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Click here or scroll down to respond to this candCandidate's Name
4929 N Galloway Ave. Apt. 611Mesquite, TX. 75150PH: PHONE NUMBER AVAILABLESUMMARY:Extensive experience in collections on all 16 facilities for all our emergency room physicians, Hospital Medicine, Acute Care Surgery, and Radiology physicians.Sound experience in providing account registrations, billing and administrative support to the physicians at my assigned facility which was Presbyterian Hospital of Rockwall and Presbyterian Hospital of Dallas. Worked with ICD 9 and CPT.Proficient in using Windows 95,98,2000, and XP, Word, Excel, Intranet, Internet, Google, Lotus Notes, ITS, Nasco, 10 Key by Touch, Macess, Blue Chip, Adding Machine, Copier, Multi-Phone Lines and Printers, HIPAA Certified, EOB, Cubs, IDX, WebMD, Touch works, Edge net, Bridge Net vision, Dalcon, Proclaim, Meditech, Medisoft, Centricity, OBR, Master Database.Well versed in contacting insurance companies and parents/patients, processing daily billing, completing and submitting daily/monthly statistics.Employment History:AIS Healthcare, Dallas, TX.October 2021 to PresentInsurance Collctor for HumanaIVIG Medical Biller.Worked on a system called CPR+. Corrected claims and resubmitted. Phone and written appeals. Applied adjustments. Wrote up overpayment request and mailed out to Humana. Viewed various websites in orders work my accounts. Worked 45 accounts per day. Also called patients as well as texted patient through a system called Tiger Connect to collect outstanding balances or set them up on a payment plan. Printed and mailed out patients statements Using the same system, reviewed the pharmacy tickets on what medications and supplies that were sent out to the patients and billed out the appropriate CPT 10 codes and transmitted through Waystar for my payers which is UHC commerical, UHC Medicare, Medicaid, and UMR, basically all UHC PPO1 carriers. Transmitting the claims through our clearing house called Waystar. Also uploaded the HCFA and the primary EOB on Various websites to collect on our drug copay assistant programs. Such as Opus, One path etc. Faxed and email our HCFA to such carriers as Cigna Etc. Entered all 2ndary claims in Waystar for payment processing. As well and printed all HCFAs that had to be sent out through the mail. Still completing 45 or more claims..One Share Health, Irving. TX January 2020 to September 2021Customer Service RepresentativeManaged calls professionally with providing information, discussed bill status with providers as wellAs members. Provided answers to questions the new expense sharing support agents may have had. Assisted with Escalations on excel spreadsheet and by way of emails and instant messaging. Handled supervisor calls when needed. Coach agents on areas of opportunities. Worked interactions on a system called Admin123 opening and closing these interactions. Provided feedback for new processes and procedures for the ESS department to roll out as well. For bill status I used the Loomis system called AS400 as well as our phone system which is call Ring Central. To view the Explanation of Sharing (Explanation of Benefits) I used the Loomis Employer Portal as well as our newest system called Sales Force which has been implemented, but not used as of yet. Been trained on how to use it.Dallas Nephrology Associate, Dallas, TX Sept 2016 to July 2019A/R SPECIALIST. Bill and collect from all insurance carriers, from Medicare, Medicaid, UHC, BCBS Etc. Working with ICD 10 codes and various CPT codes for dialysis and office code For my clinicsWhich includes DTI, Puerto Rico, ASC Dallas, and ACS Plano,. Send in the billing by way of HCFA either by mail or electronically to the carriers and follow up on thepayment process to make sure that they are paying per our contract, if not that I do a phone appeal all theway up to a third level appeal.. Call patients to get their correct demographics, insurance information and obtain payment over the phone.. I work out of a system called All scripts PM and All scripts EHR and various insurance website.Emcare Healthcare, Dallas, TX Mar 2016 to Sept. 2016A/R SPECIALISTInvolved in collections on all 16 facilities for all our emergency room physicians, Hospital Medicine, Acute Care Surgery, and Radiology physicians.Insurance companies I am responsible for is UHC, UMR, TRICARE, HUMANA & HUMANA Military. As well as the supplemental plans that are attached to these carriers.Work 50-75 accounts per day. Do corrected claims. Add or change modifiers. Do phone appeals as well as written appeals for underpayments, nonpayments, bundling, etc.Work off a system called Pulse Collections, and Pulse Pro.Pediatrix Medical Group, Richardson, TX Mar 2009- Aug 2015BILLER/COLLECTORProviding account registrations, billing and administrative support to the physicians at my assigned facility which is Presbyterian Hospital of Rockwall and Presbyterian Hospital of Dallas.Contact insurance companies and parents, processing daily billing, completing and submitting daily/monthly statistics.Responsible for daily registration and billing, obtaining authorizations when needed.Worked billing system and excel reports.Daily inbound/outbound soft collections.SPECIALTY BILLING, Dallas, TX Dec 2007 - Aug 2008BILLING/COLLECTIONWorked electronic claim rejects through Availity clearinghouse.Worked denied and underpaid claims by calling various insurance companies, by way of phone and appeals.Wrote up appeals to send to the carriers as well as to the Texas Dept. of Insurance.Coded claims, as well as posted payments when necessary, as well as other various functions for this position. Chiropractic, Cardio Pulmonary and Family Medicine billing.CMI, Carrollton, TX Apr 2007 Oct 2007BILLING SPECIALISTResponded and closed out patients account through Net Vision that the phone representatives sent through.Research and closed out accounts or sent back to the representatives for additional information from the patient.Wrote up manual statements to send out to the patients.Trained all HS personal on various functions as well as trained them to operate the system.Oversee the payment posters to insure that payments were posted correctly to the patients account. Reported directly to the Director and the VP of Client Services.MEDICAL EDGE HEALTHCARE, Dallas, TX Aug 2006 Apr 2007CSRReceived and responded to correspondence from various insurance companies concerning pricing, coding, medical records as well as other various information to get claims processed for payments.Processed patients payments that they had sent in.Reviewed outstanding insurance claims and contact carrier for resolution prior to patient billing.Updated and rebilled claims to various insurance carriers. Reviewed rejected claims and sent out appeals. Requested medical records and other various information from the clinics to send back to insurance carriers to get claims paid.CYMETRIX, Lewisville, TX Dec 2004 Jun 2006PATIENT ACCOUNT REP. /BILLERWrite up Appeals and request Medical Records for underpayments and denials.Followed up on payments with the carriers by telephone on internet.Contact patients on their accounts, assisted them with understanding their policy and reading their EOBS.Collected payments from patients, setting up payment plans, requesting statements and itemized billing.Served as group leader/coach, trained new employees that were hired into read and understand insurance contracts, the system and all aspects of the job.PEROT CLAIMS PROCESSING, Dallas, TX Aug 2004 Sep 2004CLAIMS PROCESSORProcessed claims for one of their contractors, Kaiser Permanente processing UB92 and HCFA using the members Medicare assignment as well as their secondary insurance information, using Perots system called Macess.EDUCATION:Lathrop High School Lathrop, MOHigh School Diploma |
