional practice and seeks opportunity for growth.

Skills

Customer Service/Cash Handling Process
Greenway/Athena E.M.R., RPMS
Managed multiple phone lines/ Scheduling/Triage
Medical Terminology
Patient Billing/Collections/ ICD-9/10 coding/ Prior Authorizations/EOB'S
Insurance Verification (One Health Port, Availity)
Payment Posting
Problem solving and research
Leading employees

Interviewing and Training
(Typing 40+ WPM)/ 10 key 12846+KSPH
Medical Benefits Knowledge
Insurance Claims (HCFA 1500, UBO4, Dental, DME,Optical)
Understanding HIPPA Guidelines
Electronic funds transfer
HMO plans (Medicare/Medicaid) Knowledge
Microsoft Office, Excel
Data entry specialist

Work History

Lead Purchased Referred Care Specialist02/2017 to 04/2020
Muckleshoot Indian Tribe – Auburn, Washington

Developed a tracking system to analyze how many loose claims were received without a purchase order.
Accomplished a 30 day turnaround time from 90 for processing and payment of claims.
Managed daily operations by scheduling work and verifying that all tasks have been completed.
Developed Time Studies to measure productivity.
Assisted with interviewing and trained all new hires.
Handled monthly purchase order reports, weekly register close, and daily processed claims from EOBS, posted payments.
Created remittance advise for payment and processed all checks for providers.
Read professional and facility claims forms for processing of payment.
Liaised with customers, management and sales team to better understand customer needs and recommend appropriate solutions.
Directed incoming calls to internal personnel and departments, routing to best-qualified department.
Corresponded with clients through email, telephone or postal mail.
Routed incoming mail and messages to relevant personnel without delay.
Supported various administrative duties by proofreading, transcribing and invoicing.
Managed office inventory by restocking supplies and placing purchase orders to maintain adequate stock levels.
Answered telephone calls to field inquiries from clients, vendors and various other callers seeking information.

Front Desk Receptionist Lead/Billing Associate09/2015 to 02/2017
Primary Care NW – Tacoma, Washington

Serving as the first line of communication between patient and doctor, my duties include: answering multiple phone lines, scheduling patients, and answering billing questions.
Entering insurance and demographic information into the EMR system and money collection.
As the lead I am in charge of doing the front desk staff schedules to ensure proper coverage, adjusting doctor's templates to their needs and making sure that the schedules are verified for time, need and insurance.
Over saw the Chronic Care Management Program.

Payment poster/Billing Specialist02/2014 to 09/2015
Pulmonary Consultants – Tacoma, Washington

Post available electronic remittance advice's, perform timely and accurate posting of manual and electronic cash receipts.
Daily manual cash batches, balance all manual and electronic posted cash batches by generating the cash balancing summary report and reviewing for any variances.
Speak with patients via phone or in person with any billing questions.
Obtained prior authorizations for Tricare and all HMO plans.
Verified insurance information and entered patient demographics, including scheduling new patient appointments.

Front Desk Receptionist/Billing Associate08/2010 to 02/2014
Primary Care NW – Tacoma, Washington

Once a month key charges from an invoice to the patients account.
Duties include accurately setting up payment arrangements, processing and posting payments, adjustments, and denials and rejections for Medicare, Medicaid, private insurance, workman compensation, patients, and electronic funds transfer to patient line item by the deadline.
Read and analyze Explanation of Benefits.
Act as a liaison between the patient and insurance companies.
Research accounts in credit balance status and prepare correspondence to correctly adjust and refund patient and insurance company accounts.
Input daily totals of patient payments and lock box deposits into a spread sheet and balance with the bank deposit.
Weekly prepare and monitor patient statements, updating their status and mailing them in a timely matter.
Print daily schedules for collection on delinquent accounts.

Education

Medical Insurance Billing and Coding: Ambassador2010Everest College- Tacoma, WA

GPA: 4.0 GPA

Associate of Arts: Business Marketing and Selling1999Highline Community College- Des Moines, Washington

Certifications

Sundance Solutions Medicare Like Rates certificate of completion

Optum 360, United Healthcare conference certificate of completion

Resume Overview

Companies Worked For:

Muckleshoot Indian Tribe
Primary Care NW
Pulmonary Consultants

School Attended

Everest College
Highline Community College

Job Titles Held:

Lead Purchased Referred Care Specialist
Front Desk Receptionist Lead/Billing Associate
Payment poster/Billing Specialist
Front Desk Receptionist/Billing Associate

Degrees

Medical Insurance Billing and Coding : Ambassador 2010
Associate of Arts : Business Marketing and Selling 1999

Lead Purchased Referred Care Specialist Resume Example

Resume Score: 80%

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