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Click here or scroll down to respond to this candidateCandidate's Name
Troy, MI Street Address
Phone: PHONE NUMBER AVAILABLEEMAIL AVAILABLESUMMARY:Over 20 years of experience in Customer Service. >5 years of experience in Medical Billing.>5 years of experience in healthcare.Extensive experience in medical billing claims processing, outbound calls to insurance companies, Read and interpret Explanation of Benefits, Identify and correct claims issues, Contact payer for billing discrepancies.Expert in Handling and resolving customer complaints, Answer questions concerning medical billing, insurance coverage, provider information etc.Proficient in MS Outlook, MS Word, MS Excel, A & G Appeals Denial Database, CVS Caremark, Alequeus (DMS) and CHAMPS- Ohio Medicaid Processing System, QNXT, Relay Health/Eprimus, Invision, Parallon, Rev Cycle, Citrix, Epic and Ability (DDE)EDUCATION:High School Diploma, Marian High School Bloomfield Hills, MIDavenport University, Grand Rapids, MI onlineHealth AdministrationCompleted 28 credits, including 16 credits in administrationEXPERIENCETrinity Health Farmington Hills, MICommercial Billing Analyst Jul 2019- PresentProof reading and updating billingSubmit claims to various insurance payers: Workmens Compensation, Auto carriers, HAP, Cigna and other commercial payerCorrect claims rejected by the insurance payerVerify all patients eligibility & insurance coverageEvaluates accounts, resubmits claims, and performs adjustments, write-offs and/or balance reversals, if charges were improperly billed or if payments were incorrectFollowing policy on rebilling/ adjustment requests for late chargesMeeting daily goalsUsing various websitesUpdating Insurance informationWorking rejectionsResearching and resolving payment discrepanciesBeaumont Health Southfield, MIBilling/Follow-up Rep Dec 2017- Jul 2019Completing primary and secondary claimsFollowing - up on claim holdsRebilling /cancelling claims.Reviewing claims after analyzing readmission reportsFollowing policy on rebilling/ adjustment requests for late chargesAnswering questions and assist patients in regard to billing questions as neededMeeting daily goalsUsing various websitesCalling payer requesting claim statusUpdating Insurance informationWorking denials/rejectionsResearching and resolving payment discrepanciesPosting all adjustments appropriately to maintain accurate account balances for all accountsSubmitting corrected claims, appeals or reconsiderationsR1 (Aerotek) Southfield, MIBilling Specialist Jul 2017- Dec 2017Review patient accounts ensuring claims are accurate and billableIdentify and resolve claim edits and understand billing guidelinesProactively fix claims rejections errors and submit claims based on payer requirements.Initiate contact and respond to inquiries from various external sources.Comply with all government and third-party payers regulatory mandated requirements for billing and collectionsAnswers questions and assist patients in regard to billing question as neededProcessing Medical Resource Group (MRG) accounts combining Physicians and Hospitals charges.Ability to read and understand Explanation of Benefits ( EOB) formsKnowledge of medical terminologyPractical knowledge of patient accounting systems such as Invision, Ability(DDE), Mckesson, Centrix and StarQuality in Real Time Troy, MIADR Medical Reviewer Administrative Assistant Aug 2016-July 2017Maintain tracking tool to note reviews/appeals for each agencyLog in and review documentation sent by each agency to ensure all paperwork needed to process a review/appeal is receivedLog in and maintain tracking of completed appeal documentsSend completed reviews/appeals to agencies/reviewing entityMaintain tracking of all documents returned to agenciesReview ADRs for chart order and completeness via chart audit toolMaintain knowledge of types of denials, documents needed for appeals and communicate with the agency if documents are needed so that they can be obtainedProvide denial/appeal examples to agency if requestedAnswer questions from customers related to review/appeal processMedaRx Charlotte, NC Oct 2015-Aug 2016Hospital Medical Billing SpecialistMedical billingClaims processingMake outbound calls to insurance companiesRead and interpret Explanation of BenefitsReview delinquent accountsIdentify and correct claims issuesDetermine if claims paid according to contractContact payer for billing discrepanciesUniversal claims, stop loss, surgery, and anesthesia, high dollar complicated claims, COB and DRG/RCC pricingCoded referrals with correct ICD-9 and CPT codes of inpatient and outpatient procedures.Registration/Billing lab feePreparing appealsWestmed (Aerotek) Charlotte, NC Feb 2015-Jun 2015Customer Service RepresentativeCentricity EMROpenscapeOnbaseRx RefillServicing 53 doctors with 11 specialtiesTaking messages in a professional mannerCommunicate with physicians, providers and patientsAnswering high number of inbound calls from patients, medical offices andPrescreening and scheduling patients for appointments using appropriate insurance guidelines, confirming appointments, triaging calls and taking messages in a professional manner.Communicate with physicians, providers and patientsAnswer questions concerning medical billing, insurance coverage, provider information etc.Aon Hewitt (Randstad) Charlotte, NC Sept 2014-Jan 2015Customer Service RepresentativeObtain client information by answering telephone calls, interviewing clients, and verifying informationEstablishes insurance policies by obtaining client information, determining eligibility, and maintaining databaseMaintaining and improving quality results by adhering to standards and guidelines, recommending improved procedures.Manage employees benefits programAssist in the annual enrollment process for active employees and retireesAssist in updating indicative data for benefit purposesTransferring or Referring client to the appropriate channel(s) when necessaryMolina Healthcare of Michigan, Troy, MI Sept 2010- Sep 2014Inquiry Dispute/Appeals Resolution CoordinatorConducts all pertinent research to evaluate, respond and close incoming Member Appeals and Hearings accurately, timely and in accordance with all established regulatory guidelines inclusive of appropriate review of claims and prior claim payment historyAttend Administrative Law Judge hearings, testifying as an expert witness; and to assist the Medical DirectorProcess Special Disenrollment For-Cause RequestsResearch, respond, and track all inquiries from outside agencies including the OFIS, MDCH, and FIA.Customer Service - Medicare and Medicaid Coordinator ProcessorPrinting, editing and preparing letters mailing to Members and their Primary Care ProviderProblem solverTaking high volume calls from members and providers a dayScheduling transportation for membersClaims processing experienceData entryApproving authorizations for outpatient surgeriesEntering monthly authorizations into Molina DatabaseClaims review and Provider Dispute or Member Appeal resolutionResponsible for data entry of patient referrals for surgeries, MRIs, CT scans, Physical Therapy, and durable |
