To achieve a career in Management and Administration as a member of a unified team that is both professional and inspirational.
Education and Training
Medical Billing and Coding Certification Program : 2010Branford Hall Career Institute
Associate Degree : Liberal Arts, 1998Fordham UniversityLiberal Arts
Certified Medical Billing and Coding Versed in HIPAA Regulations Medical Administrative Procedures Coding Principles Medical Management Health Insurance Processing Company sponsored courses in the areas of: Leadership/Mgmt. Supervision/Training Interpersonal Leadership Diversity Conflict Management Teamwork Strategic Planning
Administrative, benefits, Billing, billing system, cable, Call Center, cash flow, Interpersonal, Conflict Management, customer satisfaction, customer service, dispatching, Documentation, frame, HIPAA Regulations, Insurance, Leadership, team lead, Mgmt, Medical Billing, Medical Management, office, processes, process improvement, Coding, quality, Strategic Planning, Supervision, Teamwork, websites
Medical Billing and Insurance Specialist March 2012 to CurrentST. Francis Hospital － West Islip, NY
Served as liaison between management, clinical staff and the community. Observed strict confidentiality and safeguarded all patient-related information. Organized, updated and maintained over 200 patient charts. Maintained patient privacy and confidential patient information. Thoroughly investigated past due invoices and minimized number of unpaid accounts. Carefully reviewed medical records for accuracy and completion as required by insurance companies. Acquired insurance authorizations for procedures and tests ordered by the attending physician. Accurately entered procedure codes, diagnosis codes and patient information into billing software. Acted as a liaison between the business department, billers and third party payers in resolving billing and reimbursement accuracy. Demonstrated knowledge of HIPAA Privacy and Security Regulations by appropriately handling patient information. Added modifiers as appropriate, coded narrative diagnoses and verified diagnoses. Thoroughly reviewed remittance codes from EOBS/AR's. Confirmed patient information, collected copays and verified insurance. Remained up-to-date with all insurance requirements, including the details of patient financial responsibilities, fee-for-service and managed care plans. Efficiently performed insurance verification and pre-certification and pre-authorization functions. Patient Demographics and Insurance Verification.
Review all patient information for accuracy at time of visit.
Submit all insurance information for verification and activation.
Work with patients regarding insurance inquiries and advise them of all insurance discrepancies.
Obtain all authorizations for diagnostic testing on a daily basis via insurance websites.
April 2010 to March 2011
Thoroughly investigated past due invoices and minimized number of unpaid accounts. Carefully reviewed medical records for accuracy and completion as required by insurance companies. Acted as a liaison between the business department, billers and third party payers in resolving billing and reimbursement accuracy. Dr.
Yambo Family Practice.
Medical Billing- Managed all No Fault and Workers Compensation cases.
Submitted all related information necessary for new and subsequent medical follow-ups as required.
Worked with commercial accounts regarding appeals and denial explanations.
Also monitored all Medicare and Medicaid accounts regarding remittance inquiries and denials.
Responded to patient's inquiries on account balances, insurance explanations of benefits, patient co-payments and co-insurance responsibilities and payment history.
Also followed up with collection calls to patients as needed.
In a three month time frame was able to investigate and recover approximately $3000+ monies from and outstanding NF and WC A/R report that had outstanding balances going back at least five years.
Telecommunications Business Operations Manager May 1983 to December 2008
Management: Billing and Claims center, Billing and Revenue Assurance, Training and Documentation Staff Support, Maintenance Call Center.
Assured optimal cash flow and productivity via management and monitoring of business bill production procedures for a major global communications customer.
This involved approximately 1 million dollars monthly billing on all products and services.
Served as team lead for 20 union representatives in support of bill cycle management processes beginning with inputs(new order request, initial bill establishment, payments, subsequent order activity)this was done through balancing, monitoring, verification (including quality and revenue assurance), analysis and finally correction of billing error conditions prior to bill release to maximize revenue.
Served as point of contact for five national billing centers in need of billing system and process support Co-ordinated all training for new products and procedures for customer service billing centers Maintained employee records to ensure all Representatives were properly trained and informed on all product offerings and billing elements to ensure proper billing and product advancements.
Supervised 50 union technicians on a daily basis in a 24x7 call in maintenance work center.
Reviewed and resolved approximately 100 trouble tickets on a daily basis involving minor interruptions, major cable failures, and emergency situations.
These various situations involved multiple departments such as cable technicians, central office technicians, and other various tier support groups.
This required coordinated efforts with dispatching of crews to field locations, customer locations, and other various remote sites.
These situations were managed under extreme time constraints that required accurate and frequent communications to assure minimal disruption times and to guarantee that the task was completed accurately for the customers involved.
Responsible for root cause analysis reports on a monthly basis to meet all department standards for customer satisfaction as well as to identify process improvement opportunities.
Coordinated vacation schedules and timely posting of the three month tour schedules for approximately 150 union technicians in accordance to Labor and Relations regulations as well as weekly timesheet submission for assigned technicians.
Also reviewed with union technicians one on one when necessary to ensure that they were properly informed on any actions taken against them (re: tardiness, absence) as required by Labor and Relations and in accordance with Union contract rules.
Medical Billing and Coding Certification Program : 2010 Associate Degree : Liberal Arts , 1998 Certified Medical Billing and Coding Versed in HIPAA Regulations Medical Administrative Procedures Coding Principles Medical Management Health Insurance Processing Company sponsored courses in the areas of: Leadership/Mgmt. Supervision/Training Interpersonal Leadership Diversity Conflict Management Teamwork Strategic Planning
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