Livecareer-Resume
Jessica
Claire
resumesample@example.com
(555) 432-1000,
, , 100 Montgomery St. 10th Floor
:
Summary

Methodical Senior Patient Account and Follow up representative seeking position as Follow Up QA Specialist with a over 10- year track record of providing exceptional discretion, quality management, and performance analysis services in the Healthcare industry. Adept at training new hires and retraining employees and managing the accuracy of all products.

Skills
  • Staff development
  • New employee training
  • Talent Management
  • Training methods
  • Strategic thinker
  • Problem resolution
  • Microsoft Office
  • Decision-making
  • Data management
  • Teambuilding
  • Conflict resolution
  • Analytical
  • Work ethic
  • Active listening
  • Leadership
  • Clerical
  • Improvement planning
  • Medical record security
  • Healthcare claim coding
  • Patient data identification
  • Documentation oversight
  • Data entry
  • Medical terminology
  • Knowledgeable in EPIC
Education and Training
Houston Community College Houston, TX Expected in 06/2008 Certification : Coding Specialist - GPA :
Green Run High School Virginia Beach, VA Expected in 06/1992 High School Diploma : - GPA :
Certifications
  • Certified Billing Specialist (CBS)
  • Cardiopulmonary Resuscitation (CPR)
  • First Aid & Automated external defibrillators (AEDs)
Experience
Md Anderson - Senior Patient Account Representative/Preceptor
Katy, TX, 09/2013 - Current
  • Maintain insurance queue for accounts with a balance larger than $1700
  • Call Medicare Advantage plans on accounts greater than 30 Claires old where a payment has not been received
  • Research all denials on claims for appropriate next steps (correction to coding, charges, modifiers, etc.) and forward the issue to the correct department for correction
  • Rebill corrected claims once corrections are made
  • Appeal outpatient claims with medical records along with signed waiver of liability
  • Forward inpatient denials to the appeals department to be appealed when needed
  • Medical records are pulled from EPIC EMR system
  • Escalate claims with insurances when claims have not been processed within a reasonable time-frame (normally 30-45 Claires)
  • Verify eligibility with other insurances and/or patients to clear COB issues
  • Reconcile accounts to ensure balance is correct insurance/patient responsibility/Utilize MedAssets
  • Train new hires for the unit on the follow-up process and follow-up/billing software
  • Familiar with billing secondary Anthem BCBS and Virginia Medicaid claims
  • Resolved inquiries from patients, families and external payers.
  • Collaborated with relevant parties to resolve billing issues, insurance claims and patient payments.
  • Applied organizational policies and complied with regulations for patient privacy.
  • Reviewed flagged items daily and resolved issues.
  • Submitted electronic bills following facility and legal compliance standards.
  • Generated detailed reports outlining billing, flagged items and other important data.
  • Applied HIPAA privacy and security regulations while handling patient information.
  • Verified demographics and insurance information to register patients in computer system.
  • Organized and maintained records by updating and obtaining both personal and financial information from patients.
  • Reconciled codes against services rendered.
Kindred Healthcare - PBS Billing Specialist
Hobart, IN, 07/2010 - 02/2013
  • Follow-up on all inpatient claims 15 Claires and older for traditional Medicare and Advantage plans
  • Reviewed and printed all necessary medical records from OnBase for appeals to Novitas and Maximus
  • Corrected RTP claims in Florida Shares System (FSS) and verified patient eligibility in CWF/HIQA
  • Reconciled accounts to ensure balance displayed current insurance/patient responsibility
  • Issues with stem cell transplant claims were thoroughly reviewed for proper billing according to Medicare guidelines
  • Government Collections
  • Researched claim denials, identified causes and resolved issues to promote prompt insurance payment.
  • Collaborated with billing functional area and business units to secure accurate customer invoicing within established deadlines.
  • Obtained prompt payments for open bills by interacting with appropriate parties.
  • Maintained confidentiality on all patient record data.
  • Executed solutions for internal process issues to streamline operations.
  • Developed and implemented policies to resolve outstanding balances.
Memorial Hermann Healthcare - Government Collections
City, STATE, 09/2007 - 07/2010
  • Work Medicare denials for accounts 15 Claires and older
  • Any denied claim that can be justified an appeal was filed with medical records
  • Possess knowledge of Florida Shares System (FSS) viewing and correcting Return to Provider (RTP) claims
  • Call commercial insurance companies daily to verify patient eligibility
  • All work is documented in the HealthQuest system
  • Train new hires.
Sentara Healthcare - Medicare Biller
City, STATE, 10/2001 - 05/2007
  • Billed Medicare outpatient claims on UB92/UB04 claim forms with a 1-2 Claire turn-around
  • Accessed Florida Shares System (FSS) to correct Return to Provider (RTP) claims
  • Cleaned and adjusted claims were worked and transmitted with the Cirius billing software
  • Trained new hires
  • Used computer system to record weekly expenditures and balances.
  • Prepared and updated new system to handle billing needs with improved accuracy, reliability and overall performance.
  • Kept operations in full compliance with state, federal and TJC requirements.
  • Used various health record indexes and storage retrieval systems to manage medical billing.
  • Handled billing for full complement of practice providers.
  • Submitted and accurately processed insurance claims with related medical code verifications and assessments.
  • Maintained high accuracy rate on daily production of completed reviews.
Accomplishments
  • Brought down delinquencies of more than $ 100K
  • Trained and helped new team members learn service, quality and compliance standards.
  • Uncovered important discrepancies
  • Improved payment rates dramatically by cultivating positive relationships with insurance provider representatives and hospital patients.
  • Super User of several applications

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Resume Overview

School Attended

  • Houston Community College
  • Green Run High School

Job Titles Held:

  • Senior Patient Account Representative/Preceptor
  • PBS Billing Specialist
  • Government Collections
  • Medicare Biller

Degrees

  • Certification
  • High School Diploma

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