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| | Related Resumes Accounts Payable Receivable Malvern, PA Accounts Receivable Payable Centreville, MD Accounts Payable, Accounts Receivable, Collections, Customer Ser Allentown, PA Service Delivery Accounts Receivable Allentown, PA Accounts Receivable Payable Blackwood, NJ Accounts Receivable Payable Conshohocken, PA Project Manager Accounts Payable William Penn Annex West, PA |
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Click here or scroll down to respond to this candidateCandidate's Name
Street Address Prichard LaneWallingford, PA Street Address
Home: PHONE NUMBER AVAILABLESUMMARYSelf-motivated individual who is resourceful professional and well organized. Strong analytical and interpersonal skills create a solid foundation for problem-solving. Also possess extensive knowledge of medical insurance claims, computer applications and project management. Proficient with numerous insurance carriers, i.e., Medicare, Medicaid, Champus, Auto Insurance, Workmens Comp, HMOs and other commercial carriers.PROFESSIONAL EXPERIENCEMainline Health, Newtown Square, Pa March 2020-PresentAccounts Receivable SpecialistsInform management of any billing, payer trends identified for additional review or escalation.Follow-up on unprocessed claims by checking payor websites and contacting payors by phone.Review and monitor work flow in EPIC for Low paid, underpaid, and Denied claimsResponsible for daily AR follow-up on assigned payers to resolve high dollar claimsUtilizes billing system to expedite problematic account resolutions.Use payer contracts for reimbursement for payments and reconsiderationsUNIVERSITY OF PENNSYLVIANIA, Philadelphia, PA 2003-2015Accounts Receivable RepresentativeGenerate and send out invoicesFollow up on collect and allocate paymentsCarry out billing collection and reporting activities according to deadlinesReview AR aging reportsResearch and resolve payment discrepanciesRespond to explanation of benefit denialsKEYSTONE MERCY HEALTH PLAN, Philadelphia, PA 1996-2003Team Leader (2000-2003)Facilitate problem solving and collaborationIntervened when necessary to aid in resolving examiner and provider unit with issuesCross trained coached and prepared the staff for changes within the healthcare industryProvided status reports for managementWorked with management to escalate insurance and provider concernsPROFESSIONAL EXPERIENCE (Continued)Senior Claims Examiner (1999-2001)Resolved escalated provider requestReprocessed over payment hospital projectsWorked suspended claims in denial statusAudited provider and member appealsClaims Examiner (1997-1999)Processed all claim types in a timely and accurate mannerKnowledge of processing rulesWritten or verbal provider feedbackResolved routine claims and appeals within 30 days of receiptWorked suspended claims for paymentKnowledge of all claim types, medical terminology, ICD9, CPT and HCPCS codingEDUCATION`Early Childhood Education, Delaware Community College, Upper Darby, PACOMPUTER SKILLSMicrosoft Windows, Microsoft Word, Microsoft Excel, Type 45 wpm, Medical Terminology, IDX, Encoder Pro, McKesson, Facets, EPIC, Navinet, Promise, Passport, SMS, DRG, ICD9, ICD10, Stockamp (Trac),Epremis, Medasset, Pear Portal, Insurance Web PortalsACCOMPLISHMENTSCEU CREDITSAHAM ACCREDIDATIONMATERNAL FETAL AND NEONATAL CARE |
