| | | 20,000+ Fresh Resumes Monthly | |
|
|
| |
Click here or scroll down to respond to this candidateCandidate's Name
Mesa, AZ Street Address
PHONE NUMBER AVAILABLEEMAIL AVAILABLECAREER PROFILEA professional with extensive customer service experience in the healthcare industry SKILLS SUMMARYFive plus years of Customer Service, Scheduling, Computer Literate, Organizational Skills, Patient Financial Service / Collections, Ability to Upsell Products and Services, Insurance/ Claims,Knowledge in Medical Terminology, and ICD-10 medical billing codes. Navigate between multiple screens.PROFESSIONAL EXPERIENCERose International / LifeWorks Chestereld, MOBenets Specialist /Contractor Nov 2022 - CurrentI work 100% remote. Guiding the members / clients through the process of selecting the right benets programs for the members needs. Process open enrollments benets, for Active Retirees, Retired Seniors,and Survivors For the State of Illinois, Medicare Advantage MAPD PPO Plan. Explaining benets packages to clients and discuss benets options with new employees. Enrolling members in optional life and health supplemental benets productsResolve customer inquiries and complaintsSatellite Healthcare Mesa, AZA/R Collector July 2022 -Aug 2022 Investigated EOB s and RAs for reimbursement based on the contract agreements. Claims system; NextGen.Health Advocate Mesa, AZContractor Medical Collector May 2022 Followed-up with payers and reimbursements per the hospital contract or Medicare rates; veried patient health benets by accessing the hospital benets portal link. Claim system; AthenaLHH Mesa, AZ Contractor Medical Collector Feb - March 2022Followed-up with payers and reimbursements per the hospital contract or Medicare rates; veried patient health benets by accessing the hospital benets portal links.Claim system; AthenaBanner Corporation Mesa, AZPatient Accounts Representative / Collections Jan 2020 -Nov 2021 Worked remote and processed claims in the Nthrive work queue claims processing system including non-participating providers, handled hospital reimbursements/EOBs denial codes. Followed-up with payers and reimbursements per the hospital contract or Medicare rates; veried patient health benets by accessing the hospital benets portal links. Referred accounts to other departments; followed-up with a patient about Coordination of Benets based on payer denial code reason.Eisenhower Medical Center Rancho Mirage,CAPatient Account Representative Jan 2006 - Oct2018 Investigated EOB s and RAs for reimbursement based on the contract agreements. Followed-up Inpatient UB04 and CMS 1500,and Medi-cal retro-authorization and veried and requested hospital authorization from the insurance. Re-billed claims electronically based on invalid information; verify commercial claims, Medi-cal, and Medicare claims through hospital portal. Handled inbound/outbound calls and resolved patient complaints/insurance disputes. Processed nancial assistance programs applications for uninsured patients and processed accounts pending bankruptcy such as chapter 7,11, and 13. Worked in Patient Access, veried insurance benets, using an automated veried an automated verication portal, insurance carrier website, and by phone, notied patient / guarantor of their out of pocket based on the patient policy/requests payments PaciCare Health System Cypress, CASenior Claims Examiner June - 1995 - Apr2004 Handle payers commercial and private Handle emergency, outpatient, and hospital claim are eligible for reimbursement Conducted Investigations based on the member policies; ensured legal compliance were met. Assembled additional information as required from outside sources, calculating benets to ensure expected service reimbursement is issued and updating EOBs letters. EDUCATION Kaplan Financial- AZ State Health Insurance License, 2021 CMS world of Medicare Certication, 2018 Epic Claims Revenue Cycle Certication, 2017 College of the Desert, CA Child Care Licenses. Licenses (2003-2005) |
