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Click here or scroll down to respond to this candidate1409 Enclave CircleNashville, TN Street Address
PHONE NUMBER AVAILABLEEMAIL AVAILABLECandidate's Name
SummaryIntelligent, consistent, responsible, and well-focused individualWorking toward expanding knowledge in a stable and progressive environment.Willing to learn different tasks to broaden knowledge.ExperienceState of Tennessee TenncareManaged Care Specialist IIIMarch 2021-February 2023Reviewed cases for Medicare coverage for single families depending on family size and income and also for individuals that were over the age of 65. Ran eligibility to make sure if they were eligible for Medicare or denied.Woodbine Health DepartmentFront Desk ClerkJune 2020-March 2021Checked in patients at the front desk. Verified insurance and updated demographics if needed. If patients did not have health insurance verified income and placed them on a sliding scale to pay forservices rendered on that day and any other outstanding balances.Centerstone Behavioral HealthClient Accounts ReceivableMarch 2019-May2020Worked on clients with Americhoice Medicaid Insurance. Worked on differentspreadsheets. Denials, On Account Balances, Unmatched, Refunds foroverpayments to the insurance company.Vanderbilt University Medical CenterDenials SpecialistMarch 2018-February 2019Worked backlog denials from various payers/system issues due to Epic go-livefor CMS-1500 claim follow up. Following up with commercial, Medicare,and Medicaid insurances. Working appeals, denials, and adjustments. Requestedmodifiers to be added where needed for reimbursement. Calling payers to check ondenial status. Working online payers to check on websites and manual payer forms.Completed tasks for redeterminations and reviewing of claims.Jackson Clinic PAPatient Representative/Insurance Claims ProcessorMay 2014-March 2018Patient RepresentativeAnswered patient calls about account balances,took personal payments overthe phone. Worked accounts that needed to be reported to collections. Updateddemographics. Sent letters to patients if the account was 60, 90, or 120 dayslate. Once promoted to Insurance Claims Processor description of duties are as followsInsurance Claims ProcessorWork patients accounts that have United Healthcare, Tricare, United MedicalResources, and Humana Insurances. Worked claims for with timely filing, ifadditional information was needed from the patient or provider. Also correct claims addmodifier, changed diagnosis after review of the doctors dictation to get claims reprocessed and or paid.Terrace Pediatric GroupMedical BillerOctober 2004-May 2014Post private payments to personal balances, post insurance payments toclaims, also ten key upon other medical computer skills.Work collections for patients 60-120 days delinquent on accounts.Work insurance claim rejections, denials, and call insurance companies toinvestigate reasons for denials and refile claims if needed.Receptionist duties, included working front desk, check in patients, verifyinsurance, schedule appointments, and multiple phone tasks. HIPPA knowledge.EducationInternship Matthew Walker Comprehensive Clinic 2004Nashville, TennesseeDraughons Jr CollegeAssociate Degree Health Information TechnologyConcentration : Medical Billing and CodingNashville, TennesseeConcentration on Professional Communications, and Medical Software Operations.Medical Computer literate, Microsoft Word and Works, Microsoft Office, ICD-10,ICD-9, all CPT coding. Medicare Part A and B, Private Insurance Claims, PatientAccounts, Patient Collections, 10 Key. Medically organized and of solid workethics.Reference Upon RequestInterests Caring for other individuals and helping others with hand on experience. Andto learn from others or teach others different skills within the medical or generalfields.Medical Software CredentialsAcardiaAprimaAthena HealthAllScriptsEpiceClinicalWorksNexGen HealthcareCernerEpicCare EMROptumKIPO |
