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Click here or scroll down to respond to this candidateCandidate's Name
Street Address Cloughmore CourtPflugerville, TX Street Address
PHONE NUMBER AVAILABLEE-mail EMAIL AVAILABLEOptumStreet Address , National Revenue Service Center Tampa, Florida Business Analyst 6/2017- 6/2022 Identify outstanding A/R leading to the reduction of Patient Bad Debt Trending by client and EMR system Run Quest Billing System Screen Scrapes and Scripts Identify Client requisition issues Analyze Bad Debt detail reports Work closely with Business Account Service Specialist team to education clients on missing or inaccurate patient insurance data Analyze Data and develop creative solutions to resolve outstanding debt Produce charts and graphs to show revenue variances for analysis A/R Tracking and ComparisonQuest Diagnostics, National Revenue Service Center Tampa, Florida Senior Billing Supervisor 9/2014- 6/2017 Carry out supervisory responsibilities in accordance with the Company policies and applicable state and federal laws. Coordinate and evaluation all Customer Service Representatives to ensure prompt, courteous and accurate information is given. Ensure the volume of work produced meets performance standards and exceeds quality standards. Prepare and deliver employee statistics, including 1-1 coaching sessions. Constantly promotes high morale, positive attitudes, and professional approach to provide pleasant and accurate responses to all our customers. Conduct Interviews for Internal and External candidate Personnel development; planning and team building Blue Cross Blue Shield of GeorgiaEnrollment & Billing Specialist 3/2005-2009 Extensive knowledge of Managed Care including Medicare and Medicaid, Cobra, Point of Service, PPO and HMO products. Provide customer friendly service by educating customers with enrollment, insurance benefits, products, claims, and billing information Provide support for open enrollment and explain coverage terms. Process Cobra applications/reinstatement of members or groups accounts. Process and verify Facility and Professional claims for reimbursement. Review and post premium payments, adjustments and account status. Analyze, reconcile billing issues of Facility, Professional, group and members claims. Process all refunds/write offs with appropriate documentation. Handle Third party vendors or self-billed groups monthly refunds. Accomplished daily enrollment/disenrollment operations Resolve discrepancies with member enrollment status data. Review daily/monthly CMS Transaction Reply Reports. Blue Cross Blue Shield of GeorgiaCustomer Service Representative Extensive knowledge of Managed Care including Medicare and Medicaid, Cobra, Point of Service, PPO and HMO products. Act as a Liaison for healthcare providers and HMO product by supplying information regarding billing matters, credentialing or new providers and affiliates, experience in utilization management skills. Process and verify Facility and Professional claims for reimbursement. Responds to escalated group representative, agents and brokers inquiries. Provide customer friendly service by educating customers with enrollment, benefits, products, claims and billing information. Work directly with physicians, medical staff, and account managers regarding group account.Functional/Technical SkillsDetailed knowledge of Insurance Websites, NaviNet, Optimaxx Web, Instamed, Flint, CSR Web, People Soft Self Service, HCFA Database, Qcare, QBS, QLS and WBS Billing System, SQL, Callista, Cobra Travis System, Microsoft Office, Web Cobra, Deltanet, Snapp EducationUniversity of Phoenix 08/2010 graduateBachelor of Science Degree in Healthcare Management |
