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Click here or scroll down to respond to this candidateCandidate's Name
Claims AnalysisCincinnati, OH PHONE NUMBER AVAILABLE EMAIL AVAILABLEObjectiveTo obtain a challenging position in a dynamic and innovative organization where I can use my claims processing and analyzing skills.ExperienceMercy Health Safety Companion 2017-presentSitting with patients whom are suicidal or homicidal to ensure their safety.Mercy Health Claim Audit Specialist 2015-2017Entered in Request and Claim information for Auditing with Commercial and Defense Audit.Researched information in PA systems Artiva, Data Ark, AS400, to complete a request.Entered Audit dates for defense audit and high dollar charge audits.Prepared the invoices and itemized statements that have to be sent for the high dollar charge audits.Worked closely with the Director.Scanned in and prepared high dollar charts for Nurses to audit.Entered in 50 or more accounts for Commercial Audits.Researched and double checked all work is correct in MAC and RAC.Mercy Health Front Office Specialist 2014-2015Scheduled and registered at least 60 appointments with patients face to face and on the phone daily.Collected copays in the forms of cash, check, and credit card utilizing Rev-springs online payments.Pulled, filed, and prepared patients charts daily.Answered up to 3 telephone lines daily.Clerical Duties such as mailing, faxing, printing, copying, making folders for patients.Scanned in patient's insurance card, photo Id's, medical records.Made bank deposits for end of the day deposits.Accessed Availity and Epic to confirm patient's insurance eligibility.Contacted Insurance companies to confirm patient's benefits for therapy.Peer interviewed possible candidates for various positions.Mercy Health Unit Secretary 2012-2014Scheduled walk in appointments for radiology such as Xray's LabsFiled, faxed, made copies..Answered multiple telephone lines..Printed out Films/medical records for patients and providers for different radiology procedures.Mercy Health Advanced Scheduler 2010-2014Scheduled and pre-registered appointments with patients and provider offices.Researched ICD-9 and diagnosis codes for medical necessity.Verified insurance, and authorizations.Interaction with Hospital departments and personnel, including Cardiology, Vascular, Special Procedures/Cath Lab, and RadiologyCincinnati Eye Institute-Trak Group AR Follow up Specialist (temporary assignment) 2022-2023Researched, processed, appealed denied claims for Medicare, Medicaid, workers compensation, skilled nursing facilities, Anthem, Humana, All government not just including correction facilities, VA, Tricare for life, VACCN for all markets in Cincinnati and Virginia MarketsWorked in Nextgen systemKelly Services Claims Processor (temporary assignment) 2021-2022Researched, processed, appealed denied claims for Medicare, Medicaid, workers compensation, skilled nursing facilities, Anthem, Humana, All government not just including correction facilities, VA, Tricare for life, VACCN for all markets in Cincinnati and Virginia MarketsWorked in Nextgen systemCouncil on Aging Care Coordination Specialist 2018-2021Team educatorTrained over 3 new employeesRetrieved over 50 calls per day to assist with transportation request.
Processed suspended clams
Processed HME, DME, HOME MODIFICATIONS
Emailed, Faxed, and made calls to providers and clients to follow up on servicesSent out Referrals for personal care services, transportation, home delivered meals, emergency response systems, transportation, adult day services, chore servicesWorked closely with care managers to assure clients needs were being metEducationCertificate in State Tested Nursing AssistantCincinnati State Community and Technical College - Cincinnati, OH 2012Associate of Arts degreeCincinnati State Community and Technical College - Cincinnati, OH 2006Skills & abilitiesCustomer Service Clerical Experience Medical Terminology Medical Office Experience Insurance Verification ICD-9 Managed Care Microsoft Excel Microsoft Word Epic AS400 Microsoft Power point Data collection Microsoft Office Medical billing ICD-10 Microsoft Outlook Medical Records Auditing Medical Scheduling Document management systems Communication skills Documentation review Medical records Workers' compensation law Medical terminology ICD-9 ICD-10 Cash handling Epic HIPAA EMR systems Analysis skills Revenue Cycle |
