Driven and compassionate healthcare professional with 23 years experience in Home Infusion Pharmacy Reimbursement, skilled in billing,coding and insurance verification. Detail oriented and focused on accuracy and efficiency
In-depth claims knowledge
Medical coding capability
Healthcare billing proficiency
Problem resolution ability
Cleveland Clinic Home Care ServicesJune 2000 to CurrentReimbursement Specialist Brecksville, Ohio
Prepared and attached all required claims documentation including referrals, treatment plans or other required correspondence to reduce incidence of denials.
Consistently ensured proper coding, sequencing of diagnoses and procedure
Evaluated the accuracy of provider charges, including dates of service, procedures, level of care, locations, diagnoses, patient identification and provider signature.
Precisely processed third party prescriptions and managed adjudication review for high volume of claims.
Performed quality control of the data entry system to verify that claims and payments were posted correctly.
Remained up-to-date with all insurance requirements, including the details of patient financial responsibilities, fee-for-service and managed care plans.
Posted charges, payments and adjustments.
Completed appeals and filed and submitted claims.
Appropriately and correctly identified errors and re-filed denied/rejected claims as they were received from the Patient Account Representative.
Create and maintain accurate contract price schedules to facilitate accurate billing
Assists in the interview process as well as training of new staff.
Developed department training programs with supervisor for Medicare Part D test claim requirements.
Contributed and participated with in-services for office staff
Acted as a liaison between the insurance staff, accounts receivable and pharmacy staff in resolving billing and reimbursement accuracy.
Confirm infusion pharmacy pick tickets for month end close.?
Cleveland Clinic Home Care ServicesJune 1997 to June 2000Payor Relation Specialist Valley View, Ohio
Efficiently performed insurance verification and pre-certification and pre-authorization functions.
Update patient account with accurate payer information.
Disseminated information to correct department, individual or outside location
Contact physician's office to submit referral or documentation for coverage approval.
Consistently informed patients of their financial responsibilities prior to services being rendered.
Knowledge of Medicare and Medicaid coverage and guidelines
Completion of Medicare secondary payor forms.
Cleveland Clinic Home Care ServicesJune 1996 to June 1997Customer service Representative Valley View, Ohio
Confirmed patient information and verified insurance.
Filed paperwork and completed patient chart.
Performed various administrative duties, including data entry and document preparation.
Obtained information by contacting appropriate personnel or patients.
Followed up with insurance companies and individuals to resolve discrepancies.
maintained complete confidentiality in accordance with organization and legal requirements.
Infusion Pharmacy/Cleveland Clinic Home Care ServicesDecember 1993 to June 1996Secretary Valley View, Ohio
Managed daily office operations.
Managed the day-to-day calendar for the Pharmacy manager.
Made copies, sent faxes and handled all incoming and outgoing correspondence.
Assist pharmacy staff with picking and packing orders for delivery.
Contacting patients to confirm supplies and completing delivery tickets.