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Click here or scroll down to respond to this candidateCandidate's Name
Dallas, TX Street Address
PHONE NUMBER AVAILABLEEMAIL AVAILABLESummaryA Medical Claims Review professional with 5+ years experience in reviewing, auditing, billing and adjusting medical claimsReviews all aspects of claims liability and accurately adjudicates the claim accordingly to complex contractual obligationsProficient in EMR/EHRAppeal claim denialsComputing accuracy of claim amounts using generally accepted auditing standardsReviewed reimbursement request submitted by policyholders and determining their validityProficient in Microsoft Word, Excel and PowerPoint. Knowledge about Microsoft Access. Professional ExperienceGuidehouse IncMarch 2024- CurrentPatient Account Representative- Vendor CollectionsComplete all business-related requests and correspondence from patients and insurance companies.Minimum call requirement for self-pay representatives is 75 calls a day.Complete all assigned projects in a timely manner.Assist client and patients in all requested tasks.Communicate to Guidehouse management areas of concern or areas of improvement.Client ResponsibilityResearch and respond to all patient inquiries received by telephone and mail.Update patient demographic information and initiate account adjustments.Try to resolve account balances to zero prior to accounts being forwarded to an outside agency for collections.Christus HealthJanuary 2024- February 2024Patient Financial Representative Senior- Commercial Collector Contract RandstadCollect balances due from payors ensuring proper reimbursement for all services.Identifies and forwards proper account denial information to the designated departmental liaison. Dedicates efforts to ensure a proper denial resolution and timely turnaround.Maintain an active knowledge of all collection requirements by payors.Works collector queue daily utilizing appropriate collection system and reports.Demonstrates knowledge of standard bill forms and filing requirements.Identify and resolve underpayments with the appropriate follow up activities within payor timely guidelines.Identify and resolve credit balances with the appropriate follow up activities within payor timely guidelines.Identify and communicate trends impacting account resolution. Baylor Scott & White HospitalSeptember 2023- CurrentCollector IIContract RandstadContacts patients and insurance company representatives by telephone or through correspondence to check the status of claimsObtain insurance information,Check on interim billings,Counsel patients on financial arrangements.Maintains collection files on the accounts receivable systemPerforms collection activities for assigned accounts. Blue TritonSeptember 2022- February 2023Claims AnalystContract WilsonHCGPrepares, posts, verifies, and records customer payments and transactions related to accounts receivableCreates invoices according to company practices; submits invoices to customers. Maintains and updates customer files, including name or address changes, mergers, or mailing attentions.Drafts correspondence for standard past-due accounts and collections, identifies delinquent accounts by reviewing files, and contacts delinquent accountholders to request payment.Creates reports regarding the current status of customer accounts as requested.Researches customer discrepancies and past-due amounts with the assistance of the Collections Manager and other staff.Collaborates with the Collections Manager to reconcile accounts receivable on a periodic (at least bimonthly) basis.Assists in generating monthly billing statements based on the general ledger.Assists Accounting Manager in reconciling revenue accounts each month.Copies, files, and retrieves materials for accounts receivable as needed.Relays changes of information to appropriate employees.Performs other related duties as assigned.Steward HealthcareSeptember 2021 - July 2022Vendor Relations Specialist/ AR Specialist/ Claims Review Contract BG StaffingUpdated medical recordsEMREHRObtain Prior authorizations and pre-certificationBilled medical claimsAble to work with moderate supervision responding to changing priorities and role needsInsurance claim preparation and submissionBillable claim determinations, corrections, and submissionsAppeal claim denialsClaims AuditingWhen EOB comes in check if its underpayment or overpayment and check if it needs to be refunded.Maintain working knowledge of Company softwareAssist with additional work duties or responsibilities as evident or requiredRuns reports and prioritize the work on daily basisWork side by side with the finance department to ensure vendors are paid in timely mannerCommunicate internal goals with the vendorsCommunicate any vendor issues and challenges with management teamMaintain emails and correspondence within a timely mannerResponsible to meet company set performance goalsAccount processingInformation analysisAuthorization and diagnosis code verificationBatch preparation for postingOversee patient accountsAnswer patient questions and advise them on their insurance coverage and benefitsEstablish repayment plans and arrangements with delinquent patientsContact insurance billing departments to address and correct billing errors and omissions HMSAugust 2020 - May 2021Report AnalystContract Enterprise SolutionGathers, interprets, and uses complex data to develop actionable steps that will improve processes and optimize results.Assesses company and client needs,Receives information,Analyzes looking for tell-tale trends or areas for improvement.Delivers information to account managers.Monitor the results of their business functionsHelp develop new business functionsParticipate in regular meetings with management,Assessing and addressing issues to identify and implement improvements toward efficient operationsPrepare, analyze, and summarize various weekly, monthly, and periodic operational results for use by various key stakeholders, creating reports, specifications, instructions, and flowcharts Pacific Dental ServicesSept 2018 Feb 2019Dental Insurance Claims AuditorContract Sincerus SolutionsBilled dental claims to insuranceUpdated EMRContacted patients due to account information set upClaims auditingWhen EOB comes in check if its underpayment or overpayment and check if it needs to be refunded.Analyze payments, procedures, and guidelines of benefitsInterprets detailed paid claims reports, payment reports, and other various reports to determine the eligible types of servicesAssisted customers patients with collections billPerforms routine follow ups for all pending claimsReviews all aspects of claims liability and accurately adjudicates the claim accordingly to complex contractual obligationsMaintain quality, quantity, and turn-time standardsReviewed reimbursement request submitted by policyholders and determining their validityReferring terms and conditions of insurance contracts and settling claims disputesComputing accuracy of claim amounts using generally accepted auditing standardsInforming policyholders about denial and acceptance of reimbursement requestTracked and generated request for claims over paymentAdjust accountsVerify benefits for patientsConsulted patient with benefitsGreen Oaks Physical TherapyDecember 2017- August 2018Patient Account Representative/ Office ManagerMedical billingUpdated EMRVerify patient insurance coverage to ensure necessary procedures are covered by an individuals provider.Check when EOB comes in to see if its underpayment or overpayment and check if it needs to be refunded.Enter data in an accurate manner to update patient benefit information in the organizations insurance system and verify that existing information is accurate (i.e., co-pays, deductibles, max out of pockets, coinsurance)Helped patients arrange payment for services that are not covered by their insurance companies, discussing different financing options to fit their budgets.Consulted with patients about financingAssisted patients with payment plansScheduled appointments for patientsAuthorization for servicesMedicare and Private insurance knowledgePhysical and Occupational knowledgeCPT codes provided to insurance companiesCoordinate, monitor, assign and document patient and clinical care activities.Communicate with clinical and management teams to execute and direct patient care services.Coordinate with all clinical disciplines to offer optimum patient care by using all resources.Prepare patients charts for future clinicsAnswer phones and direct patients to appropriate destinationReceive and send faxes to appropriate destinationsCheck patients in and out for appointmentsProvide front office with documentations for clinics or following work dayMake new patient chartsProvide new patients with all materials neededPrideJuly 2016 - October 2017Financial CoordinatorVerify patient insurance coverage to ensure necessary procedures are covered by an individuals provider.Enter data in an accurate manner to update patient benefit information in the organizations insurance system and verify that existing information is accurate (i.e., co-pays, deductibles, max out of pockets, coinsurance)Financial consults with patients so they can understand why some procedures may be covered, while others are not.Helped patients arrange payment for services that are not covered by their insurance companies, discussing different financing options to fit their budgets.Obtained prior Authorization for servicesMedicare and Private insurance knowledgePhysical and Occupational knowledgeCPT codes provided to insurance companiesCoordinate, monitor, assign and document patient and clinical care activities.Communicate with clinical and management teams to execute and direct patient care services.Coordinate with all clinical disciplines to offer optimum patient care by using all resources.Prepare patients charts for future clinicsProvide prescriptionsAnswer phones and direct to appropriate destinationDirect patients/guestsReceive and send faxes to appropriate destinationsCheck patients in and outProvide front office with documentations for clinics or following work dayMake new patient charts and provide new patients with all materials needed EducationEl Centro College 2 years college, technical or vocational school Jan 2022- currentSunset High School High School Diploma/GED 2014 GPA: 3.19 Skills/CertificatesVendor ManagementU.S. Health Insurance Portability and Accountability Act (HIPAA)Customer ServiceMedicare/MedicaidHospitalsTeam BuildingManaged CareWindowsMicrosoft Word, Excel and PowerPointMLOMedical billing |
