Senior Patient Account Representative resume example with 10 years of experience
JessicaClaire
Montgomery Street, San Francisco, CA94105(555) 432-1000, resumesample@example.com
Professional Background
Proactive in Healthcare Industry with 20 years of trained experience in various facets and knowledge of Medicare, Medicaid, Major Medical, Workers Compensation, Auto and Third Party Billing, extensive knowledge of CPT, ICD9, HCPC coding nomenclature and Medical Terminology, pre-certification and prior authorizations. Excellent communication and interpersonal skills with all levels of management, with problem solving and decision making abilities. Leadership role in teaching and responding to colleagues based on insurance regulation and policy. HIPPA compliance, maintained thorough knowledge of all Healthcare plans guidelines and protocol for payment
Skill Highlights
Microsoft Word, Some Excel, Internet research, Third party billing Operating Software: Vision PM, Optimum, MS windows, Nextgen, Sorian, EDI, Emdeon
Professional Experience
02/2014 to 09/2016Senior Patient Account RepresentativeNorthwell Health | Shirley, NY,
Third party billing company, contracted with out of state hospital provide quality review and feed back to ensure aging accounts have been resolved and closed out based on contract agreement between our clients and the insurance company.
Attained, analyzed, identified missing or incorrect registration data, diagnostic or procedure codes and ensure that all necessary documentation attached to paper claims, including operative notes, referrals, explanation of benefits for secondary insurance.
Identified claim denials and rebill claim to insurance company , filed appeal and made final decision to write off , make adjustment to close out non payable account.
Completed quality assessment on insurance company trends and with direct feedback to improve and obtain relevant documentation for further review claim medical necessary.
02/2008 to 08/2013Senior Patient Account RepresentativeNorthwell Health | Somers, NY,
perform account and administrative functions to insure accurate and timely cash collections on medical claim for a non-participating provider.
Implemented new ideas to get to increase cash flow and identified under Anthem insurance policy guidelines for non-participating providers that work out of a participating hospital to initiate a global empowerment that allowed claims to be paid at 100% of the bill charge minus patient liability, collecting $20K to $50K in full with one major payers out of Connecticut, Developed and demonstrated Presentation on coordination and save the company money by minimizing and help eliminate refund request from insurance companies to ensure proper payment based on the birthday rule and plan polices that cover newborns for the first 31 days and under grandfather and self-fund plan policies Expedited appeals to Major insurance companies and to the Department of Insurance on claim that denied base out of network, getting claim overturned on a hold harmless clause Trained newly hired on company policies to limit discrepancies and complaints from guarantor and or patients following Hippa rules and guidelines Streamlined Healthcare plans policies and regulations, such as United Healthcare plan policy cover newborn hearing test performed in the hospital, under preventive medicine and pays at 100% with no deductible to be applied.
05/2005 to 04/2007Accounts Receivable RepresentativeMarco Technologies | Hunt Valley, MD, To increase claim revenue
• Obtained prior authorization, precertification on Laparoscopy, Endoscopy and
CT scans
to guarantee payment with no denials or rejection base on plan policy
• Followed up on claims, appeals status with insurance companies within timely
manner to minimize any penalties based on rejections and denials that may
affect the claim process
• Closed out accounts, write off balances and adjustment, forward bad debt
accounts to collections
• Post Medicare check payment electronically and manually applied other payers
check payment on account and transferred patient liability accordingly
• Run reports for the month and year end closing
Education and Training
Expected in 2007Medical Billing and Coding, Certificate | BurlingtonBurlington County College, Mt Holly, NJGPA: Burlington
Expected in 1988Certificate | Essex County College, Newark, NJ EssexGPA:
Interests
Volunteer Experience Secretary-Cardiac Unit Beth Israel Hospital, Newark, NJ Prepared and maintained record; charted vital signs and other studies; arranged appointments; ordered supplies; transacted incoming, outgoing and inter-departmental calls and transported cardiac patients to other units for treatment
Skills
Administrative functions, benefits, billing, cash flow, Cash handling, closing, clients, Customer Service, Data Entry, documentation, EDI, Endoscopy, Insurance, Invoicing, notes, Medical Billing, Excel, money, MS windows, MS windows, Microsoft Word, Negotiation, network, Internet research, Internet research, policies, Presentations, Problem Solving, Coding, quality, Research, Troubleshooting, Vision, vital signs
Additional Information
COMMUNITY INVOLVEMENT Volunteer Experience Secretary-Cardiac Unit Beth Israel Hospital, Newark, NJ Prepared and maintained record; charted vital signs and other studies; arranged appointments; ordered supplies; transacted incoming, outgoing and inter-departmental calls and transported cardiac patients to other units for treatment
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