LiveCareer-Resume
Jessica Claire
  • Montgomery Street, San Francisco, CA 94105 609 Johnson Ave., 49204, Tulsa, OK
  • H: (555) 432-1000
  • C:
  • resumesample@example.com
  • Date of Birth:
  • India:
  • :
  • single:
Professional Summary
To fulfill all job descriptions as a Medical Biller / Medical Collector Supervisor where I can apply my billing experience and skills towards achieving the goals of the company.
Skills


Medical Billing, Medical Coding, Medical Terminology, Team player with positive attitude, Work well under pressure, Ability to analyze solutions and identify problems, Experience in managing Medi-Cal and Medicare HMO Departments, Experience in managing Private Pay Department, Knowledgeable with health care billing procedures, Keyboarding, Microsoft Office, Bilingual, ICD-9, CPT, HCPCS

Professional Experience
Team Lead, 01/2010 - Current
Topgolf Albuquerque, NM,
  • Answer and resolve patient billing inquires.
  • Assist with any patient complaints received via email, over the phone or from the Better Business Bureau
  • Train employees to ensure that policies and procedures are implemented in the Insurance/Self-Pay Department
  • Handle and resolve billing issues with patients and insurance companies
  • Ensure that updates are made to our billing system of any address/phone number changes of Health Plans or Medical Groups
  • Ensure that employees are provided with updated billing instructions when billing Health Plans or Medical Groups to ensure correct billing so claims are paid accordingly
  • Provide outside sources such as Law Offices with any balances and invoice request
  • Request cancellation of accounts from the collection agencies after careful review of accounts is made and a determination is made that the accounts does not belong in collections
  • Communicate with insurance companies and provide them with a report of trips when necessary for issues with payments delays or denials in errors to expedite payment from the payors
  • Assist the company with the migration from one billing system to another
  • Communicate with the System Administrators for any issues or updates needed on claim forms to ensure claims are submitted correctly
  • Process credit card payments received from Operations and communicate with the Cash Department to make sure the payments are posted to the correct trips. Also, communicate with the Initial Billing Department to ensure the trips are placed on hold once entered since a payment was received at the time of service, so the patients are not billed
  • Review Medical Records for discrepancies of information entered into the system and that recorded on the patients medical records. Will communicate with the Initial Billing Department for any necessary updates to a trip
  • Provide customer service to patients with billing issues or those in connection with their account balances which have gone to collections.
  • Direct staff during management absence
  • Train staff on specific duties such as mail return, insurance billing, appeals, collections and when necessary on any enhancements perform in the company's billing system
  • Evaluate/asses employees on their strengths and weakness of their job duties (reps doing initial billing, follow-up and those reviewing denials and submitting appeals to an insurance) to be able to assist and determine if additional training is needed for the employee
  • Report to management of any conflicts that arise whether it is with an insurance carrier, the billing system or with employees. A report is given to Management even when an issue is resolved
  • Give a report of any updates to management
  • Assist with approval of adjustments/write offs
  • Run reports of employees production
  • Review Audits of employees and provide our QA Department with feedback on any discrepancies on their review. Also, provide employees with the results of their audits to ensure they agree, and so additional training or training material is provided if necessary
  • Work on special projects. Previously assisted and trained on a project for issuing refunds to insurances and patients
  • Communicate with Operations on any billing disagreement from patients to ensure customer satisfaction
  • Maintain communication with staff and management
  • Communicate with the Cash Department to locate any misapplied payments and transfer requests
Insurance Biller/Customer Service Representative , 10/2006 - 01/2010
Pruitthealth Rockingham, NC,
  • Submitted HMO, PPO, Medicare, Medical and Worker compensation claims to both commercial Insurances as well as private via paper and electronic
  • Submitted an aging of accounts to different payors when issues where encountered such as underpayments for expediting of payment
  • Familiar with websites of insurances and have agility to check status for claims or eligibility. Negotiate collection claims that are unpaid with both insurance companies and patients
  • Reviewed EOB and denials from insurance providers. Submit appeals to insurances.
  • Billed patients once insurance pays their portion of claim or if entire claim is denied. Send EOB to secondary insurance.
  • Make calls to the Health Plan to check on status of claims and eligibility. Provide insurance representatives with any additional information requested. Assist them with the best of my knowledge on submission of claims to ensure request gets resolved.
  • Requested retro-authorizations for services provided in order to receive payment from Medical Groups, and forward claims to IPA.
  • Resolve incorrect payments and submit correct write downs or write offs for accounts paid correctly or with underpayments, overpayment's or paid at Contract rates.
  • Calculated Medicare allowable for accounts in which patients have a supplemental plan with Medicare and submit write down request.
  • Provided follow-up to ensure proper payment was made, and no overpayment or underpayment is done on accounts.
  • Check medical record charts in computer system and provide medical records of patients when requested by insurance. Maintain and organize charts for accounts with underpayments, overpayment's, EOB and for accounts requesting follow-up calls to insurances.
  • Provided customer service to patients with billing issues or those in connection with their account balances which have gone to collections. Take phone payments from patients and adjust accounts accordingly.
  • Researched in system for payments received and not posted to correct accounts. Provide reports to management on aging accounts
  • Adhered to company policies and procedures
  • Received payment information from patients made by either credit card or by check
  • Released trips for billing
  • Assisted patients with any questions regarding payments or balances on their accounts. Forwarded any customer grievances to management when necessary
  • Assisted with mail return
  • Assisted management with locating unapplied payments
  • Answered incoming calls from insurance carriers, patients or law firms


Teacher Assistance, 08/2005 - 05/2006
Los Angeles Unified School District City, STATE,
  • Clerical support for teacher, and meeting special needs of

parents.

  • Supervising children and assisting with reading and writing.
  • Operating office equipment, translating, assisting in event and program preparations.
Office Assistant/ Instructor Assistant, 02/2003 - 05/2005
Los Angeles Harbor College City, STATE,
  • Answer multiple phone lines.
  • Usage of computer, fax, copier and typewriter.
  • Wrote memos for instructors and was in charge of distributing memos to professors
  • Assisted disable students in Adaptive Physical Gym by transferring them from station to station and to their classes.
  • Demonstrated proper usage of equipment.
  • Assisted students with selecting courses from the Physical Education and Health Department
  • Assisted with communication between the Physical Education Chairman and staff
Certified Nursing Assistance, 08/2000 - 05/2001
C.N.A San Pedro Pavilion City, STATE,
  • Assist disable patients perform daily task such as personal grooming.
  • Provide personal care by giving patients bed bath and assisting.
  • patients getting up from bed.
  • Took the time to motivate and encourage patients to have a more active lifestyle.
Education and Training
CPC Certificate: Medical Coder, Expected in 2007
-
American Academy of Professional Coders - Redondo Beach, CA
GPA:
Medical Biller Certificate: Medical Biller, Expected in 2007
-
Southern CA Regional Occupational Center - Torrance, CA
GPA:
Associate of Arts: Liberal Arts, Expected in 2005
-
Los Angeles Harbor College - Wilmington, CA
GPA:
High School Diploma: , Expected in 2002
-
San Pedro High School - San Pedro, CA
GPA:
C.N.A. Certificate: Certified Nursing Assistance, Expected in 2001
-
San Pedro High School - San Pedro, CA
GPA:

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School Attended

  • American Academy of Professional Coders
  • Southern CA Regional Occupational Center
  • Los Angeles Harbor College
  • San Pedro High School
  • San Pedro High School

Job Titles Held:

  • Team Lead
  • Insurance Biller/Customer Service Representative
  • Teacher Assistance
  • Office Assistant/ Instructor Assistant
  • Certified Nursing Assistance

Degrees

  • CPC Certificate
  • Medical Biller Certificate
  • Associate of Arts
  • High School Diploma
  • C.N.A. Certificate

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