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Phone: PHONE NUMBER AVAILABLE E-mail: EMAIL AVAILABLEPROFESSIONAL SKILLS SUMMARY:Medical Claims ProcessingThird Party BillingMedicare Insurance BillingPayments PostingMedical AdministrativeAccounts ReceivableMedical CollectionsInsurance VerificationCharge EntriesAccounts ReconciliationWorkers Compensation Claims ProcessingCPT CodingPowerPointIDX- (Johns Hopkins University Software)Microsoft ExcelAS400ICD-10 CodingCommercial Insurance BillingTricare Insurance BillingMedical Claims Follow-UpEpic (Johns Hopkins University Software)Microsoft WordKeane SoftwareVision Share/CMS) MicrosoftCARES- (MD State Software) MMIS- (MD State Software)EPRMicrosoft ExcelMedical CollectionsData entryAvaility Claims Verification (Johns Hopkins University)MABS- (MD State Software)SHARE- (MD State Software)SVES- (MD State Software)EVSPARIS- (MD State Software)Medicaid BillingAccessCerner Billing SoftwareMedical BillingElectronic Health RecordGE Centricity (Johns Hopkins University Software)CPR-Medical Billing/Collection SoftwareZimax Verification SoftwareWaystar Billing SoftwarePatients Authorizations ProcessAnatomy & PhysiologyPROFESSIONAL EXPERIENCE:Nations Home Infusion & Nations Healthcare LLCMedical Reimbursement Specialist/Medical Collections Representative 02/2022-02/2023Processed aged receivable accounts, by utilizing the A/R reports and other supporting documentation to complete the billing process.Reviewed and assessed adjudicated claims for timely process in order to received proper payment for outstanding balancesResearched, corrected and resubmitted unpaid claims for processing to complete the billing process.Submitted adjustment form, charge correction forms, and payment request daily as necessary when needed.Verified and validity for account balances by researching, reviewing and ensuring accuracy of charges.Performed payments posting and payment adjustments to ensure account balances are correctly applied to the patient account.Reviewed and interpret Explanation of Benefits (EOB) for denials and underpayment of codesResearched and resolved denials and underpayments with insurance carriers.Communicate with insurance companies, healthcare providers, and patients regarding billing inquiries or disputes.Confirmed insurance eligibility to insurance carriers for policies referrals and authorization is needed for claim adjudication.Resolved account discrepancies and prepared adjustments and refunds for approvals as necessary.Submitted carrier appeals and documentations for reconsideration request in a timely manner.Identified and submitted the required insurance refund request to the specialist according to policy and procedure.Met productivity goals/benchmarks as set and communicated Department leadershipServed as a customer service representative for patient inquiries and phone calls.Follow up and collect on unpaid and denied claims to resolve any billing discrepancies.Maintained and updated confidentiality for patient information to protect and secure vital information.Performed collaboratively with other departments and coworkers as needed to complete the billing process.Attended quarterly monthly meetings with respective payers for new policies and regulations.Verified claims status for dates of services from the insurance carriers websites.Negotiates with clients repayment terms on past due accountsMakes decisions, documented on referring accounts for collection or writing off.Confirmed credit balances and gathers necessary documentations for processing refunds.Prepared delinquent accounts to transfer to self-pay when no active insurance was available for dates that were rendered.Life Bridge Healthcare/PDI 02/2019-09/2019 & 05/2018-07/2018-Recovery Specialist I (Temp)(Medicaid & Medicare Department)Analyzed accounts using EMT software to ensure that all outstanding account balances are resolved in a timely manner. Maintained the highest levels of accuracy and patient confidentiality by applying HIPPA regulations and rules.Quickly identified and resolved medical billing issues and insurance discrepancies in order to complete the billing process. Retrieved and submitted EOB along with secondary insurance or tertiary insurance for the outstanding balance. Developed and maintained an automated Excel spreadsheet for billing purposes.Followed up on denial and rejected claims to resolve accounts and maximize reimbursement for billing purposes.Escalated problem accounts to supervisor to be reviewed for special attention to resolve billing issues.Determined why the claims were denied or underpaid and requested claims adjudication corrections.Provided supporting documentation or referred payers to reimbursement agreements for resolution of non-payment.Prepared monthly billing reports by summarizing billing productivity based on financial class to complete the billing process.Escalated significant problem accounts for further action based upon factors such as unsuccessful collection efforts or age of accounts.Submitted and documented W-9 forms to the various insurance companies for correct billing address information.Identify key issues and take appropriate follow-up actions to resolve billing matters and ensure proper payments.Follow up and document all third-party insurance and self-pay accounts in order to complete the billing process.Prepared, reviewed, and transmitted claims using billing software, including electronic and paper claim processing. Using A/R follow-up systems and reports to identify unpaid claims for collection/appeal.Gathers and verifies all information required to produce a clean claim including special billing procedures that may be defined by a payer or contract.Review and update patient registration information (demographic and insurance) as needed.Resolved claim edits as needed to apply appropriate discounts and courtesies based on department policy.Prepared delinquent accounts for transfer to self-pay collection unit according to the follow-up matrix.Printed and submitted claim forms and statements according to the follow-up matrix to complete the billing process..Retrieves supporting documents (medical reports, authorizations, etc.) as needed and submits to third-party payers.Appeals rejected the claim with documentation in order to complete the billing process.Confirmed credit balances and gathered necessary documentation for processing refunds.Identifies insurance issues of primary vs. secondary insurance, coordination of benefits eligibility and any other issue causing non-payment of claims.Contact the payors or patient as appropriate for corrective action to resolve the issue and receive payment of claims.Monitor invoice activity until the problem is resolved.Process daily mail, edits reports, file or pull EOB batches.Identifies and escalates non-standard appeals to a higher-level specialist.Performed claims processing in order to receive outstanding payments from an Excel spreadsheet.Adjudicated 1500 claims daily into the computer database to complete the billing process.Identified and billed secondary or tertiary insurance timely per operational standards and company policies and regulations.Verified insurance eligibility and updated both in GE Centricity and Cerner computerized software system to complete the billing process.Confirmed and verified the patients account balances to make sure the correct third-party payer is properly addressed.Maryland Department of Health and Mental Hygiene 11/2017-01/2018Medicaid Eligibility DepartmentEligibility Determination Specialist (Temp)Provided Medicaid eligibility determination services for the Medicaid population under the services and direction of the Department of Health Mental Hygiene Division.Received and processed documents, and applications from Medicaid members in order to complete the Medicaid process.Prepared monthly billing reports by summarizing billing productivity based on financial class to complete the billing process.Reviewed, determined, and updated demographic information in the computer system in order to complete the Medicaid process for eligibility. Requested verifications, citizenships, and identities from Medicaid members and dependents for Medicaid process and determination.Interacted with the supervisor, case management, and other departmental teams to complete the Medicaid Eligibility application process for yearly coverage.Utilized the various Maryland State Medicaid software in order to complete the application process for medical coverage.Determined eligibility for Medicaid coverage by investigating searches for incomplete documents and incomplete application data.Provided and submitted insurance enrollment information to ensure cases were completed in a timely fashion.Maintained effective working relationships with management to ensure anomalies were brought to resolution and completion.Developed and maintained an automated Excel spreadsheet for demographic and billing information.Adjudicated 50-100 applications daily into the computer database to complete the billing process.Prepared, reviewed, and transmitted claims using billing software, including electronic and paper claim processing.Johns Hopkins Medicine Clinical Associates: Physicians Billing Department 12/2015-09/2016Insurance Resolution Specialist (Temp)Resolved insurance errors while maintaining productivity and quality standards in a professional manner.Accurately and comprehensively documents activities and results in the billing system and applies the correct error classification code.Updated patient registrations that are made on account level and have an impact on all claims regardless of the location where the claim is generated.Accuracy and subject matter expertise are critical to preserving the integrity of the revenue cycle across JHM as patient records are updated.Developed and maintained automated Excel spreadsheets and computerized systems, for reconciling documents.Submitted patient's confidential information to complete medical coverages for the patient and dependent to complete the billing process.Retrieved and submitted Explanation of Benefits (E.O.B) documentation in order to complete the billing process.Performed follow-up and collections on outstanding claims balance for dates of services that was rendered.Adjudicated and submitted 50-100 claims daily into the computer database to complete the billing process.Used relevant functions of GE and software patient-centric computer systems proficiently.Developed and maintained an automated Excel spreadsheet for demographic and billing information.Verified, eligibility and benefits verification for treatments, hospitalizations, and procedures.Reviewed patient bills for accuracy and completeness and obtain any missing information.Processed, scanned and documented correspondences to complete the billing process.Prepared, reviewed, and transmitted claims using billing software, including electronic and paper claim processing.Maryland Health Connection Inc. 11/2014 6/2015Customer Service Representative (Temp) Developed and maintained an automated Excel spreadsheet for demographic and billing information.Accurately resolve simple and complex billing issues with the ability to understand and follow Maryland State insurance policies, procedures, and work rules.Performed and educated using customer services skills to enhance knowledge to members and the public.Identified key issues and took appropriate follow-up action to resolve billing issues and ensure proper payment is received for dates of services.Obtained relevant information to respond to difficult patients and addressed inquiries to resolve complex issues.Appropriately utilize various websites to verify customers eligibility and resolve customers accounts.Proficiency in the process of documentation on customers accounts and follow-up on accounts to resolve issues. Answer calls daily from customers and providers seeking assistance with navigating the Medicaid system and tracking the disposition of the calls using a customer relationship management (CRM) system based on unit policies and procedures.Received 50-150 inbound calls per day from clients regarding services provided by the faculties.Utilized the various Maryland State software in order to complete the application process for medical coverage.Maintains a regulatory/compliance environment by following organizational policies and procedures to ensure compliance with state, local, and federal standards and regulations.Interacted with customers to provided and process information in response to concerns, requests, and inquiries about servicesHealthcare Access Maryland Inc. 11/2005 11/2013Clerical Support RepresentativeProcessed 50-100 MD Medical Assistance applications daily into the computer database.Researched and reviewed medical eligibility policies and regulations to verify that the information is accurate.Applied the appropriate procedures to establish eligibility information in the MD State database (Cares/MMIS).Conducted and organized Healthcare events to educate the public about the various services and programs.Prepared monthly billing reports by summarizing billing productivity based on financial class to complete the billing process.Performed insurance verification on patients information for dates of services and knowledge of the Affordable Care Act program.Expert knowledge of the policies and procedures related to the determination of eligibility for the State Medicaid Program.Provided customer services to various agencies regarding issues related to Medical Assistance eligibility.Resolved discrepancies that prevent recipients from receiving Medical Assistance benefits in a timely fashion.Transmitted and submitted patient's confidential information to insurance carries complete medical coverages for the patient and dependentsInvestigated and researched denied cases on Excel Daily Log sheet report for Medical Assistance completion.Provided a monthly statistical report to the Eligibility Director and Supervisors for the monthly update.Utilized technical skills to navigate and updated data to establish eligibility to obtain missing verifications.Updated and maintained Excel monthly log sheet for department informational data and coverages.Interment policies, procedures, and regulations using the Cares and MMIS software when interacting with my customers that were applying for Medical Assistance benefits.Using MS Word software when formatting and composing letters to clients about their medical coverageEducated and informed the public about nutrition and healthy choices to maintain a healthy lifestyle Directed and referred potential applicants to the various programs that are offered in the state of Maryland and the surrounding counties.EDUCATION:Northwestern Sr. High School 1979 Diploma/GEDCommunity College of Baltimore County 2023 Certificate Awarded Microsoft Word Program- Advanced & IntermediateCommunity College of Baltimore County 2023 Certificate Awarded Excel Program- Advanced & IntermediateBaltimore Community College of Baltimore 2017 Certificate Awarded-Medical TerminologyBrightwood College 2016 Certificate Awarded- Medical Billing & CodingCenters for Medicare & Medicaid Services 2016 Certificate Awarded- ICD 10 CodingCenters for Medicare & Medicaid Services 2016 Certificates Awarded- Medicare Billing A &Medicare Billing BHealthcare Access Maryland Inc. 2012 Certificate HIPPA TrainingEssex Community College 1997 Certificate Awarded Advanced Medical BillingJohn Hopkins University 2003 Certificate Awarded EPR TrainingHonors & AwardsHealthcare Access MD 2008 Letter of Appreciation Awarded Governor Martin OMalleyJohn Hopkins Hospital 2001 Certificate of Appreciation Awarded Patients Accounting Dept. |
