LiveCareer-Resume

regional reimbursement specialist resume example with 16+ years of experience

Jessica Claire
  • Montgomery Street, San Francisco, CA 94105 609 Johnson Ave., 49204, Tulsa, OK
  • H: (555) 432-1000
  • C:
  • resumesample@example.com
  • Date of Birth:
  • India:
  • :
  • single:
  • :
Summary
Highly motivated Sales Associate with extensive customer service and sales experience. Outgoing sales professional with track record of driving increased sales, improving buying experience and elevating company profile with target market.
Highlights
  • Guest services
  • Inventory control procedures
  • Merchandising expertise
  • Loss prevention
  • Cash register operations
  • Product promotions
Accomplishments
Experience
Regional Reimbursement Specialist, 08/2011 - Current
Common Spirit Council Bluffs, IA,
  • Insurance verifications via calls to payer or payer secure websites.
  • Responsible for notifications of insurance terminations to facility for patient updates.
  • Updates and verifies all new coverage for new, restart, visiting or transfer patients.
  • Re-verify and remove any terminated coverage record from patient account.
  • Obtain authorizations for services from insurance for patient treatments.
  • Set patient coverage in Boris Billing application for proper claim accounting and billing.
  • Respond to field inquiries regarding insurance updates, insurance denials or verification requests.
  • Maintain registration reports including new Medicare entitlement, Medicaid exception discovery, coordination of benefits reports, and patient pending plan reports.
  • Address, review and resolve any denial of claims related to registration matter.
  • Maintain/enter account notes for all actions taken.
Patient Account Representative, 01/2009 - 08/2011
Yale-New Haven Health Stonington, CT,
  • Contact insurance companies for Texas-based facilities including Medicare, Texas Medicaid, Government plans, Blue Cross of Texas, and various secondary insurance plans to resolve outstanding and short paid claim balances ranging from $100-$100K for 5 facilities with patient counts of up to 115/ site.
  • Work closely with Texas teammates to communicate and stay aware of, all known payer issues that could hinder proper and timely payment of claim balances.
  • Resolve insurer denial of claims via denial work list and No pay/short pay claim report.
  • Closely monitor timely filing guidelines for payers to ensure claims billed correctly.
  • Send claims to insurers and payer appeals as needed for dispute of payments made by insurers or to resolve non payment on claims.
  • Monitor and maintain web access log-ins to payer websites for claim status checking.
  • Complete re-bill projects, account adjustments for contractual amount differences, untimely adjustments, transfers to other coverage/patient responsibility, or small balance adjustments as needed.
  • Communicate payer issues to leadership as needed for escalation.
  • Organize and prepare agendas for weekly team meetings on rotation of teammates.
  • Contacting all primary, secondary and tertiary non- patient Hemodialysis claim payments for 3 California- based facilities and insurers ranging from Blue Cross of California, Medi-Cal, Medicare, and Blue Shield of California to Northern Kaiser.
  • 1 Million and up of Account Revenue to obtain payment for, appeal, bill, re-bill, submit for adjustment, and research Responsible for up to $1.3 Million and up on a monthly basis in AR collection for Nebraska, Missouri and 1 Nevada sites.
  • Maintained low Daily Sales Outstanding of 65 and under during collection time for these facilities.
  • Main responsibilities were to obtain payment for, appeal, bill, re -bill, submit for adjustment, and research claim balance to reduce Daily Sales Outstanding and increase yield and collections for sites.
  • Currently involved in Secondary Pilot project aimed at reducing Secondary AR and No Pay Claims.
  • Performed weekly close for 7 facilities to ensure charges reconciled correctly and information up to date for month end Close.
  • Assisted with month end Close/reconcile of facilities for other Teammates on as needed basis.
  • to reduce Daily Sales Outstanding and increase yield and collections for sites.
Senior, Secondary Billing and Collections Rep, 12/2005 - 01/2009
DaVita, Team Evergreen City, STATE,
  • Identify and problem-solve secondary insurance claims and accounts with teammates.
  • Address teammate questions regarding payer issues, denials, no pay accounts, and claims billing.
  • Assist Supervisor with Special Team Projects.
  • Perform account audits and reviews with teammates via Access Program Coaching Tool.
  • Review transfers and adjustments for accounts to balance Secondary revenue and key adjustments.
Commercial Collector/ Billing Rep/ Secondary, 04/2005 - 12/2005
DaVita, Team Evergreen City, STATE,
  • Contact secondary insurers to reconcile accounts with balances due.
  • Prepare adjustment logs for transfers, untimely follow up, and contractual adjustments or bad debt write off.
  • Decipher whether account balances require transfer or contractual adjustment based on amounts paid by secondary insurance coverage.
  • Maintain high performance standards to achieve department goal each month.
  • Bill claims to 2ndary insurers.
  • Create tasks to follow up on claims billed.
  • Process denials from insurers and take necessary action toward resolution.
Patient Resource Specialist, 06/2004 - 04/2005
DaVita, Team Evergreen City, STATE,
  • Contact patients to reconcile accounts with balances due.
  • Prepare adjustment logs for Medicare bad debt write off, ancillary write off, or bad debt write off.
  • Decipher whether account balances require transfer or contractual adjustment based on amounts paid by primary and secondary insurance coverage.
  • Maintain high performance standards to achieve department goal by the end of the month.
Education
COMPASS Leadership Development Program Graduate, DaVita 11/2007 Paula Dillard Leadership Development Training, DaVita 2007: , Expected in
-
University of Puget Sound - Tacoma, WA
GPA:
Status -
Bachelor of Arts: Sociology, Social Services, Expected in 1997
-
Aster Technology Institute - Tacoma, WA
GPA:
Status - Sociology, Social Services
Skills
accounting, AR, balance, benefits, Billing, Coaching, filing, Government, Hemodialysis, Insurance, leadership, Leadership Development, notes, meetings, Access, month end Close, research, Sales, Supervisor, websites
Additional Information
  • Medical Billing and Coding, Davita Externship 160hours 2004 Thank you for this opportunity to apply. I am ready to meet and exceed new challenges and am confident that my strong skills that are listed on my resume would be an asset within MultiCare Health System. I welcome the opportunity to further discuss my qualifications at your earliest convenience. Thank you for considering me for the position. I look forward to meeting with you to discuss becoming part of your team.

By clicking Customize This Resume, you agree to our Terms of Use and Privacy Policy

Your data is safe with us

Any information uploaded, such as a resume, or input by the user is owned solely by the user, not LiveCareer. For further information, please visit our Terms of Use.

Resume Overview

School Attended

  • University of Puget Sound
  • Aster Technology Institute

Job Titles Held:

  • Regional Reimbursement Specialist
  • Patient Account Representative
  • Senior, Secondary Billing and Collections Rep
  • Commercial Collector/ Billing Rep/ Secondary
  • Patient Resource Specialist

Degrees

  • COMPASS Leadership Development Program Graduate, DaVita 11/2007 Paula Dillard Leadership Development Training, DaVita 2007
  • Bachelor of Arts

By clicking Customize This Resume, you agree to our Terms of Use and Privacy Policy

*As seen in:As seen in: