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Click here or scroll down to respond to this candidateCandidate's Name
Shelby Township, MI Street Address
Mobile PHONE NUMBER AVAILABLEEmail: EMAIL AVAILABLEObjectiveTo secure a position that utilizes my outstanding knowledge of claims and give me the ability to develop and learn different experiences that will help me perform various responsibilities within the company.Supervision/TrainingOffice ProceduresMedicare/ Medicaid CoordinationCollections/BillingCPT -4 CodingScheduling AppointmentsExcellent typing skillsWord & ExcelMedical BillingOrganizational SkillsMed D CertifiedInventoryHCPCS CodingOperate Office Equipment10 KeyICD-9 Coding/UB04 knowledgeExcellent Customer ServiceAnderson Medical Supply Auburn Hills, MIBilling Specialist 07/2021 - PresentPosting of payments for Auto/work comp claimsSubmitting over purchase order extension request to third party administrators for the patients to continue with usage of Icct units for a total of 90 days.Contact and verify with patient that they are still using the Icct unit if denied by insurance companyWork missing Rx report for continued usage of Icct unit if patient is still using unit after 90 days.Work pending re-auth report, /submitting over new purchase order by emailsWorking A/R monthly billing report, denials, sending out missing claims if none was received, sending appeals on denied claims, negotiation letters, write-offs and submitting over subrogation letters.Centene Corporation (Healthcare Support Staffing) Tempe, AZGrievance & Appeal Coordinator 12/2019-05/2021Researching and investigating complaints and appeal requests.Enters denials and requests for appeal into information. System and prepares documentation for further reviewLogging and tracking information into excel spreadsheet.Researching and closing out appeal requests with decisions to uphold or overturn appeals.Obtaining Medical records as needed.Collaborating and communicating with providers.Researching and analyzing claims relative to appeal.Generating formal resolution letters and sending them via mail or fax.Assures timeliness and appropriateness of appeals according to state and federal Medicaid guidelines.McKesson(Rem X Staffing), Scottsdale, AZCase Manager 09/2019-12/2019Inbound calls from provider/patients regarding applying for program to receive help with high-cost medicationsOutbound calls to patients regarding approval of applicationGathering and reviewing patients medical information to determine if patient's diagnosis qualifies and products required are covered for program (ASNF)Processing applications for uninsured, Medicare patientGaining authorizations for servicesfaxing and mailing out applications for enrollment of programConsumer Cellular (Aerotek Staffing) Tempe, AZCustomer Service Advocate 03/2019-07/2019Communicates effectively with management and peers.Inbound/outbound callsAssisted customers with purchasing new phones and accessories.Upsell on phonesAssist customers with correcting issues with phone and technical support questionsTriwest HealthCare - Phoenix, AzMedical Clerk Review/ Telecommute 12/2015-12/14/2018Perform and conduct all workload in Care Radius and Facets systems.Conducts retrospective review of medical/surgical claims and behavioral health claims for inpatient and outpatient services.Conducts medical documentation review and audits to determine appropriateness of coding of serviceApplies clinical, coding and processing knowledge to conduct review and process claims.Compiles information necessary to prepare cases program payment.Attached authorizations to patient documentation.Provides clinical and coding-related information to medical director, providers, peer reviewers, Claims Administration, Program Integrity, Quality Management and the claims subcontractor as neededAdvises clinical and non-clinical staff on claims and coding questionsThorough knowledge of policies and procedures, Managed Care concepts and medical terminology. Proficient with claim and coding tools such as Find-a-Code. Familiar with UB04 and 1500 forms for processing claims.Performs special projects as assigned, attaching correct authorizations to medical docsPhoenix Health Plan-Phoenix, AZMember Service Representative 11/2013- 5/2015Able to deal effectively with customers on a one-on-one basis and demonstrate appropriate customer care skills such as empathy, active listening, courtesy, politeness, helpfulness and other skills as identified.Interact with customers (internal and external) by understanding inquiry and providing accurate and timely responses about benefits, authorizations, services and claims. Knowledge of (AHCCCS)Gather information, research, resolve inquiry and record in customers account/health plan database system. Communicate appropriate options for resolution in a timely manner and escalate inquires to appropriate staff as required.Reviewed and approved payment and denials to the doctor office. Handled high volume of inbound and outbound calls, Verification of insurance and authorizations. Knowledge of UB04 and 1500 claim forms.Accurately and efficiently processes assigned outbound calls to members that include outreach to members regarding health services and appointments. Track and monitor inbound & outbound calls for regulatory compliance.Identify, record and refer and member grievances/complaints according to internal and regulatory guidelines. Identify potential member appeals and provide appropriate instructions and guidance to the caller.Maintain working knowledge in all lines of business and adhere to production standards that includes service availability, calls returned to the queue, use of scripts and agent complaints.Uses, protects and discloses member's protected health information (PHI) in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.EducationRio Salado Community College- Tempe, AZ, 08/2012-08/2013 Life Education- Non-gradDetroit Business Institute- Southfield, Mi-08/2001-06/2002 Medical Billing- CertificateFerris State University - Big Rapids Mi, -08/1994-05/1995 English-Non-gradHighland Park High School- Highland Park, Mi - -08/1990-06/1994 Diploma |
