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 CollegeHouston, TXExpected in 06/2008 – –Certification:Coding Specialist - GPA:
Green Run High SchoolVirginia Beach, VAExpected 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.
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