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Click here or scroll down to respond to this candidateCandidate's Name
West Des Moines, IA Street Address
EMAIL AVAILABLEPHONE NUMBER AVAILABLEExperienced medical biller utilizing multiple systems for different specialities. Durable medical equipment, behavioral health services, family medicine. Work rejections, contacting insurance companies regarding denials. Prepared appeals and reconsiderations to be submitted to insurance companies. Experience in medical records both in clinic and hospital settings. Work ExperienceMedical Billing SpecialistCIMB/Provana-Clive, IAOctober 2023 to PresentScrub daily Durable Medical Equipment claims in Exdion making sure demographics, DX codes and ordering providers are correct. Check providers against NPPES they are able to order durable medical equipment. Work rejections in Waystar, updating DX codes, providers, insurance and resubmit claim from either Waystar or Exdion. Work Accounts Receivable for Blue Cross Blue Shield plans from across the country. Contact insurance for claim status or denials. Request reconsideration, appeals or overpayment requests. Assist with incoming calls from patients making payments on their accounts. Work any project assigned by team lead or director.New Business Case CoordinatorPrincipal Financial Group-Des Moines, IAMarch 2023 to September 2023Working amendment requests, policy anniversary changes, enrollment of members. I work with two systems COMPASS and CAPture.Office Manager/Administrative AssistantInnovative Counseling & Consulting, Inc.-Des Moines, IA February 2020 to March 2023Schedule client appointments for therapy and BHIS (behavioral health intervention services) prepared authorizations for services and submitted to Managed Care Organizations, confirmed insurance eligibility, collected copays, outstanding balances, prepared medical records requests for requesting entities. Scheduled interviews for potential employees, reviewed resumes, applications, submitted background checks to State of Iowa. Supervised team of five to ten staff, assigned daily tasks. Scheduled staff meetings. Accounts Receivable Specialist Electronic Billing Conifer Health SolutionsApril 2017 to November 2019Working daily billing assignments to make sure clean claims are submitted either electronically or by mail. Submit requests to coding or departments, depending on what the edit is asking for. Once the department or coding advises, update the claim to submit to various insurance companies. Use of WPS web portal to check eligibility for Medicare claims. Access to multiple websites to other website to check eligibility for various insurance companies. Update insurance information as needed. Determine why a claim has been rejected/denied by an insurance company and work to get rejection/denial updated and claim re-billed. Assist other team members as needed. Working on special projects as assigned by supervisor, manager or director. Electronic billing works directly with the follow up team and various other departments to make sure the claims are correctly submitted to insurance companies. Medical Insurance Specialist IIEarly Out ServicesMarch 2016 to April 2017Confirmed patient eligibility for medical insurance & entered into computer programs correctly. Requested providers to file claims to insurance companies. Worked with both UBO4 for facility claims and CMS 1500 forms for professional claims. Used ICD-9 and ICD-10 coding. Reviewed and investigated rejected and denied claims. Insurance SpecialistAvadyne HealthJune 2013 to May 2016Confirmed patient eligibility for medical insurance & entered into computer programs correctly. Requested providers to file claims to insurance companies. Worked with both UBO4 for facility claims and CMS 1500 forms for professional claims. Used ICD-9 and ICD-10 coding. Reviewed and investigated rejected and denied claims. Mailroom Clerk Data Entry/Mailroom ClerkOklahoma Tax CommissionJanuary 2013 to May 2013Entered handwritten tax information into different computer programs. Separated mail to be distributed to different departments.Worksite Clerk/Premium Accounting Department, Mailroom Globe LifeApril 2012 to August 2012Posted payments or made adjustment to life insurance accounts, contacted franchises or branches for clarification payments when needed, opened and processed mail, assisted in inventory, balanced payments at end of day and recorded daily production on spreadsheets. EducationAssociate's degree in Legal StudiesMetropolitan College - Oklahoma City, OKApril 2004 to December 2006Skills Supervising experience Human resources Schedule management Office management Accounts Receivable (Less than 1 year) Medical Billing (Less than 1 year)AssessmentsMedical receptionist skills ProficientJanuary 2023Managing physician schedules and maintaining accurate patient records Full results: ProficientMedical billing ProficientJanuary 2023Understanding the procedures and forms used for medical billing Full results: ProficientProtecting patient privacy ProficientJanuary 2023Understanding privacy rules and regulations associated with patient records Full results: ProficientManagement & leadership skills: Impact & influence Proficient January 2023Choosing the most effective strategy to inspire and influence others to meet business objectives Full results: ProficientCase management & social work ProficientJanuary 2023Determining client needs, providing support resources, and collaborating with clients and multidisciplinary teamsFull results: ProficientIndeed Assessments provides skills tests that are not indicative of a license or certification, or continued development in any professional field. |
