Candidate Information Title Medical Billing Customer Service Target Location US-TX-Plano Email Available with paid plan Phone Available with paid plan	20,000+ Fresh Resumes Monthly     View Phone Numbers     Receive Resume E-mail Alerts     Post Jobs Free     Link your Free Jobs Page     ... and much more Register on Jobvertise Free
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Seeking a great company where I canutilize my skills and professionalism. Ihave exceptional ability to understandthe healthcare industry and would liketo bridge that experience andknowledge to develop professionalgrowth in the insurance industry.Skills and Highlights:Licensed All Lines. AdjusterExperienced with both Self and fullyinsured Benefit PlansEDI BillingReimbursement ManagementCritical ThinkingMedicare and Medicaid ProcessesMedical Billing and CollectionsBilling CodesCustomer ServiceCPT Code ModifiersReviewing Patient InformationHIPAA ComplianceICD-10 CodingClaims ReviewTracking SpreadsheetsInsurance ClaimsMedical Coding KnowledgeMicrosoft Office PackageMedical Records SecurityVerbal and Written CommunicationMedical Billing TechnologyAccounts Receivable ManagementICD-9ICD-10Training and DevelopmentA/P and A/R ExpertiseHomecare HomebaseMedical Billing Analyst 02/2020 to CurrentProcessing, monitoring, and collecting of Home Health/ Hospice Medicare, Medicaid and other commercial insurance claims in accordance with payor requirementsVerifying accuracy of billing data and revising any errors Identify contracting errors/billing errors. Identify discrepancies, such as denied claims, underpaid claims, or differences in reimbursementCreating and distributing various financial reports as needed Timely resolution of all claims including appealsFollowing up on accounts for billing and on overdue accounts for collections via phone calls, re-submissions and adjustments for billing errorsCommunicated with insurance providers to resolve denied claims and resubmitted.Analyzed complex Explanation of Benefits forms to verify correct billing of insurance carriers.Prevented financial delinquencies by working closely with managers to resolve billing issues before becoming unmanageable.Reviewed patient records, identified medical codes, and created invoices for billing purposes.Verified insurance of patients to determine eligibility. Generated reports and analyzed trends to maximizereimbursement and reduce claim denials.Audited and corrected billing and posting documents for accuracy.Pediatrix Medical GroupAppeal Analyst/ Neonatal Govt. Collector 01/2017 to 01/2020Current responsibilities include conducting billing and Collecting on all commercial and Govt accounts greater than 90 daysAlong with analyzing and managing accounts to provide feedback to managementKelli QShaversEMAIL AVAILABLEPHONE NUMBER AVAILABLEPlano, TX 75025SummarySkillsExperienceKSDiagnostic CodesTime ManagementClient InquiriesWorkers' Compensation licenseInsurance CollectionsPayments PostingWaystarEmdeonSMSReimbursementsCredentialing Data CoordinationProvider Enrollment ExpertiseStrong Communication SkillsNextGenMediSoftCernerRealMedAll ScriptsPower PointExcelMcKessonGE HealthcareE Clinical WorksAdvanced MDXisinBUSINESS APPLICATION SPECIALISTPROGRAM- CERTIFICATERichland CollegeDallas, TXBusiness Administration, 08/1996BACHELORS OF SCIENCEUNIVERSITY OF PHOENIXHEALTHCARE ADMINISTRATIONMEDICAL OFFICE PRACTITIONERPROGRAM-CERTIFICATIONX-RAYRICHLAND COLLEGETECHNICIAN PROGRAM- Registered withthe Texas Department of Health T.D.H.Performance MastersFluent in Medical Terminology includingI identified trends, audit accounts and forward findings to the Director along with make credit balance adjustments and initiate refunds meeting departmental productivity standards Ensures that claims are processed accurately through review and audit functions to ensure timely paymentResponds to inquiries regarding claims with under payment or non-paymentResponds to inquiries, questions, and concerns from patients regarding the status of claims in a clear, concise, and courteous mannerInterfaces with external and internal customers to ensure optimal efficiency of serviceMonitors aging of claims to ensure timely follow-up and payment.Addison Group/ Pinnacle PartnersReconciliation Specialist 09/2016 to 01/2017Successfully reconciled outstanding deposits to balance financial records identifying issues attributing to account delinquency and communicate with management and billing department when necessary the collection and follow-ups Resolve all variances before final processing of claims. CCS MedicalSenior Revenue Appeals Analyst 07/2013 to 03/2016Responsible for claims submission and claims resolution for insulin and non-insulin dependent patients in regards to Medicare patient accountsMade corrections if needed, review audits, begins the refund processesCollaborated daily with the teams on the productivity output along with the projected dollarsSuccessfully corrected accounts receivable issuesCollected and communicated with all clinical and IT departments for adding, deleting, changes and updates in the company database, including the CMS and AMA codes updatesWork with government and commercial payers and payer guidelinesInitiate contacts and negotiate appropriate resolution(internal and external)Receive and resolve inquiries and correspondence from third parties and patientsResearching accounts and refiling or appealing claims Submitting additional medical documentation and tracking account status by monitoring and analyzingassigned unresolved third party accountsConducted ongoing file reviews with the supervisor. Education and TrainingCertificationsICD9/ICD10 CPT coding-CertificateKnowledge of Computers in Healthcare-Certificate Medical Assisting andPatient Care Management-CertificateRadiography Training, Radiation Safety,Radiological Equipment, SafetyOperation and Maintenance/ImageProduction and Evaluation MicrosoftOffice Package CPR & First AidCertified- American Heart AssociationLicensed Workers compensation AllLines AdjusterSix Sigma TrainedChristus HealthcareSenior Commercial Collector 08/2012 to 07/2013Responsible for billing, collections and reimbursement services of Workers' Compensation claims to hospitals Ensured that all claims are billed and collected meet all government mandated procedures for integrity andComplianceDemonstrated a level of accountability to ensure data and codes are not changed on claims prior to submission if related to diagnosis, charge and other clinical type data Coordinated training classes and quality assurance for the revenue cycle department along with policy compliance with Federal (CMS) and State Regulations (HSCRC)Ensures all Compliance errors are reported to the Director and maintain records and files of documentation supporting bill changes that are directed by Director and/or Integrity OfficerUsed logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems.Communicated with claimants, providers and vendors regarding claim issuesManaged medical treatment and medical billing, authorized as appropriate based on the claims handling guidelines. Tenet Healthcare/ Conifer Health SolutionsMedical Billing/Sr. AR Specialist 10/2007 to 07/2012 Performed task as follows:Successfully managed desk- and caseload of at least 55 65 commercial claims in an efficient and professional manner Maintained accounts receivable/billing to ensure that all claims are billed properly and free from errorsAnalyzed and produce data, reviewed trending issues for procedures and identified areas for improvementAccurately checked and invoiced endorsements and attached insurance policies to the company database, reviewed premium rates, Audits accounts to ensure all demographic, insurance payer information and signatures are required and documented correctlyCollected on outstanding balances due from third party carriers in a timely fashionInvestigate claims thoroughly, including coverage, liability, denials, appeals and overpaymentBaylor SurgicareInsurance Verification Trainer/Coordinator/Sr. Collector 11/2004 to 09/2007Knowledge of Commercial insurance policies, applications, endorsements and insurance proposals .and performed the following taskBilling and collection of Workers' Compensation accounts Contact insurance companies to determine when payments will be made and if additional information is needed for processing payments and claimsTrained all new employees on Front Office procedures and job responsibilities, Reviewed monthly reports from the insured/ checked the rates and premiums, secure pre certifications and authorizations prior to surgeries Assisted patients in applying for financial assistance and or hardshipsReceive and process invoices, code invoices and perform other account payable duties.