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Click here or scroll down to respond to this candidateCandidate's Name
EMAIL AVAILABLE or PHONE NUMBER AVAILABLEOBJECTIVETo obtain a meaningful position that allows me to utilize acquired knowledge and practical skills along with excellent people and problem-solving abilities to be of assistance to others. To continue to learn and grow both personally and professionally.PROFESSIONAL EXPERIENCEITs Fashion, Garner, NC (August 2022-Dec 2022)Asst Store ManagerAssist with recruiting, hiring, training, management, and supervision of associates in Managers absence.Supervise the sale of all retail goods and services including money drop procedures.Supervise, schedule and train staff, review performance and offer constructive feedback.Collaborate on setting and achieving team- specific goals.Receive, verify, process merchandise and vendor shipments. Display all new merchandise to maximize purchasing appeal.Ensure a pleasant shopping experience for all customers through personal interaction and resolve complaints and grievances as needed.Perform open and close procedures, perform bank deposits/drop offs.Aerotek, Morrisville, NC (Dec 2019 April 2020)Reimbursement Case Manager/Medical claims representativeServe as an expert on reimbursement issues and conduct medical and/or pharmacy benefits investigations.Work closely with the Revenue Cycle Managers and billing staff to identify and resolve any denials or authorization issues related to provider/service location credentialing.Handled billing issues and answered billing questions the patient may have. Created pickup and delivery tickets when equipment was returned to the office or a technician.picked up from a patients home. Maintain and update all credentialing systems with current information for all providers.Coordinate and maintain all credentialing documents necessary to complete credentialing and re-credentialing for all employed and contracted providers.Worked claims and claim denials to ensure maximum reimbursement for services.Other duties included data entry, answering phones, insurance verification, assisting walk in patients, scanning documents.Identify and facilitate submission of required documentation for prior authorization review.Process appeals according to program standard operating procedures.Maintain knowledge and understanding of multiple types of mayor payers including Medicare, Medicaid, VA and DoD.Maintain records in accordance with applicable standards and regulations based on program and promotion.Understand health and disease state of patients, follow program guidelines and escalate complex cases, as appropriate.Determine coverage availability and coordinate financial aspects of healthcare services to ensure patients have access to prescribed therapy.Partner with Franchise Program Manager and clients to maintain open lines of communication and awareness regarding therapy access restrictions, policy changes and other changes in the reimbursement landscape.Maintain a high level of ethical conduct regarding confidentiality and privacy.Ad hoc duties as necessaryWake Spine and Pain Specialists, Cary, NC (Aug 2018-Dec 2019)AR Billing SpecialistTimely resolution of all Medicare, Medicare Advantage & Part C Commercial Medicare account balances to ensure no accounts older than 90 days.Follow up on all insurance denials and rejected claims.Submit written and online appeals for all denied services.Medical records submission as necessary for claim appeals per insurance company or law office request.Verify insurance and obtain authorization for services to be performed.Estimate customer bills and collect payments prior to procedures being performed.Establish customer payment plans to resolve outstanding balances.Bi-monthly payment processing.PROFESSIONAL EXPERIENCE (contd)Print and mail patient statements.Answer inbound calls and online patient inquiries about account balances.Review and respond to insurance correspondence.Document actions taken on customer accounts.Work independently and as part of a team to achieve departmental goals.Intermedix/RDMG, Raleigh, NC (Feb 2009 June 2018)AR Billing SpecialistTimely resolution of A/R balances to ensure no accounts older than 90 days pending insurance.Follow-up on denied and rejected claims.Validate billed cpts, hcpcs, modifiers, drug and ndc numbers are correct.Submit online and/or paper corrected claims, identified as such.Online claim submission via Blue E, UHC, Medicare, Cigna, NC TracksResolve secondary balances to include Medicare secondary claims submission and status with secondary carrier.Contact payer to resolve unpaid, pending, or partial pay claims.Obtain medical records as needed for appeals, denials, referrals, or request for additional info.Post deductible balances and transfer patient responsibility.Review and respond to insurance correspondence as necessary.Bill missing or additional charges per clinic request.Document notes and actions taken on patient accounts.Assist new clinics with patient registration and insurance verification.Assist with training of new employees.Medical Edge Healthcare Grp/RDMG, Raleigh, NC (Jun 2006 Feb 2009)Customer Service RepresentativeResolve patient billing statement inquiries.Update account demographics, verify and update insurance information, submit claims to insuranceFollow up with insurance carriers to resolve unpaid claims.Process and apply credit card payments to patient accountsPerform account adjustments and document corrective action notesUS Oncology, Raleigh, NC (Jan 2006 Apr 2006)Patient Accounts RepresentativeProcess credit card payments and apply to patient accountsFollow up with insurance companies to resolve insurance balances on accountsUpdate patient demographics and insurance information in Mysis/Tiger billing systemFile electronic claims to insuranceProcess all returned mail statementsPROFESSIONAL EXPERIENCE (contd)Resolution of all Medicaid, Project Access, Self-Pay, Payment Plan, Indigent, Bad Debt, Bankruptcy, & Patient Estate ageing accounts for Raleigh, Durham & AshevilleSubmit weekly report using Excel to track work completed on each accountOncology Hematology West PC, Papillion, NE (2001 2005)Coordinator Payments & RefundsPatient Accounts RepresentativeBergan Mercy Hospital, Omaha, NE (1998 2001)Medical Secretary Cardiology AssociatesBellevue Family Practice (1992 1998)Medical ReceptionistEDUCATIONMetro Community College, Omaha, NE Certified Medical Terminology (1993)Nebraska College of Business (Hamilton College), Omaha, NE Certificate Computer Office Skills (1991)RELEVANT COURSEWORKCPT Coding Directives, ICD-10 Correct Medical Coding Directive, ICD-10 Diagnosis Coding for the Physician Office, Reimbursement Strategies for Medical Oncology, Medical Oncology Reimbursement Made Easy, Mastering the Basics of Medical Oncology Coding, Winning Strategies for Oncology Reimbursement, Oncology, Coding, Reimbursement and Compliance Update, Hospital Inpatient & Outpatient, Stop Burnout Stress Management for Caregivers, Principles of Medical Record DocumentationCOMPUTER SKILLSMicrosoft Office (Excel, Word, Outlook, Word Perfect), 10 key by Touch, + Medic/Mysis, Tiger Medic, Group cast/ IDX Billing system, Flowcast, Allscripts, Emdeon, Payerpath, In-Contact Phone System, Eclinical billing system, Claim Remedy clearinghouse, Chartfinder Medical records, Ring Central Call System, Max Agent, Zoom, UltiProREFERENCES AVAILABLE UPON REQUEST |
