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Click here or scroll down to respond to this candidateCandidate's Name
Street Address EMAIL AVAILABLE PHONE NUMBER AVAILABLEMedical Services Professional with exceptional achievement record in securing resolutions to billing and accounts receivables issues. Strong negotiation skills. Able to sell solutions to outside parties. Noted for astute problem solving capabilities. Train staff in job skills with emphasis on developing initiative, energy, loyalty, dedication and high quality performance. Seek a position in a progressive environment where her medical, financial, negotiation and leadership skills will be maximized. Proficient in MGM, N-DAS, EnCare, EPIC, PCon, HBO Medical Pathway, MedAsset, Microsoft Office and all Medical Billing and Collection proprietary software and all script systemCORE COMPETENCIES:Prioritize work Maximize reimbursements Effective communicatorConflict resolution Staff training Research discrepanciesTeam leadership Close receivables Project managementUsa Vein ClinicA/R Medical Collections SpecialistOctober 2021 to Still PresentSubmitting Medical Claims to insurance company for paymentContracting insurance regarding claim status, and denialsOutstanding payments, authorization explain benefits to patientsContact patient regarding outstanding co -payments and deductiblesSubmit appeals and medical records timely filing for denied claimsand other documentations request to insurance company as neededReview eob and payment check benefits through navinet mass healthor any other websites prepare medical records if required. Performhigh clerical duties including copying, faxing, and filingTakes parts in chat with email communication other guidelines relatedto the company. Demonstrates knowledge of servicesProfessionalism and outstanding customer services. Handle multi-linelanguage telephone calls on daily basic research resolved outstandingclaim issus work with report management systemWORK EXPERIENCE:Healthcare Information ServiceNovember 2020-July 2021Reimbursement SpecialistSpecialist is to Analyze the billing process to determineappropriateness in payment responsible for handlingall components of claims processing including coordinationof disputed rejected and delay claims and to review returneddisputed or rejected claims from commercial medicare medicaidand w/c claims and other third party payers and problem solveResponsible for communication with all type of insurance codingprocesses to prevent future denials. Work with spreadsheet andtop priority accounts on a daily basis.Incart ShopperFebruary 2018-October 2020Buying grocery at different stores location through the city areathere are local stores that the company has partnered with anddelivering those items to the customers home. Also intercartpartnered with binnys stores as well for the customers.Wolcott, Wood, & TaylorJanuary 2018- May 2018A/R RepresentativeResolve outstanding receivables with 3rd party payors or patients.Identifies denial trends and works to correct issues or errors.Works with a high volume of claims.Work off multiple ques to manage open A/R.Resolve claim form edits, rejected claims and patient or insurance correspondence.Exhibited superior organization skills to maintain high levels of productivity.RUSH UNIVERSITY MEDICAL CENTERJune 2011-August 2017Financial Representative IManage Blue Cross/Blue Shield (BC/BS) accounts receivables to maximize reimbursements on outstanding, denied or disputed claims. Research thoroughly all documentation relevant to each case and analyze discrepancies. Prepare information for resolution. Contact BC/BS and negotiate due reimbursements. Monitor contractually agreed upon payments schedule. Create a permanent record of outcomes.Avoid lost payments through account management and fiscal analysis.Take ownership of special projects as assigned by senior management.Prepare volume, productivity and management reports.Establish collaborative working relationships with all internal departments.NORTH SHORE UNIVERSITY HEALTH CARE SYSTEMMarch 2005- June 2011Insurance Follow-up RepresentativePrepared documentation regarding follow-up and collection activities and created files in the Patient Accounting System. Monitored and reported discrepancies, errors or denials. Contacted payee to resolve unpaid accounts. Keep records current to ensure outstanding payments submitted on time. Determine all data required, recorded and available. When necessary, resubmitted claims via Ecare System. Partnered with managers and other departments to complete tasks. Utilized Epic System to make records accessible for future reference.Advised senior management of problem accounts when intervention required.Verified patient information was current and updated when necessary.In cases of denied claims appeals, forwarded all information to the appropriate department.Ensured all Federal and State billing/collections regulations were in compliance.EDUCATION:AT HOME PROFESSIONFort Collins, COStudies in Medical Claims and Billing SpecialistWILBUR WRIGHT COLLEGEChicago, ILStudies in Data ProcessingProfessional ReferencesAvailable Upon Request |
