May 2016-Program Evaluation Course HS3083-completed with 'A' average Knowledge of qualitative and quantitative data analysis steps during health program evaluation Creating data collection instruments; questionnaires, conducting interviews Knowledge of key components in reporting findings of an evaluation Collaboration skills; work with team of student evaluators to research, conduct and report findings Knowledge of CHES Health and Health Educators Core Competencies & Responsibilities Medical Terminology, Interpreting Fee schedules & Contracts, Interpreting State Legislature, Adjudication processes for Hospital, Commercial, and Interpret Coordination of Benefits i.e., Medicare, Medicaid, tertiary provider claims. Navigation of Insurance Payers website, looking up MVP reports, researching Medicare Guidelines, Payment Investigation & Appeals Follow-up.
Skill Highlights
MEDITECH, ZIRMED, AEPAY, KINNSER, MCKESSON, PECOS, ICD9-10 LOOK UP, COPATH, RUMBAS, MACROS, EXCEL, WORD, OUTLOOK, WINDOWS XP WINDOWS 7, CHROME, GOOGLE DOCS, GOOGLE FORMS, COMMUNITY TOOLBOOK, CDC PROGRAM EVALUATION RESOURCES
Accomplishments
Professional Experience
Non-Government Lead Biller & Collections Specialist, 01/2014 to Present Change Healthcare Inc. – Columbia, SC,
Manage collections for a $300k portfolio, state of Virginia: Commercial insurance Self Pay, Workers compensation, no-fault accident insurance.
Recoded and resubmit $20k-$80K in revenue for various clients/patients.
Track trends and determinants to payment; i.e., eligibility, timely filing errors, authorizations, coordination of benefits, changes in contracts, and/or pilot programs to reverse denials.
Report trends and resolve of account to management every 45 days via excel spreadsheet.
Work correspondence, electronic submission, acceptance and rejection reports daily.
Financial Services Pre-Registration Representative, 01/2009 to 01/2012 Premium Waters Inc. – Fort Worth, TX,
Verified all insurances, doctor's orders, pre-certifications and authorization for all procedures.
Interviewed patients to obtain patient's insurance and financial information for pre-registration completion.
Calculated and collected patient liable amounts.
Substantially increased collections within first 3 months of hire performing pre-registrations.
Maintained patient charts according to departmental flow, while meeting productivity standards.
Advised and instructed patients of hospital policies, location of services, to the success of their procedures.
Member of "MCD Tracer Aces" designed to perform mock hospital inspections in preparation for OSHA.
Client Response Representative, 01/2008 to 01/2009 ProPath Laboratories – City, STATE,
Received and responded to clients request via telephone &in writing; i.e.
preliminary & final reports Explained laboratory policies and procedure.
Performed callbacks & follow ups to Hospitals/ Doctor's office.
Interacted with various departments within company to resolve request and/or inquires.
Maintaining and handled confidential patient information according to company policy.
Provided and maintained medical record release.
Compiled proper documentation and demographics for patient's furtherance of care.
Prepared patient tissue blocks/slides for shipment & tracked specimens in CoPath system.
Customer Service Representative, 01/2003 to 01/2008 AETNA US Healthcare – City, STATE,
Responded daily to 55-100 calls & correspondence requiring immediate resolution to complaints and request.
Provided Doctors and Hospitals with thorough explanations of patient claim status and benefit eligibility.
Contacted appropriate department for pre-certification & authorization processing.
Maintained sufficient knowledge of state legislatures pertinent to evaluating and explaining claims processing.
Managed and followed through with appropriate actions on accounts that required call backs & status letters.
Performed research on underpaid/overpaid claims and trail backs.
Assisted with mentor and training of new team members.
Education and Training
Bachelors of Science: Health Studies, Expected in December 2016 TEXAS WOMAN'S UNIVERSITY - , GPA: Health Studies
Certified Nursing Assistant Program: , Expected in April 2014 NORTH TEXAS INSTITUTE OF FORT WORTH - , GPA:
Associates of Arts Degree: , Expected in December 2013 TARRANT COUNTY COLLEGE - , GPA:
Certifications
Certified Community Health Care worker-2014-present
BLS - Basic Life Support
AHA Healthcare Provider CPR Certification
Affiliations
Phi Theta Kappa, 2012 Gamma Rho Chapter, Tarrant County College The National Society for Leadership and Success (Sigma Alpha Pi), 2015 Texas Woman's University
Skills
benefits, charts, contracts, copying, clients, documentation, faxing, filing, financial, FORMS, general office duties i, insurance, letters, MACROS, MEDITECH, mentor, EXCEL, office, OUTLOOK, WINDOWS 7, WINDOWS XP, WORD, Nursing, policies, PROGRAM EVALUATION, receiving, research, spreadsheet, telephone, TOOLBOOK
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School Attended
TEXAS WOMAN'S UNIVERSITY
NORTH TEXAS INSTITUTE OF FORT WORTH
TARRANT COUNTY COLLEGE
Job Titles Held:
Non-Government Lead Biller & Collections Specialist
