Highly motivated, very strong willed and driven. Technically-savvy with outstanding relationship building, training and presentation skills. Excellent at juggling multiple tasks and working under pressure. Multiple areas of expertise.
- Attention to detail
- Filling and data archiving
- Intermediate Excel spreadsheet functions
- Professional and Superior organizational
skills - Behavioral & medical health billing, and
collections - Hospital inpatient and outpatient records
- HIPPA Compliance Articulate and well-spoken
- Microsoft Office & Outlook
- Proficient Pleasant demeanor
- Claims Processing
- Eligibility Verification
- Accounting remittances
Waldorf, MD, 09/2020 - Current
- Performs timely and accurate follow-up on claims to payers and patients following prescribed policies and procedures
- Responsible for preparing and submitting timely and accurate rebilled claims and initial billed secondary/tertiary claims to payers
- Enters certain demographic data into billing and collections software
- Generates claims for both electronic and/or hard-copy submission.
- Generates Missing Information Requests (MIR)
- Identifies variances between booked revenue and expected reimbursement to facilitate accurate reimbursement of claims as defined by contracts, and state and federal law.
- Participates in collecting and documenting payer specific claims processing rules, practices and guidelines to contribute to, and maintain, the currency and accuracy of payer requirements
Scranton, PA, 10/2017 - Current
- Establishes and maintains professional and effective relationships with peers and other stakeholders
- Establishes and maintains a professional relationship with clinics and FMG staff in order to resolve issues
- Reviews and posts payments and write-off/adjustments from insurance and patients
- Explanation of Benefits (EOBs)/ Electronic Remittance Advice (Eras), payments, adjustments, insurance insurance
contracts and contracting system, insurance benefits, and all account comments; applies knowledge of payer contracts and experience with insurance reviews to gather additional information as necessary - Posts and tracks electronic funds transfer (EFT) information and validates EFTs for accuracy
- Follows write-off approval protocols for non-routine adjustments. Completes daily posting log and quarterly cash
handling audits and reports findings to Supervisor - Applies current knowledge of government/commercial insurance reimbursement terms, contractual
and/or other adjustments and remittance advice details
City, STATE, 07/2014 - 10/2017
Professionally handle incoming telephone calls from Internal and External customers
Explain EOB's (Explanation of Benefits) to members based on questions asked
Posted payments to member accounts from statements received
Enter telephone inquiry report of contact into customer service intake screen
Maintain telephone performance goals established by the specified division
Manage personal route list daily
Provide the same high quality service to “walk-in” inquiries that is provided for telephone inquiries
Work with all departments in the division or company to resolve customer service inquiry issues
Attend available training sessions to further enhance skills
Ensure timely and accurate completion of daily/weekly telephone reports
Stay up-to-date regarding online resources, such as Online Help, BlueAlert, Medical Policy, and all other electronic resource changes when applicable
Processed claims
City, STATE, 04/2014 - 07/2015
Receive and direct all incoming calls to the appropriate party, in a timely and professional manner.
Interview patients at workstation or at bedside to obtain all necessary account information. Bed-side
registration performed utilizing carts/computers on wheels
Coordinates with business office meal ticket monies, safe entries and removals, mail distribution, and
vehicle sign ins/outs.
Calculate and collect patient liability amounts
Verify insurance benefits and determines pre-certification/authorization status via on-line or other
resources. If pre-certification/authorization/notification of admission is required and has not been
obtained, initiate via Passport, on-line or phone call. - Enter all information and authorization/referral
numbers into the registration system
Interview incoming patients, his/her relatives, or other responsible individuals to obtain identifying and
demographical information with insurance and financial information
Assign Insurance Plans (IPlans) accurately
Search MPI completely and assign the correct medical record number. Notify HIM for any duplicate unit
numbers
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School Attended
- Brainerd High School
Job Titles Held:
- Reimbursement Specialist
- Billing Specialist
- SCD Customer Service Rep
- Registrar/PBX Phone Operator
Degrees
- High School Diploma
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