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Click here or scroll down to respond to this candidateCandidate's Name
Street Address E Lupon RdSt Hedwig, TX Street Address
Phone: PHONE NUMBER AVAILABLEEmail Address: EMAIL AVAILABLEWORK EXPERIENCE:07/2016 to 12/2021; 04/2022 to 12/2022. Insurance Collector University Health, 4502 Medical Dr, San Antonio, TX 78229 Contact: Human Resources PHONE NUMBER AVAILABLE Underpayment research on high dollar claims Write off contractual adjustments Appeal claims due to underpayments Respond to Insurance requests for Itemized Bills or Medical Records Verification of eligibility and claim status via Provider portals Maintain daily work via ATB report Place account write-offs over limit on Managers Log Set up packets for Refunds Accounts worked: Commercial, Tricare, ChampVA, Managed Care, Medicaid, Transplant Cases, PIP, Non-Contracted to include the No Surprise Act for 2022 Cross-Train new employees; oversee Data Search Collectors and assist with questions Programs used: MedAssets, Contract Manager, IDX, OnBase, nThrive, Sunrise, EPIC 12/2021 to 03/2022. RAC CoordinatorUniversity Health, 4502 Medical Dr, San Antonio, TX 78229 Contact: Human Resources PHONE NUMBER AVAILABLE Review correspondence and determine if account is to applied to RAC audit Request Release of Information (ROI) for Medical Record requests and Itemized Bills Monitor and maintain spreadsheet to include ROI, records sent, audit reviews for DRG or Medical Necessity reviews Provide status to Utilization Management (UM) for possible appeals Audit reviews for refund requests Notate accounts as to whether there are findings or no findings on the review Provide documentation to UM or Coding for appeals Reindex correspondence to Collection Department if not part of RAC 04/2015 to 06/2016. Reimbursement Specialist.The START Center: South Texas Oncology and Hematology, 4348 Medical Dr, San Antonio, TX 78229 Contact: Human Resources PHONE NUMBER AVAILABLE Work accounts over $10K using Centricity program Work weekly denials and set up for appeals Work weekly accounts based on aging report Submit request for refunds and for adjustments Complete requests for Medical Records from payers Review payments for possible appeals03/2012 to 04/2015. Patient Account Specialist IICancer Care Centers of South Texas, 100 NE Loop 410, Ste 600, San Antonio, TX 78216 Contact: Jennifer Coward, Human Resources, PHONE NUMBER AVAILABLE Maintain patient accounts on a daily basis by working aged reports Work accounts over $10K Work with patients on setting up a payment plan Accept patient payments on account balances via credit/debit card or personal check Setup accounts for payment monitoring and/or submission to collections Submit appeals and second level appeals to insurance carriers, including Medicare and Medicaid Verify claims processed correctly through verification of benefits Verification through Medicare in whether patient is under Hospice Care or Skilled Nursing; filed claims accordingly Submit adjustments to be written off patient accounts; work accounts that are capitated and fee-for-service File claims to secondary and tertiary carriers Follow-up with patient and Insurance for balances due on the accounts by way of insurance explanation of benefits or remits that have been received through Availity, Fisacure, or TotalView Programs Work credits & submit refund requests to accounting Provide monthly reports to management on returned statements Backup to assist in payment posting.02/2011 to 03/2012. Billing SpecialistCenter for Disease Detection. 11603 Crosswinds Way, Ste 100, San Antonio, TX 78233 Contact: Human Resources PHONE NUMBER AVAILABLE Open, scan, and verification of Insurance Cards with verification ran through on edit lists Upload claims to EMDEON for electronic billing Print out CMS-1500 forms and mail paper claim to various insurance companies Work incompletes and rejects in EMDEON Post electronic remit advices with $0 pays or rebill claims with corrected data Post any denials for rebills and or write-offs Rebill any claims that have amendments to the correct insurance payer Work on Aging Reports.12/2009 to 2/2011. Collector/Accounts Receivable Specialist The SCOOTER Store. 1650 Independence Dr, New Braunfels, TX 78132 Contractor through Aerotek. File claims to Medicaid, Medicare, Medicare Advantage Policies, and other group insurance carriers, as well to secondary insurance Appeal claims, status calls for payments, refunds if needed Contacts made to multiple insurance payers for payment collections Maintain spreadsheet of problem accounts for appeals and make appeals and/or second level appeals as needed Resolve the accounts by payments, write-offs, or adjustments Review contracts for correct payment Answer customer calls in regards to any balance billing received 01/2009 to 08/2017. Area Representative Sunbelt Region (Supplemental Income) International Student Exchange. 119 Cooper St, Babylon, NY 11702 Contact: Larisa Waloski, Regional Director (214)538-6175 As an Area Representative for the San Antonio & surrounding area: Placement of High School foreign exchange students with Host Families Verify school acceptance of student placement Supervise student throughout the program by calling once a month and visiting student bi- monthly When problems or conflicts arise within the host family & exchange student, a problem identification and problem resolution form are submitted to corporate. Maintain monthly progress reports Assure all documents required for hosting are filed with student folder for audits by the Department of State Setup and provide Organization information for potential host families at local community events. Be available for questions by the student and/or family and resolve any issues that might arise Encourage students to obtain community service hours Attend workshops and additional webinar classes as needed. 02/2005 to 12/2009. Recovery Specialist / Appeals & Billing Benefit Recovery. 1111 N Loop West, Ste 1000, Houston, TX 77008 Contracted at Wilford Hall Medical Center, 2200 Bergquist Dr, Ste 1, Lackland AFB, TX 78236 Contact: Jimmy Rhodes; HR Dept PHONE NUMBER AVAILABLE Contractor for the United States Air Force located at Lackland AFB Review accounts for payment accuracy and any adjustments, write-offs, and or appeals are completed Run daily and/or weekly Ad Hoc reports Reconcile paid accounts received from various insurance companies, to include Medicare/Medicaid, Workman's Comp, Victims of Crime, Auto carriers Appeal claims according to Federal Guidelines Answer calls from patients, insurance carriers, and other military sites Maintain spreadsheet of problem payers to appeal as a massive appeal Maintain and report monthly billed and collected accounts to other military treatment facilities Bill inpatient accounts & outpatient Civilian Emergencies for several air bases to various insurance carriers; utilizing patient demographics & insurance information; obtain preauthorization and /or pre-certifications Verify benefits & billing address Complete daily cash voucher reports Work correspondence and refunds Update database, excel spreadsheet, and various programs (CHCS, AHLTA,TPOCS, ARMS). EDUCATION:Bachelors Degree/ Wayland Baptist University (Health Care Administration) Associates Degree / San Antonio College (Interpretation for the Deaf) RHIT program / St Philips College Graduate 1975, East Central High School.TRAINING:KASET Training in Customer Service Claims Processing- 6 week intensive course through Principal Financial Group Stephen Ministry Leadership 40 hour courseAWARDS:University Graduate with Honors (3.6 GPA)2015 Dean's List - 1999/2000 *2005/2008 Scholarship 2000 Employee of the Month 1994ADDITIONAL EMPLOYMENT ADDENDUMGroup Administrators (1995 2005) Claims Processor / Benefit Analyst Caremark PSD (1993 1995) Sr Claims Processor / Team Lead Gallagher Bassett Ins (1992 1993) Claims Processor Principal Financial Group (1988 1992) Claims Data Analyst / Claims Examiner Zurich American (1985 1988) Mail and File ClerkGPM Life Ins (1982 1984) Mail and File Clerk |
