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Click here or scroll down to respond to this candidateCandidate's Name
Allen, TX Street Address
EMAIL AVAILABLEPHONE NUMBER AVAILABLESUMMARYDedicated and Adaptable Office manager with experience in Pain Care and Neurological offices. Specialized in physician and practice credentialing, insurance precertification and verification and billing while still being a capable Medical Assistant to the physicians and training team members in all roles, whether clinical or office roles. Maintaining positive relationships with Drug Representatives, Medical Facilities, Physicians offices, Technology and Office Vendors and Insurance Companies.WORK EXPERIENCERegional Pain Care Center, Allen, Texas 07/2013 Present(Office closing 7/31/2024)Office ManagerManager of a Pain Care clinical office supporting three doctors and their clients. Work closely with the associated Pain Care of North Texas (PCNT) outpatient surgical center and other hospitals that the doctors are on staff at. Builds positive relations with clients and other medical offices to build referrals and future growth of the practice.Manage, Hire, and train all clinical and non-clinical staff including managing meetings, personnel reviews, discipline, improvement plans and HIPPA compliancy.Maintain credentialing for the physicians at the Practice, PCNT and multiple hospitals for insurance purposes.Verification of Insurance benefits for surgical procedures, office visits and in-office procedures, radiology procedures, medications and all other required.Precertification of surgical procedures, radiology, medications, and all other procedures, including medical necessity reviews with insurance companies for precertification.Extensive knowledge of ICD-10 codes for Insurance billing and perquisites for billing procedures and making sure physicians are aware for their treatment planning.Manage billing for office visits and procedures, Opioid education, psychological, surgical procedures at PCNT and the physicians portion at outside ambulatory surgical centers and Methodist McKinney Hospital.Work with Insurance claims that have been denied and recover outstanding payments.Posting EFTs for Regional Pain Care and Pain Care of North Texas.Administrator on all accounts used in the office, including but not limited to insurance websites, EMR and billing EDI.Work with patients so they can understand insurance coverage, address complaints and for collection accounts and recovering outstanding debts.Schedule new and existing patients, in-office procedures, surgical procedures, and radiology procedures and all other required.Maintain medical and billing records so that they are available for patients, physicians, audits, insurance companies and other authorized parties.Created and maintain patient paperwork and forms used in the office.Saved the company thousands by analyzing use of office systems and supplies and finding inexpensive alternatives or negotiating new contracts.Able to work in all positions of the office, work remotely in home office or even on the go.iHeart Centers, Richardson, Texas 07/2012 07/2013Intake SpecialistIntake specialist for Centralized billing, scheduling, transportation, and insurance verification for iHeart cardio and vascular procedures. Created policies and procedures for billing, scheduling, transportation and insurance verification. Worked closely with referring physicians to help create positive relationships for the retention of their business and promote new business. Worked with other groups within the Vannevar Group to help facilitate their work to create a dynamic environment.Centralized billing to make it more robust while requiring fewer resources at each facility.Part of the oversight team for implementation of eCW EMR and created templates for use.Managed and trained new employees on billing and scheduling of patients in eCW.Corrected billing and recovered payments for physician practice that was purchased by Vannevar Group.Managed billing for all iHeart sites, billing and scheduling documentation for the associated physicians, including billed radiological reads through Cortex EMR.Managed physician certification for Medicare.Managed verification of benefits for all office visits, radiological and surgical procedures.Managed insurance data for billers and insurance verifiers and negotiated claims with Multiplan.Managed ABI screenings, scheduling and reading from the physicians.Managed records for scheduling of ABIs to SNF facilities and Senior Centers.Touchstone Imaging, Garland, Texas 05/2010 07/2012Insurance SpecialistResponsible for verifying insurance and obtaining authorizations for two imaging facilities. Manage all incoming and outgoing correspondence with patients, their insurance companies and medical billing offices. Provided information to insurance companies include demographics, medical history information and medical necessity letters to obtain authorization for procedures.Scheduled, maintained, and assisted in all aspects of medical records, scheduling, billing and assisting customers with concerns and problems.Verification of benefits for patients and referring physicians.Obtain authorizations from insurance companies, worker comp insurances and Letter of Protection cases.Maintained constant contact between different insurance verifiers to make sure all aspects of training are correct and completed.Inform patients of their benefits and estimated out of pocket.CERTIFICATIONSCertified Medical AssistantHIPPA Compliance CertificateNotaryMEDICAL PROFICIENCIESICD 10 CodingBillingApplications: Availity UMR UHC Tricare Humana Cigna AIM Evicore Golden Rule HS Connect Meritain/Quantum Enformed/Entrust Cohere Health Web TPA 90 Degree Benefits OrthoNet HealthSprings RadMD NIA Ebms Texas Prescription Program NPI Registry PPN Dr. ProveIT SN Charts Smart MD Leading Reach Vault into HealthEMR: Practice Fusion, Lytec,EDUCATIONCertified Medical Assistant PCI, Dallas, TexasPrevious experience available upon request. |
