Efficient, organized Medical Office Professional with a background in medical billing, insurance follow-up and collections. Excellent performance oriented team player with a positive attitude who has the ability to readily adapt to changing environments and demands, seeks a position for further growth and opportunities.
Core Qualifications
Electronic Medical Record (EMR) (EHR) software
Multi-Practice & ER Physician billing experience
Medical, Auto, Workers Compensation, insurance billing & follow up experience
HIPPA compliance
Strong work ethic
Fast Learner
Team player with positive attitude
Exercises good judgement
Good written communication
Experience
01/2015 to Current
Refund AnalystDekalb Health – Archbold, OH,
Responds to inquiries from patients, clinical departments, and third parties via telephone, written correspondence and personal contacts.
Adds/corrects registration, insurance, and demographic data in the billing system to ensure accurate records.
Processes adjustments as requested by the Departments and/or Supervisors.
Obtains necessary information and records for researching and resolving accounts.
Sends requests to resolve misapplied payments and credit balances.
Participates in special meetings and projects as required.
Analyzes accounts that are not resolved within the time specified by the contract to determine causes of unresolved issues.
Manages work through use of multiple systems.
Analyzes credit balances including returned checks and refund requests from various sources, and then takes action to resolve by initiating a refund or moving money.
Analyzes underpayments and overpayments and processes refund related offsets.
Maintains strict confidentiality of sensitive information. Demonstrates sharing of appropriate information and knowledge with team members.
Discuss over the phone patient past due medical bills.
Help patient access their monthly budget to fulfill repayment obligations.
Set up budget plans and followed up with patient if payments were missed.
Analyze and interpret patient medical and surgical records to determine billable services.
Complete appeals, file and submit claims.
Preform full-cycle medical billing in a fast-paced medical billing company.
Thoroughly investigate past due invoices and minimize number of unpaid accounts.
Demonstrate knowledge of HIPPA Privacy and Security Regulations by appropriately handling patient information.
Confirm patient information, collect payments and verified insurance.
Effectively review remittance codes from EOBS/AR's.
Appropriately apply adjustments into medical manager system.
Acquire insurance authorizations for procedures and tests ordered by the attending physician.
Correctly identify errors and re-file denied/rejected claims as they were received from the Patient Account Representative.
Train new employees & up-train on insurance filing and procedures Assist manger/supervisor with duties when one or both are out of the office.
04/2003 to 06/2005
Team LeaderAmita Health – Sturtevant, WI,
Analyzed and organized office operation and procedures such as billing, correspondence and customer service.
Prepared and submitted claims for payment.
Researched and resolved problem claims.
Monitored incoming telephone volume and telephone coverage, auditing, statistical and financial reporting.
Conducted practice operational assessments, collection reviews, and month end reporting.
Trained new employees, recorded training accomplishments and conferred with management regarding training needs.
03/2001 to 04/2003
Pre-certification CoordinatorUniversal Health Services – Bowling Green, KY,
Assessed, reviewed and monitored each patients insurance coverage and advised medical director.
Followed guidelines for medical necessity procedures ensuring that treatment decisions serve the purpose of quality assurance and cost containment with minimum utilization of physicians time and effort.
interfaced with physicians, nurses, social workers, referring practitioners and case managers to discuss the nature of services suggested or provided.
Compiled and kept records for information concerning services rendered to be used for evaluation.
08/1997 to 04/2001
Utilization Coordinator21St Century Oncology – Cape Coral, FL,
Verified insurance benefits to determine if insurance coverage meets the standards of admission as stated in the policy.
Performed initial evaluation relating to pre-admission, admissions and discharge of patients.
Followed guidelines for medical necessity procedures ensuring that treatment decisions serve the purpose of quality assurance and cost containment with minimum utilization of physicians time and effort.
Interfaced with physicians, nurses, social workers, referring practitioners and case managers to discuss the nature of services suggested or provided.
06/1995 to 08/1997
Referral CoordinatorCity Of San Antonio, Tx – San Antonio, TX,
Prepared and submitted claims for payment Researched and resolved problem claims.
Billing patients/beneficiaries or other responsible parties for balance after insurance payment.
Maintained knowledge of current policies and procedures.
07/1990 to 05/1995
Claims AdjusterBetter Health Plans – City, STATE,
Processed medical claims, secondary insurance, and written correspondence.
Processed adjustments, auditing and resolved complex claim questions.
Answered inquires to insured individuals, policyholders, physicians, hospital representatives, agents, brokers, and group field offices.
Maintained claims exception monthly reports.
Education
Expected in 1989
High School Diploma: General Leto Senior High School - Tampa, FL GPA:
General
Expected in 2015
Certification: Phlebotomy Miller Motte Technical College - Chattanooga, TN GPA:
Certified Phlebotomy Technician
Skills
AR, auditing, balance, benefits, Billing, budget, customer service, fast, filing, financial reporting, insurance, director, medical billing, Medical Management, medical manager, access, office, policies, quality assurance, Fast Learner, reporting, supervisor, Team player, telephone, phone, written, written communication
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