| | | 20,000+ Fresh Resumes Monthly | |
|
|
| |
Click here or scroll down to respond to this candidateCandidate's Name
Buckeye, AZ Street Address
PHONE NUMBER AVAILABLEEMAIL AVAILABLEPROFESSIONAL SUMMARY:Seeking Medical Claims Review and Processing Administrative Medical Clerk Complex Authorization Specialist, and Registered Medical Assistant, Unit Health Coordinator, where I can use my skills in clerical and medical back office knowledge, and experience to provide excellent, compassionate family health care, and customer service. To utilize my clerical skills to the best of my ability, as well as my customer service skills.PROFESSIONAL EXPERIENCE:I have 40 Years in the Medical Office and Hospital Health Care Organizations.25 Years as a Registered Medical Assistant20 Years as a Unit Health Coordinator in a Hospital SettingArtesia ABC Adult School (GED) 1978Compton Community College 1976The Bryman SchoolEMPLOYMENT:2017-Present: Arizona Health Care Cost Containment, DFSM.2016- 2017: Trizetto Processing medical and Hospital Claims check new claims for various items, and approved to process for payments, Validates the information on all medical claims, or deny claims, Terminology, processing COB, EOB, Verifying Claims information. CPT, HCPCS, ICD-9 and ICD-10. Experience with UB CMS-1450 and CMS 1500 claims. Medicare billing and payment and coverage. Processing claims utilization review QA procedures, CMS payment,Medicare Physician Fee Schedule, Lab, DRGs, Outpatient Payment System, Ambulatory Surgical Center, ESRD, Ambulance, Anesthesia.2014-2016: TriWest Health care Alliance Administrative Medical Clerk Complex Authorization Specialist1998-2014: Maricopa Health Integrated Health Systems Lead R.M.A.1985-1998: Yuma Regional Medical Center Lead Unit Secretary1978-1985: Ronald E. Jefferson, M.D. Internal MedicineJOB DUTIES:AHCCCS CLAIMS CUSTOMER SERVICE REP MEDICAL CLAIM PROCESSORResponds to telephone inquiries and orders from patients and referred sources.Providers information on equipment, supplies and services. We determines the bestMethod for providing services. Verifies insurance and payment types. Compare Claims to the CMS 1500, and the UB04. to make sure all data entry is accurate and correct, and matches whats on the Claim forms, Performs data entry. Distributes paperwork to appropriate departments. Assist with the billing process as needed.Process Claims in a timely manner, denying claims, processing claims placing outbound to providers to verify information on claims. And resolved providers and patients, complaints when is problems and coordinate appropriate corrective actions.Processing State Ahcccs claims for Medicare and Medicaid ForFFS work claims adjustments as they pertain to encounters and reconciliationDetermine approval or denial of waivers request, process claims. Answering providers phone calls, verifying all claim information, obtaining medical records for processing claims. Problems solving claims when providers have questions. Reports member insurance benefits not identified a time of claim submission to AHCCCS.Medical Claims Processing, third party liability and or Coordination of Benefits.Administrative Medical Clerk Complex Authorizations SpecialistReview and Enters Authorizations and Referrals from VA and Providers.Communicate with Clinical staff, place outbound phone calls to the Veterans and Providers.Ensures accurate Data Entry and Completion of Authorization, from Veteran information.Medical records, referrals Authorization forms, Assist Patient Service Reps (PSR) in obtaining ConsultsReports within turn around times. Medical Processor for Auth Entry Data, SAR Medical Documentation,Medical Documentation, Medical Documentation Claims, Choice Programs Consults.Responds to inquires from the Veterans and Providers, regarding the VA program.Consistently meet Department Productivity and performance.JOB DUTIES:Lead R.M.A, Referrals CoordinatorOversees back office scheduling.Lead all back office personnel under the direction of the Medical Director/or Management.Assigns duties and responsibility for back office staff.Performs ongoing training and development for back office personnel.Maintains pharmacy inventory system.Participates with the Center Medical Director in hiring of New Back Office Staff.Performs, any other tasks and duties as assign.Prepares patients for exams.Chart Preps/closing charts in Epic EMRVital signs.Assist Physicians during examinations.Maintain Supplies, clean stock rooms with required supplies.Performs UDS, HIAC POC, URINES POC, PREGNACY URINE TEST, ACCU CHECKS POC.Performs Front Office Duties, answering multi phone lines.Patient check in-outsDispenses Medications as by Physicians EMR System Epic HyperspaceReferral Coordinator over all Internal and External though out the MIHS.Insurances verification /and Approvals.Certifications:CPR certified, expires May 02, 2015American Registry of Medical Assistants March 26, 2014Registered Phlebotomy Technician, December 07, 1979Electrocardiograph Technician Certificate Of Merit October 20, 1979Completion ivpcare The Specialty Pharmacy November 09, 2004Administrative Skills:HIPAA Certificate Medical TerminologyFiling ChartsInsurance BillingMedical CodingCustomer ServiceTelephone ReceptionPowerPoint, Word, and ExcelInventory ManagementReferrals Coordinator for all of the Comprehensive Health CareOnline Insurance Prior Auths and VerificationsEMR Running Hyperspace Epic Systems, and ARK Epic Super UserCLINICAL SKILLS:CPR CertifiedAnatomy and PhysiologyPhlebotomyVital SignsPerforming EKGsPatient CareUrinalysisSurgical Set-UpLead Registered Medical AssisistantEDUCATION:Diploma in Medical Assisting from Bryman School December 1979Graduated from ABC Adult High School, July 30th, 1979EXPERIENCE:Maricopa Integrated Health Systems (Phoenix, Arizona ), Medical Assistant, Referrals Coordinator ( 2000 -2014 Present)Texas Neurology Consultants, LLP (Plano, Texas ) Front Office Manager (1990-2000)Responsible for insurance filing. Took blood samples and recorded vital signs from patients. Assisted in minor surgical procedures. Expedited stocking of supplies.REFERENCES:Sam Diltop: Essculations Specialist (480) PHONE NUMBER AVAILABLE Co-WorkerNorma Manskar -Medical Management Supervisor -623-313-0035Heather Roland Supervisor, Maricopa Internal Medicine 602-752-6109NP Tracy Demistry Clinical Resource Leader, Maricopa Internal Medicine PHONE NUMBER AVAILABLEJenny Neal Registration Lead PHONE NUMBER AVAILABLE/pre> |
