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Click here or scroll down to respond to this candidateCandidate's Name
Street Address * PHONE NUMBER AVAILABLE * EMAIL AVAILABLESummary of QualificationsOffering excellent analytical skills with experience in project development and implementation of paperless claim submittal environment. Specializing in office management, human resources, employee relations for primary care and occupational medicine companies. The ability to handle high levels of stress and be congenial with other employees/clients at all times.Areas of ExpertiseOver 20 years experience in medical collections of government, private insurance, third party administration and workers compensation.Particularly strong in staff development, including training, coaching, and evaluation.Highly focused and results-oriented in medical collections.Possess a sound understanding of all billing and collection practices.Exceptional work ethic, demonstrating a sense of urgency to display professional conduct at all times through appearance and behavior.Succeeded in increasing company revenue through accurate medical service billing.Created training manuals to assist with training of new and seasoned employees.Team player with great attention to detail, follow through and can quickly adapt to change.Experienced in Electronic Medical Records (EMR)EducationMergenthaler Vocational High School Baltimore,Maryland 1980-1983Southern New Hampshire University currently enrolledProfessional ExperienceCrossroads Hospice of Atlanta Tucker, GA 2014-2016Billing CoordinatorVerify insurance coverage for pending hospice patients.Complete Medicaid Communicators forms for Room and Board servicesVerify coverage for GIP patientsRegister new patients into All scripts systemCollect information for Respite/Inpatient patientsComplete Physician Certification forms for new patientsKey activity of daily activity logs for payrollAssistant in Accounts receivables for nursing homes and private pay patientsFollow up on Commercial Insurance patientsSubmit clinical notes to insurance company for authorization coverageExperience in Electronic Medical Records (EMR)Process and follow up on all Medicaid and MedicareVisiting Nurse Health System, Atlanta, GA 2011-2014Insurance Verification CoordinatorWorked account receivable reports for Medicaid accounts over $10,000Follow-up with aged billing over 120 days to receive payments from insurance carriers.Responsible for all aspects of daily office operation at this high-volume practice with aDiversified medical staff (Orthopedics, Neurology and Pain Management).Billing: Pre-certify all inpatient and outpatient medical tests) and medications.Handle HMO/PPO, Workers' Compensation, no fault, third party and private pay accounts.Duties include processing all incoming/outgoing referrals, verifying insurance information,Obtaining authorizations for all procedures, ICD-9 and CPT coding, researching and resolvingDenied claims, writing appeal letters, issuing Requests for Review, obtaining reimbursements,Referring delinquent accounts to collections, and submitting requests for hospice care and DME.Administrative: Duties include researching and providing confidential clinical data for nurses,Scheduling medical deliveries, processing laboratory and radiology tests, explaining insuranceProcedures and benefits eligibility to patients, updating account records, and special projects.Liaison between patients, doctors, and nursesProcess and follow up on all Medicare and MedicaidUnited Hospice Corporation, Norcross, GA 2007-2009Collection SpecialistWorked account receivable reports for Medicaid accounts over $10,000Follow-up with aged billing over 120 days to receive payments from insurance carriers.Assist management with end of the month goals to meet all company expectations.Electronic Medicaid billing through the GHP Web portal.Developed a training program to assist social workers to sign up patients for Medicaid.Billing, follow-up and/or collection step (s), including calling patients, insurers or employers as appropriateResponsible for all daily reconAnalyzing previous account documentation in Webmats, HIS, and other available sources, in order to determine the appropriate action (s) necessary to resolve each assigned accountWorking rejections, and other billing reports daily regarding Medicaid and Medicare billingFollow-up with responsible parties to ensure the receipt of timely, accurate paymentsEvaluates payments received for correctness and ensures that they are applied appropriatelySubmit timely, accurate invoices to payer for products and services providedTargets high dollar, over 120 days, accounts as a priorityMonitors accounts receivable, collections and billing servicesReview all remittances for under and over payments and outright denialsResponsible for payment postingProcess and follow-up on all Medicare and Medicaid.Elite Sports Medicine, Dacula, GA 2006-2007Office ManagerStrong contract negotiation skills to generate new lines of business.Make weekly bank deposits for the branch office.Implemented office policy and procedures to ensure accurate billing of all insurance carriers.Consistently excelled in complex customer issues by investigating and problem solving alltransactions.Gwinnett Resource Center, Lawrenceville, GA 2004- 2006Account Resolution RepresentativeManaged claim resolutions for all government and commercial insurance accounts.Performed electronic and paper billing process.Provided World Class Customer Service to any inbound phone calls received in reference to accounts.Collect and posted all payments to the system and made recommendations for adjustments/write off to management.Emory Clinic, Decatur, GA 2000- 2003Financial CounselorEnsured accurate verification of insurance eligibility through insurance companies.Implemented procedures for proper reimbursement of medical services.Audit and review patient accounts prior to appointment to prevent billing errors.Collect and post all payments due at the time of service.Monitored patient accounts to identify billing and collection problems utilizing reports.Credit resolutionsJohn Hopkins University, Baltimore, MD 1997-2000Collection LiaisonRecall accounts sent in error from all major collection agencies.Refer physician accounts to collection agencySupervised collection specialist to collect payments, post payments, make contractual adjustments and transfer outstanding balances to appropriate reports for follow-up.Prepare refunds for patients, insurance companies when recommended.Prepared legal actions for delinquent accountsRepresentative for collection department for court appearances.Credit resolutionsAdditional Skills & Relevant CourseworkSeminars: HIPAA Education, Infection Control, Security Management, Effective Communication & Patient Quality Improvement, ICD-10Computer Skills: MS Office Suite 2000/2003 & XP, including Word, Excel, PowerPoint, Access, Outlook, IDX and McKesson, E-Premus, Palmetto, VisionShare, EPIC, AllscriptsCoursework: Human Resources Management, Financial Management, Diversity in the Workplace, & Accounting. ICD-10 webinar |
