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Click here or scroll down to respond to this candidateCandidate's Name
Street Address N.LewisMesa, Arizona Street Address
PHONE NUMBER AVAILABLEProfessional Summary:Medical field for over 20 years in different areas of the medical field from Nursing to Customer Service to Authorization to Processing Claims, Billing and Denials. I havework in many speciality of billing from infusion to wound care and revenue cycle billing to many more and feel very confident in my billing, AR Collection ability to performat any speciality. I have worked with all insurances commercial to AHCCCS, Medicare, Medicaid.With my wide range of expertise, I feel I have a greater understanding and would be a great candidate for any company looking for a hard honest worker with a lot of experience.Professional Experience:May 2024- current - Phoenix NeuroPsychiatricI perform Billing, Collections, insurance verification. Interact with patients to get insurance information and insurance plansto verify insurance also look up the insurance information via insurance websites. Assist with intake of the patients. I work with many HCPC codes and CPt codes fromPsychiatric to wound care, Mental health. Process denials. Collection by contacting the patients to set up payment arrangements.2024- I have worked for job agencies part time work.July 2022 August 2023 MBI Industrial MedicineI handle billing and collections, claim denials, patient accounts, and administrative duties. Medical claims appeals. Responsible for billable claim determinations, corrections, and submissionsFacilitates and ensures accurate and timely billing of services and fees to clients, resolving discrepancies, and recording these transactions. Collect, post, and manage patient account payments.Uses coded data to produce and submit claims to insurance companies.Responsible account resolution on outstanding accounts receivable for treatment claimsWorks claims appeals, denials and zero pay.Works primarily with workers compensation insurance and some individual payors, Third Party Administrators and labs.Makes payment arrangements and collects past due accounts, liaising with collection agencies, medical facilities and courts.Provides customer support to patients and insurance companies via phone or electronic communications.March 2017 2022 CVS Healthcaresupport the claims follow up, denial and appeals processes. work out of an agedtrial balance queue processing denials, refunds and secondary billing efforts for both commercial and government payers. ensure proper reimbursement efforts have beenapplied to patient accounts and working with payers to get anydiscrepancies resolved.February 2016 February 2017 Sonora Quest LabIn bound calls for Sonora Quest patients, billing insurance companies, updating patient demographics. Taking payment, setting up payment arrangement, offering discounts for balances paid in full, resolving customer billing issues. Contact the providers offices for information that is needed.August 2015 January 2016 - Conifer Health (Contract)I perform medical billing duties for Conifer. I bill new claims out from the beginning to the end.I also work denied claims for various plans which entails that I make calls out the provider office, insurance companies and hospitals to get the claims paid. I analyze why a claim has been denied or why it paid or why it did not pay. I work on a variety of applications: for example, Noridian, Passport, Ahcccs website, Medicare website, and all of the commercial websites.June 2015 - August 2015 - McKesson (Contract)I was a case manager for a cancer medication that patients were in stage 4 of cancer. I would follow up with the providers for authorizations for the medications. I would then process the claims from beginning to end. I would work on various applications to assure that the patients get their medication and that the claim is a clean claim going out.2013 - 2015 - Bridgeway Health SolutionsI assisted providers with resubmitting claims that were denied. I assisted the providers with following Medicare and Medicaid guidelines to fill their claims correctly. I performed negative balance calculations for the providers. Assisted supervisor and managers with special projects with processing of claims that were denied for hitting encounters denials, and many more reasons that I would figure out why the claims would deny. I assisted the supervisor with escalated calls and called back to the providers.2012 - 2013 - District Medical GroupBilling Collector for the Psych team. I managed all the Psych Medicare and Commercial plans. I processed claims. Performed redetermination forms to Medicare, Appeals and much more than collecting.2012 - Bridgeway Health Solutions (Contract for 6 months)Answered inbound calls regarding the provider claims, performed negative balances. Read UB04 and 1500 claims following Medicare and Medicaid guidelines. Assisted the Providers with reprocessing of claims. Assisted the Manager with escalated calls.2011 - 2012 - HyundaiAnswered incoming calls and did callbacks to customers and dealerships to set up appointments for the customers that bought the more expensive cars. Also did data entered of customers regarding their concerns and input regarding their care that they purchased from Hyundai.2010 - 2011 - Self EmployedOperated own cleaning service business, with several employees. Estimating, job costs, meeting with clients to ensure customer satisfaction, billing and accounting.2008 - 2010- HumanaAnswered inbound calls, assisted in member services, was added to Spanish team assisting the members in Spanish and also took prior authorization calls in Spanish. Always assisted my coworkers with any questions they might have. I assisted Doctors, nurses and other Humana associates with Prior Authorizations for medications, why they were rejecting and assisted them in running the authorizations through. I was promoted to Team Lead in the Call Center, and took escalated calls from the members, doctors, pharmacies. Assisted a team of 15 associates and my supervisor. I performed stats for the team. I assisted associates that needed to be helped with their quality, and overall stats. |
