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Patient Account Representative II KFORCE Resume Example

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PATIENT ACCOUNT REPRESENTATIVE II KFORCE
Professional Summary

Dynamic and highly qualified Patient Account Representative with extensive knowledge of insurance billing, claims and collections, follow up. Employs high-level negotiation skills in resolving claims to the satisfaction of all involved parties. Analytical thinker and innovative problem solver.

Licenses

N/A

Skill Highlights
  • Knowledge of HMOs,PPOs,
  • Medicare and Medicaid MO and IL,
  • EOBs, UB04s, HCFA 1500,Electronic Filing CPT and HCPCS coding
  • Copays, Deductibles,
  • Adjustments,Appeals, Internet,Medical Records
  • Faxing,Scanning,Copying, Multi Phone Line,
  • HIPAA compliance
  • Strong planning skills
  • Strong work ethic
  • Patient-focused care
  • Team player with positive attitude
  • Good written communication
  • Exercises good judgment

Critical thinker

Analytical

Complex problem solving
Professional Experience
Barnes Jewish Hospital St. Louis Mo April 2013 to Current Patient Account Representative II KFORCE
Saint Louis, MO
  • Responsible for billing secondary and tertiary insurance after Medicare has paid Also follow up on claims after secondary and tertiary claims has been filed Contact payer to obtain claims status via Telephone, Internet , Fax Rebill claims, updated patient demographics, contact patient on outstanding balances Make any necessary adjustments generated by contractual, non-covered, untimely filing Document all collection efforts.
St. Louis Children's Hospital St. Louis Mo April 2012 to February 2013 Patient Account Representative II KFORCE
Saint Louis, MO
  • Responsible for reviewing delinquent accounts of patients and working solely with insurance companies, rebilling of accounts for denials, missing codes, or required information not provided at the time of initial billing.
  • Verify insurance via phone, web, update patient demographics, rebill claims via fax, mail, electronically, request medical records.
  • Contact patients about co pays, non-covered services, insurance transfer balances, mail statements, make contractual adjustments to accounts, document all collection and follow up efforts.
  • Focus primarily on Missouri Medicaid, Illinois, Medicaid, Tricare payers.
Express Scripts St Louis Mo The CSI Companies September 2011 to January 2012 Accounting Assistant
Saint Louis, MO
  • Open and sort mail received from US Bank Lockbox daily.
  • Forward scripts and other correspondence to appropriate department for resolution Process checks by AR number or other information provided by customer, attached AR look up sheet to check for further processing.
  • Bundle checks by one hundred to be scanned and posted to the US Bank system, once checks or balanced.
  • Process credit card statements through Compass software and apply payment to A/R.
St. Johns Mercy St Louis Mo Manpower Inc October 2010 to June 2011 Medical Collector / Customer Support
Saint Louis, MO
  • Responsible for the preparation and resolution of managed care government and non government Medicare and Medicaid insurance claims, including claims follow up, billing and appealing.
  • Check Medicare (MVP) live and Mo Medicaid website for eligibility Contact payor to obtain claims status via Telephone, Internet and/or Fax Request billing for secondary payers Rebill claims, updated patient demographics, contact patient on outstanding balances Request the necessary adjustments generated by contractual, aging non-covered, untimely filing Talk to patients about their bills, suggested payment arrangements Document all collection efforts.
SSM Home Care St Louis Mo January 2002 to September 2009 Insurance Verification Representative
Saint Louis, MO
  • My responsibilities were to run the referral report every morning, every hour thereafter, log the time the report is pulled, separate referrals according to payors and soc dates, fill out the insurance verification form, Determine primary payor Verify all insurances, primary and secondary for commercial plans, verify Medicare and Medicaid eligibility via (MVP), verify any Medicare Advantage plans listed in the common working file Identify all covered services and benefits, verify effective date, policy number, group number, insurance carrier name, phone number, address for claims, get phone number for auth even if they state no auth needed Add insurance in the correct billing sequence, under bill codes choose the correct insurance and address, add claims address in the episode notes Upon completion of the insurance verification, I would print the patients letter for each payer and attach it to the referral before passing it on to the Authorization Coordinator for further processing Document all action taken on account 1 10-07 - 08-08 SSM Central Billing Office St Louis Mo Patient Account Representative I OfficeTeam Healthcare Responsible for the preparation and resolution of managed care (government and non government), Medicare and Medicaid insurance claims, including but not limited to: claims follow up, billing and appealing Work correspondence daily received from insurance plans.
  • Review the Explanation of Benefits received from the insurance plan to resolve incorrect denials.
  • Contact payors to obtain claims status via Telephone, Internet, and Fax to make sure provider is paid according to contract.
  • Access multiple payer websites for claim status, eligibility, and benefits As needed rebill primary, and bill secondary claims by electronic billing or hardcopy with necessary attachments, updated patient demographics, and Phone patients for payment or payment arrangements on outstanding balances.
  • Request the necessary adjustments generated by contractual, aging non-covered, untimely filing.
  • Other duties as assigned by supervisor.
  • Document all collection efforts.
Tenet PFS St Ann Mo November 2006 to September 2007 Patient Account Representative I
Saint Louis, MO
  • Responsible for the preparation and resolution of managed care (government and non government), Medicare and Medicaid insurance claims, including but not limited to: claims follow up, billing and appealing Work correspondence daily received from insurance plans Review the Explanation of Benefits received from the insurance plan to resolve incorrect denials.
  • Contact payors to obtain claims status via Telephone, Internet, and Fax to make sure provider is paid according to contract.
  • Access multiple payer websites for claim status, eligibility, and benefits As needed rebill primary, and bill secondary claims by electronic billing or hardcopy with necessary attachments, updated patient demographics, and Phone patients for payment or payment arrangements on outstanding balances.
  • Request the necessary adjustments generated by contractual, aging non-covered, untimely filing, document account Other duties as assigned by supervisor.
  • Document all collection efforts.
Professional Solutions September 2004 to December 2005 Patient Account Representative I
Saint Louis, MO
  • Responsible for the preparation and resolution of managed care (government and non government), Medicare and Medicaid insurance claims, including but not limited to: claims follow up, billing and appealing Work correspondence daily received from insurance plans Effectively researches unidentified payments/recoupment Review the Explanation of Benefits received from the insurance plan to resolve incorrect denials.
  • Contact payors to obtain claims status via Telephone, Internet, and Fax to make sure provider is paid according to contract.
  • Access multiple payer websites for claim status, eligibility, and benefits As needed rebill primary, and bill secondary claims by electronic billing or hardcopy with necessary attachments, updated patient demographics, and phone patients for payment or payment arrangements on outstanding balances.
  • Request the necessary adjustments generated by contractual, aging non-covered, untimely filing, document account May receive patient payments and/or issue payment receipts Request Medical Record, customer support Document all collection effort.
Saint Charles Clinic St Charles Mo April 1999 to March 2004 Patient Account Representative I
Saint Charles, MO
  • Responsible for researching and collecting on unpaid and denied HCFA 1500 insurance claims in an expeditious manner to ensure account resolution: Payors (Managed Care, Commercial, Government, WC) Work correspondence daily received from insurance plans Review the Explanation of Benefits received from the insurance plan to resolve incorrect denials.
  • Effectively researches unidentified payments/recoupment Contact payers to obtain claims status via Telephone, Internet, and Fax to make sure provider is paid according to contract.
  • Access multiple payer websites for claim status, eligibility, and benefits As needed rebill primary, and bill secondary claims by electronic billing or hardcopy with necessary attachments, updated patient demographics, and Phone patients for payment or payment arrangements on outstanding balances.
  • Request the necessary adjustments generated by contractual, aging non-covered, untimely filing, document account May receive patient payments and/or issue payment receipts Request Medical Record, customer support Other duties as assigned by supervisor.
Education and Training
Central High School 1982 Diploma: General Studies Saint Louis, Mo, United States
Skills

AR, Benefits, Billing, credit, customer support, Fax, filing, Focus, Government, insurance, notes, Access, mail, Office, researching, scripts, supervisor, Telephone, Phone, website, websites

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Resume Overview

Companies Worked For:

  • Barnes Jewish Hospital St. Louis Mo
  • St. Louis Children's Hospital St. Louis Mo
  • Express Scripts St Louis Mo The CSI Companies
  • St. Johns Mercy St Louis Mo Manpower Inc
  • SSM Home Care St Louis Mo
  • Tenet PFS St Ann Mo
  • Professional Solutions
  • Saint Charles Clinic St Charles Mo

School Attended

  • Central High School

Job Titles Held:

  • Patient Account Representative II KFORCE
  • Patient Account Representative II KFORCE
  • Accounting Assistant
  • Medical Collector / Customer Support
  • Insurance Verification Representative
  • Patient Account Representative I

Degrees

  • Diploma : General Studies

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