patient account representative resume example with 10+ years of experience
JessicaClaire
, , 609 Johnson Ave., 49204, Tulsa, OK100 Montgomery St. 10th Floor
H: (555) 432-1000
C:
resumesample@example.com
Date of Birth:
India:
:
single:
:
Summary
My objective is to obtain a position where I can maximize my management, analytical, and communication skills. Also, the opportunity to establish myself with an organization that encourages professional growth as well as financial stability. Well-organized Patient Access Representative with 15 plus years of experience in managing over 80 insurance claims per day and 5-7 control Id's per day. Talented at analyzing and validating patient information, diagnoses and billing data. Skilled in drafting invoices and resolving billing disputes quickly. Proficient in Nthrive, Star and Epremis.
Skills
Effective staff coach
Planning and development
Analytical Thinker
Knowledge of Medicaid statues and regulations
Promotes positive Behavior
Type 40 WPM
Insurance Verification
Team collaboration
Excellent judgment
Coding expertise
Payment processing
Medical billing
Insurance collaboration
Insurance billing
Regulatory compliance
Medical terminology
Healthcare claim coding
Knowledgeable in Microsoft Office, Ace,Star, Epremis
Experience
Patient Account Representative, 03/2017 - Current Good Shepherd Hospice – Roslyn, NY,
Accessed patient information through variety of office software applications, maintaining strict confidentiality to remain compliant with HIPAA regulations.
Collaborated with all relevant parties to resolve billing issues, insurance claims and insurance payments.
Generated detailed reports outlining billing, flagged items and other important data.
Submitted electronic bills following facility and legal compliance standards.
Reviewed flagged items daily and resolved issues in accurate and efficient manner.
Met demands of busy collections group by performing high volume of daily calls.
Overcame objections by applying advanced training and persuasion techniques.
Responsible to work each account actively within a 30 day time frame.
Responsible for claim resolution from initial billing through final adjudication, with Insurance Carriers to facilitate appropriate reimbursement within a timely manner.
Responsible for verifying eligibility and coverage for all the claims, authorizations, follow up with the Case Manager for a breakdown of the authorization.
Responsible to review correspondence and EOB’s for proper reimbursement, research validity of denial and payer contracts.
Responsible for monitoring insurance payments, retrieve payments and EOB’s from portal, providing payment information to the posting department.
Responsible for forClaireing any secondary insurance information, billing, errors, and resubmitting claims within a timely manner.
Responsible to review denials and proceed with all appropriate steps to have claims, reprocessed and paid.
Responsible for creating appeals with supporting documentation if applicable, notating appeal submission, receipt of acknowledgement and follow up on appeal until appeal process has ended.
Responsible for documenting and notating all findings actions taken on the account in the system.
Responsible for maintaining Insurance Aging below 120 days & keep at 10% or lower when possible.
Responsible to work on assigned AR, special projects or any additional duties as directed by upper Management.
FMLA Claim Analyst, 06/2006 - 10/2010 Aetna – City, STATE,
Receives claim assignment, confirms policy coverage's and directs acknowledgement of claims.
Investigates claim to determine validity and verify extent of damage by telephone contact with clients, claimants, witnesses or other parties required.
Helped train new employees for new hire, and also audited claims before sending for closure.
Answer inbound calls from Boeing employees creating FMLA and different state leaves, Conducts comprehensive telephone interviews with potentially eligible members to complete application for appropriate federal disability program(s)].
Regularly communicates and interacts with treating providers to obtain appropriate medical information needed to complete initial STD/FML/LOA claim approvals or continued recertification of benefit for STD & FMLA/LOA.
Applies federal, state and local laws and regulations affecting claim investigation, disability decision, claim payment and taxation of benefits.
Education and Training
: , Expected in 2006 - - , GPA: Status - Reviews and applies State Disability Laws within scope of FMLA/LOA Administration. Nations Health –Sunrise, FL
Provide extensive outreach services to include an effective level of customer satisfaction
Responsible for Insurance Verification, such as and not limited to Medicare, Medicaid an in network Commercial Providers
Responsible for taking over the counter drug medical supply orders for diabetic patients, updating patient account information
and sending diabetic supply catalogs upon request.
High School Diploma: , Expected in 1996 - Miami Central Senior High School - Miami, FL GPA: Status -
Medical Billing And Coding: Medical Claims Examination, Expected in 08/2020 - DeVry University - Downers Grove, IL GPA: Status -
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