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Click here or scroll down to respond to this candidateCandidate's Name
Previous Business Office Manager/Medical BillerLancaster, KY Street Address
EMAIL AVAILABLEPHONE NUMBER AVAILABLEI have 20 years of experience, including as a Business Office Manager, as a Medicare AR Collections Specialist, as an Authorization Specialist, as a Medical Biller, and as a Patient Accounts Associate in industries including, Accounting, Research, Management, and Related Services, Educational Services and Health Services. I was recently the Business Office Manager at a Long Term Care Facility. At that same facility I was also the HR/Assistant Business Office Manager for six weeks before being promoted to the Business Office Manager position. As HR I did the payroll for over 90 employees, I did weekly orientations where I went over policies and procedures, benefits, FLMA, and retirement. I hold a Diploma degree in General Studies from East Jessamine High School. I am authorized to work in the US for any employer.Work ExperienceBusiness Office ManagerLandmark of Lancaster - Lancaster, KYSeptember 2022 to April 2024I worked as the Business Office Manager at a nursing and rehabilitation facility. I updated the Census, posted insurance payments and resident liabilities daily to accounts, provided assistance in getting residents approved for Long Term Care Medicaid. I verified insurance for Long Term Care and therapy for all of the residents. I did withdrawals and deposits as well as balanced the residents Trust checking accounts, and handled other manager duties.Insurance Authorization SpecialistKenney Orthopedics - Nicholasville, KYOctober 2019 to August 2022I verify patients insurance participation and identified any policy exclusions of orthotics & prosthetics. I gathered documentation for medical necessity required for pre-certifications / pre-authorizations.I communicated effectively with all Kenney Orthopedic offices and staff. I obtained pre-certification / pre-authorizations and filing appeals on denied pre-certification / pre-authorizations. I promptly verify receipt of any submitted requests for pre-certifications / pre-authorizations. I communicated effectively with all payers to receive accurate patient policy information. I utilized all available payer websites to track the progress of pre-certifications pre-authorizations. I did follow up with submitted requests of pre-certifications / pre-authorizations in a timely manner and other duties as assigned.AR Follow Up RepKentucky Medical Services Foundation - Lexington, KYOctober 2016 to January 2019I worked aged and denied claims for Commercial insurances. I sent appeals and reconsiderations to tryand receive payments that were owed. I perform routine clerical duties and applied my knowledge of all of the systems used to perform my duties.ROI SpecialistMedicopy Services, Inc - Lexington, KYSeptember 2015 to March 2016I copied medical records and maintained confidentiality of all medical records information. I delivered andretrieved medical records upon request. I responded to release-of-information requests. I obtained correctauthorizations for record requests. I performed routine clerical duties. With my previous knowledge of medical terminology I was able to apply that when gathering those records by looking for request needing, certain ICD-9-CM, CPT, HCPCS codes. Because of this I exhibited strong attention to detail.Business Office RepAerotekAugust 2014 to October 2014I worked aged accounts on Medicare and Commercial insurances from a spread sheet. I workeddenied EOB's from Medicare and wrote up appeals to Medicare as well as making copies for reconsideration's and redeterminations to Medicare.Medicare AR Collections SpecialistConifer Health SolutionsMay 2013 to September 2013I worked aged accounts from a work list, a spread sheet, or an email. I followed up on zero pay accountsto find out why Medicare didn't pay whether it is due to the COB information on the CWF, non-coveredcharges, or MSP issues. I contacted the patient if they needed to update their COB information withMedicare. I corrected account issues and requested the Medicare claims to be re-billed, or bill the patientin certain situations. I placed accounts on a spreadsheet for either the medical records department, thecharge audit department, or the modifier department. I viewed the ADR list in the Medicare system toknow what information is required for payment. I worked the credit balance report and corrected Medicareadjustments so the account would have the correct balance.Patient Accounts AssociateMethodist Medical Center of Illinois - Peoria, ILJanuary 2011 to November 2012I billed medical claims using UB04 and HCFA 1500 via paper and electronic. I scanned EOB's into an electronicfiling system. I requested medical records for appeals and claims. I followed up on aged claims to preventuntimely filing. I answered patient phone calls. I also put together list of aged claims and re-filed or wrote offamounts to correct denials.CSA LiaisonMedical Reimbursements of America(MRA)May 2010 to January 2011I expedited the placement of medical claims by means of hard copy documents or system assignmentthrough an insurance plan code, financial class, and/or a vendor agency. I assisted hospital personnelwith questions about MRA activity including request or outstanding issues. I forwarded all incomingcorrespondence to MRA from attorneys and/or insurance carriers. I closed accounts in the hospitasl systemwhen remaining balances are recoded in accordance with hospital collection policies. I provided UB04's,HCFA 1500's, itemized statements, face sheets, and account notes to MRA as well as other informationneeded, i.e., medical records, EOB's, etc.Billing AssociateCentral Kentucky Radiology, LexingtonAugust 2008 to December 2009I worked denied claims for Kentucky Medicaid and all commercial insurances. I re-filed corrected claims.I faxed medical records through fax and email. I scanned medical records and attached them to thepatient's chart. I also answered patient phone calls.Billing AssociateKentucky Diabetes Endocrinology CenterSeptember 2004 to June 2008I coded HFCA 1500 claims and submitted them to the insurance companies. I posted insurance and patient payments to the patients accounts. I worked and re-filedcorrected claims. I wrote appeals and submitted with documentation for denied claims to the insurance companies. I faxed medical record requests. I received medical records and EOBs that I filed in the patients charts.EducationDiploma in General StudiesEast Jessamine High School1999Skills CLERICAL (20+ years) CPT (20 years) ICD-10 (10+ years) ICD-9 (20 years) FILE (20 years) Accounts Receivable (20 years) AR (20 years) Medical Billing (20 years) Receivables (20 years) Accounts Payable (20 years) Cash Application (20 years) Medical Records (20 years) EMR Systems (20 years) Hospital Experience (10+ years) Insurance Verification (20 years) Medical Scheduling (20 years) Medical Office Experience (20 years) Medical Receptionist (20 years) Data Entry (20+ years) Medical Terminology (20 years) Phone Etiquette (20+ years) Microsoft Outlook (20+ years) Medicare (20 years) Communication skills (20+ years) 10 key typing (20+ years) Basic math (20+ years) Time management (20+ years) Organizational skills (20+ years) HIPAA (20+ years) Customer service (20+ years) Microsoft Excel (20+ years) Microsoft Office (20+ years)Certifications and LicensesKY Driver's LicenseNovember 2021 to November 2025Additional InformationSkillsAdr, Assets Recovery, Attention To Detail, Balance, Clerical, CPT, Credit, Email, English, Fax, FileManagement, Financial, ICD-9, ICD-10, Insurance, Lotus Notes, Personnel, Policy Analysis, Programming,Spreadsheets, Telephone SkillsLanguagesEnglish |
