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Overprovision Specialist Resume Example

Resume Score: 80%

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OVERPROVISION SPECIALIST
Summary

Highly efficient Medical reimbursement specialist with experience in over-provisions (refunds) payment posting and general office management. offering 14 years in medical office management experience, Excellent multi-tasker and demonstrated team player with positive attitude. Committed to obtaining highest level of patient satisfaction by ensuring regulatory compliance standards. Excellent communication and interpersonal skills with patients, team members and management team.

Skills
  • Word
  • MS Excel
  • Internet
  • 10 Key Stroke
  • Smart
  • ETM
  • IDX
  • Emdeon
  • Accounts receivable
  • Administrative Skills
  • Billing system
  • Billingual
  • Insurance
  • Kronos
  • Over-provisions,billing and insurance specialist
  • Quality-oriented team player
  • Files and records management
  • Documentation procedures expert
Experience
Overprovision Specialist03/2018 to CurrentTeam Health CorporationSunrise, FL
  • Responsible for reviewing/processing GE reports and correspondence in ETM system related to credit balances, refund requests, recoups, payment research, and unidentified payments for Emergency service business line. As well as handling some customer service calls from insurance companies, patients and working with Fifth Third Bank. Maintains accuracy and production.
  • Processes guarantor, Medicare, Medicaid, Champus, Federal, and specific other situations for all groups to determine who is to be refunded.
  • Assembles appropriate documentation to validate refunds and forward to senior for approval.
  • Handles customer service calls that are transferred from NPSC or Patient Services.
  • Contacts insurance carriers/guarantors via phone call as necessary on credit balances, offsets, payment research invoices, mail correspondence, unidentified payments, and other reasons as needed.
  • Handles correspondence related to credit balances according to written procedures.
  • Processes transfer of payment.
  • Researches cancelled checks to determine if a check has been endorsed and cashed but not posted to the patient's account.
    Retrieves and processes NSF checks from the bank's secured website.
  • Reports any consistent errors identified that affect accounts from being processed correctly.
  • Processes special projects as assigned by Management.
Posting Specialist and Reimbursement Specialist II02/2015 to 03/2018I Sheridan Healthcorp, IncSunrise, FL

POSTING SPECIALIST

  • Post all payments received into the billing system while maintaining a high level of productivity through speed and accuracy, and generate reports to ensure the accuracy of the data entered.
  • Researches patient inquiry to verify correct account for applying payment.
  • Sets weekly goals to maintain timely postings in accordance with productivity standards.
  • Monitors reimbursement for any underpayments.
  • If underpayments is made the account is forwarded to the collections department for follow up resolution.

REIMBURSEMENT SPECIALIST

  • Promoted to the reimbursement department (collections) and my process to date is just beginning, my training is in progress.
  • Calling and checking on claim status, working A/R and insurance carrier reports and insurance denials.
  • Resubmitting improperly paid/denied claims to carriers for proper payment in a timely manner.
  • Notified customers of delinquent accounts with attempt to collect outstanding amounts.
  • Reviewed accounts to determine payment plan compliance.
    Located and monitored overdue accounts using billing system to begin collections process.
  • Received payment and ensured proper posting to appropriate customers accounts.
Posting Specialist01/2008 to 01/2014Med Receivables AdvDeerfield Beach, FL
  • Posts customer payments by recording cash, checks and credit cards transactions.
  • Resolves valid or authorized deductions by entering adjusting entries.
  • Summarizes receivables by maintaining invoice accounts; coordinating monthly transfer to accounts receivable account; verifying totals; preparing report.
  • Accomplishes accounting and organization mission by completing related results as needed.
  • Maintains confidentiality of company information and member personal health information (PHP) in accordance with HIPPA privacy and security regulations.
  • Verified patients insurance, claims coverage by coordinating with providers.
  • Maintained strict patient privacy and confidential patient information, taking care to meet all HIPAA guidelines and statues for data security.
  • Investigated past due invoices and delinquent accounts to generate revenues and reduce number of unpaid and outstanding accounts.
  • Submitted claims to insurance companies.
  • Reconciled clinical notes, patient forms and health information for compliance with HIPAA rules.
  • Performed insurance verification, pre-certification and pre-authorization.
  • Reviewed account information to confirm patient and insurance information is accurate and complete.
  • Used ETM -IDX-Waystar and Zirmed to record weekly statements, including expenditures and balances.
  • Reviewed received payments for accuracy and applied to intended patient accounts.
  • Applied HIPAA Privacy and Security Regulations while handling patient information.
  • Investigated denials and collaborated with internal team members and third-party representatives to identify solutions.
  • Provided prompt and accurate services through knowledge of government regulations, health benefits and healthcare terminology.
  • Managed benefit contract pricing, processing, policies and procedures.
  • Verified final claim submissions by comparing account charges with documentation.
  • Reviewed medical records to meet insurance company requirements.
  • Effectively coordinated all communications between patients, billing personnel and insurance carriers.
Accounts Receivable01/2007 to 01/2008ME Direct LatinoPompano Beach, FL
  • Accomplishes accounting and organization mission by completing related results as needed.
  • Set up new patients accountants.
  • Accurately applied payments to patient accounts.
  • Maintained the patient's information, reports, income reports and statistics with balancing the daily schedule.
  • Data entry.
  • Accounting.
  • 954.
Education and Training
General Compliance Training07/2019TeamhealthSunrise, FL
Sunrise, FL Compliance and DRA (v13) Medical billing Compliance (v132017
High School Diploma2003New Millennium High SchoolCali, Colombia
Languages
Fluent in English and Spanish
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Resumes, and other information uploaded or provided by the user, are considered User Content governed by our Terms & Conditions. As such, it is not owned by us, and it is the user who retains ownership over such content.

Resume Overview

Companies Worked For:

  • Team Health Corporation
  • I Sheridan Healthcorp, Inc
  • Med Receivables Adv
  • ME Direct Latino

School Attended

  • Teamhealth
  • New Millennium High School

Job Titles Held:

  • Overprovision Specialist
  • Posting Specialist and Reimbursement Specialist II
  • Posting Specialist
  • Accounts Receivable

Degrees

  • General Compliance Training 07/2019
    Sunrise, FL Compliance and DRA (v13) Medical billing Compliance (v13 2017
    High School Diploma 2003

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