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Click here or scroll down to respond to this candidateCandidate's Name
Local to: Pewee Valley, KYSummary:An experienced Accounts Receivable Specialist with excellent experience of working in a fast-paced healthcare environment.Specialized in medical billing, denial, and patient collections and handled billing for Medicare, Medicaid, Commercial Insurance and Workers Compensation claims.Researched and identified root causes of insurance denials, sent appeals to payors, knowledgeable on medical billing process, clearinghouses and the RCM Process.Collaborated with providers, insurance companies, patients and social workers to resolve outstanding financial ob. insurance companies, patients and social workers to resolve ligations and submitted or set up payments from insurance companies and/or patients.Experienced in reviewing patients accounts to make sure insurance and adjustments were applied correctly also worked with patients for patient liability and responsibility after insurance has processed and paid.Obtained correct and updated insurance and patient demographics to bill patients and insurance correctly.Local to: Pewee Valley, KY and available for available for telephonic/virtual interview and ready to start immediately.Skills:EPIC SoftwareMedicareMedicaidCommercial InsuranceRCM ProcessMedical BillingICD-10 codesMicrosoft OfficeData EntryMedical RecordsEducation:High School Diploma, South Oldham High School, Crestwood, KY, 1999Experience:Pharma Cord, LLC. Jeffersonville, IN March/23 Dec/23Case ManagerWorked with specialty pharmacies to get patients access to medication VOWST.Interacted directly with patients and/or patient reps, physicians, Dr offices, hospitals & insurance companies to get required information so we can screen patients to get them approved for VOWST medication.Done KPIs to adhere to, quality standards that had to be met and patient response times to adhere to.Fresenius Medical Care North America / Azura Vascular Care, Remote Sep/21 Jan/22AR SpecialistSpecialized in medical billing, denial, and patient collections. Handled billing for Medicare, Medicaid, Commercial Insurance and Workers Compensation claims.Researched and identified root causes of insurance denials, sent appeals to payors, knowledgeable on medical billing process, clearinghouses and the RCM Process.Collaborated with providers, insurance companies, patients and social workers to resolve outstanding financial ob, insurance companies, patients and social workers to resolve ligations and submitted or set up payments from insurance companies and/or patients.Obtained correct and updated insurance and patient demographics to bill patients and insurance correctly.Read and submit EOB's, patient medical records, referrals, verified insurance and familiar with medical billing coding (reading ICD-10 codes & posting or applying adjustment codes).Focused on ambulatory, inpatient and outpatient acute kidney dialysis careCynote, Inc. / Amsurg Remote, Apr/21 Aug/21AR and Patient Self Pay Collection SpecialistSpecialized in medical billing, denial, and patient collections and handled billing for Medicare, Medicaid, Commercial Insurance and Workers Compensation claims.Researched and identified root causes of insurance denials, sent appeals to payors, knowledgeable on medical billing process, clearinghouses and the RCM Process.Collaborated with providers, insurance companies, patients and social workers to resolve outstanding financial obligations and submitted or set up payments from insurance companies and/or patients.Obtained correct and updated insurance and patient demographics to bill patients and insurance correctly.Read and submit EOB's, patient medical records, referrals, verified insurance and familiar with medical billing coding (reading ICD-10 codes & posting or applying adjustment codes).Focused on collecting patient liability and responsibility after insurance has been processed and paid.Called patient to set up payments or work out a payment arrangement.Reviewed patients account to make sure insurance and adjustments were applied correctly.Bennett & Bloom Eye Care Center, Crestwood, KY Sep/20 Dec/20AR SpecialistSpecialized in medical billing, denial, and patient collections.Handled billing for Medicare, Medicaid, Commercial Insurance and Workers Compensation claims.Researched and identified root causes of insurance denials, sent appeals to payors, knowledgeable on medical billing process, clearinghouses and the RCM Process.Collaborated with providers, insurance companies, patients and social workers to resolve outstanding financial obligations and submitted or set up payments from insurance companies and/or patients.Obtained correct and updated insurance and patient demographics to bill patients and insurance correctly.Read and submit EOB's, patient medical records, referrals, verified insurance and familiar with medical billing coding (reading ICD-10 codes & posting or applying adjustment codes).Focused on eyecare health and patient liability and responsibility after insurance has been processed and paid.Reviewed patients account to make sure insurance and adjustments were applied correctly.KORT Physical Therapy / Select Medical, Louisville, KY Feb/19 Aug/20CSS-Customer Service SpecialistSpecialized in medical billing, denial, and patient collections.Handled billing for Medicare, Medicaid, Commercial Insurance and Workers Compensation claims for several physical therapist and occupational therapist in KY & IN.Submitted charges based off Physical and Occupational therapist notes.Researched and identified root causes of insurance denials, sent appeals to payors, knowledgeable on medical billing process, clearinghouses and the RCM Process.Collaborated with providers, insurance companies, patients and social workers to resolve outstanding financial obligations and submitted or set up payments from insurance companies and/or patients.Obtained correct and updated insurance and patient demographics to bill patients and insurance correctly.Read and submit EOB's, patient medical records, referrals, verified insurance and familiar with medical billing coding (reading ICD-10 codes & posting or applying adjustment codes).Focused on PT & OT health and patient liability and responsibility after insurance has been processed and paid.Reviewed patients account to make sure insurance and adjustments were applied correctly.Baptist Health Medical Group, Louisville, KY Sep/14 Dec/18Accounts Receivable Team LeadSpecialized in medical billing, denial, and patient collections.Handled billing for Medicare, Medicaid, Commercial Insurance and Workers Compensation claims for several in-patient, out-patient, Urgent Care Centers, hospitals, dr. offices associated with Baptist Health Care and services from urgent and emergency care to geriatrics and pediatrics care.Submitted charges based off Physical and Occupational therapist notes.Researched and identified root causes of insurance denials, sent appeals to payors, knowledgeable on medical billing process, clearinghouses and the RCM Process.Collaborated with providers, insurance companies, patients and social workers to resolve outstanding financial obligations and submitted or set up payments from insurance companies and/or patients.Obtained correct and updated insurance and patient demographics to bill patients and insurance correctly.Read and submit EOB's, patient medical records, referrals, verified insurance and familiar with medical billing coding (reading ICD-10 codes & posting or applying adjustment codes).Focused on office visits, emergency care, scheduled surgeries, sleep apnea services.Worked with patients for patient liability and responsibility after insurance has processed and paid.Reviewed patients account to make sure insurance and adjustments were applied correctly.First Source, Louisville, KY Jul/09 Aug/14Claims ProcessorExperienced in processing insurance claims as a third party.Processed UB04 claims and HCFA's by reading and paying claims based off the providers contracts with the insurance company.Worked on the Kaiser Permanente account as well as Anthem BCBS Facets account.Processed and paid claims based off contracts for Kaiser but For Anthem BCBS.Experienced in using Citrix and processed Facet claims as a claim processor paying claims based off contracts then advanced to being a team lead for the Anthem BCBS Facets Team.Trained incoming and current employees.Helped set this account up and get it going by participating in conference calls, performing internal audits and keeping the Facets team up to date with any training and/or quality updates.Trained groups/classes of people as well as individuals.Trained groups/classes of people as well as individuals.Anthem BCBS, Louisville, KY Oct/02 Jul/04Data EntryRCM/Doc Management Dept. scanning and entering information from paper claims into the Anthem system for processing purposes. |
