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Click here or scroll down to respond to this candidateCandidate's Name
Summary of Qualifications:Experience in managing accounts, which involve posting of payments, charges, collections, processing of insurance claims and appeals.Proven ability to meet deadlines and adapt to changing environment.Strong interpersonal skills-exceptional ability to communicate and obtain resolutions.Professional Experience:Greathope Psychiatry and Behavioral Health ServicesOffice Manager 2023 to 2023Responsible for leading the entire office staff, all the daily operations of the front office, Billing, and Coding functions.Ensemble Healthcare Partners (Contract) 2022 to 2023Account Receivable SpecialistResponsible for following up directly with commercial and governmental payers to resolve claim issues and secure appropriate and timely reimbursement.Examined denied and underpaid claims to determine reason for discrepancies.Communicated directly with payers to follow up on outstanding claims, filed technical appeals, resolve payment variances, and ensure timely reimbursement.Ability to identify with specific reason underpayments, denials, and cause of payment delay.Works with management to identify, trend, and address root causes of issues in the A/R.Maintains a thorough understanding of federal and state regulations, as well as payer specific requirements and taken appropriate action accordingly.Documents activity accurately including contact names, addresses, phone numbers, and other pertinent information.Axis Neuromonitoring 2018 to 2022Account Receivable/Precert SpecialistAR for United Healthcare claims.Calls to UHC on unpaid claims, submit medical records and handle patient statements and patient calls as well.Moved to the Precert department, verification of benefits for in-network and out-network, precertification/ authorizations /gap exceptions/PPO waivers for out of network provider for the intraoperative neuromonitoring.Familiar with commercial, Medicaid, Medicare, Government Plans, and Workers CompensationUS Anesthesia Partners 2017 to 2018Charge Entry Specialist:Upload Anesthesia charges when received and enter them in BOSS (Billing Operations Support System).Also work in the queues in BOSS.Work spreadsheets on open DOS that charges are not attached to.Trained the global team and other employees on BOSS and EMR.Cotiviti Healthcare 2016 to 2017Sr. Collections SpecialistCollections for UHC insurance refunds.Calls to the providers regarding the refund request or appeal denials.Updating productivity spreadsheet daily and entering notes into the system.Work with auditors and other departments on issues with accounts.Process offsets when authorization is received from provider for recoup.Help assist the UHC team collectors with questions on an account or with one of the systems.Trained the India Global team. Oversee the urgent aging spreadsheets sent from UHC.OrthoEconomics 2013 to 2015Account ManagerClinic and surgery charge entries, pulled EFTs, Patient/Insurance, and lockbox payment entries,Balanced all clinics daily, updated Excel spreadsheets daily on all clinics, Month End Close, and Year End CloseTrinity Mother Frances Health System 2011 to 2012Lead Office AssistantSupervise The Neuroscience Institute Front Office/Assist Clinic Manager.Work the Hold Report for Unpaid Claims, Audit Doctor Charges, and Enter Neurology Charges. |
