| | | 20,000+ Fresh Resumes Monthly | |
|
|
| |
Click here or scroll down to respond to this candidateCandidate's Name
Fort Wayne, IN Street Address
EMAIL AVAILABLEPHONE NUMBER AVAILABLEWith 20+ years of experience specializing in Customer Service & Medical Insurance and Billing, I am knowledgeable in data confidentiality and privacy practices when reviewing patient information. I have an acute eye for detail as well as being effective at resolving discrepancies and working with third-party vendors to clear issues. I have trained in many varied and diverse environments, which has helped me become multifaceted.Willing to relocate: AnywhereAuthorized to work in the US for any employerWork ExperienceMedical Patient Services RepresentativeNeighborhood Health-Fort Wayne, INDecember 2022 to PresentI am part of a team that is committed to building healthier communities by delivering comprehensive, quality health care with compassion and respect. Along with greeting and registering each patient upon arrival, I also: Obtain and enter new patient demographics; enter preferred pharmacy information; schedule appointments for both new and established patients; room sick patients, in an effort to avoid crossing with those that are well or have chronic illnesses; update patient information as needed, to maintain accuracy for billing; research, enter, and update all information needed to complete the billing process; verify income for self-pay patients, insurance and Medicaid and/or Medicare coverage, and check the eligibility to these programs that affect the billing process; collect copays and balances, as required by office policies; distribute copies of receipts to patients; balance charges and receipts at end of each shift; schedule from Medicaid non-compliant lists and prep provider accounts to help keep track of our No Show/non-compliant, Well Child, self-pay and the needs of our chronic care patient. Medicaid Eligibility SpecialistKnowledge Services (TEMP CONTRACT)-Fort Wayne, INSeptember 2022 to December 2022 The Allen County Regional Call Center (RCC) serves Hoosiers on behalf of the Division of Family Resources. The Eligibility Specialist (ES) staff is responsible for gathering information related to requests for assistance in the form of Medicaid, SNAP (food assistance), and TANF (cash assistance). The ES role involves tasks such as answering phone calls, gathering data from clients over the phone, then entering that data into the State eligibility system to prepare cases for State authorization. Insurance SpecialistVisiting Nurse and Hospice Home d/b/a Stillwater Hospice-Fort Wayne, IN August 2020 to March 2022 Verify insurance and request prior authorizations, as needed Submit monthly room and board charges to Medicaid and all Managed Medicaid accounts; Inquire about and reprocess denied claims (code corrections and/or updates) Adhere to time constraints required by the State of Indiana Submit appeals and advocate for proper payment, in accordance with the State of Indiana fee schedules.Senior Biller Intake Authorization CoordinatorBrightstar Care-Fort Wayne, INApril 2019 to August 2020 Payroll, billing, accounts receivable, obtain authorizations for multiple payer sources Weekly billing spreadsheet updates for reconciliation Admissions Coordinator for skilled patient intake a well as gathering all pertinent information for new and returning patients from hospital and clinic physicians Research discrepancies in insurance billing, process bank deposits. Resource person for patients, families, physicians and referral sources. Perform intake and assessment of potential patients while gathering all referral information according to program policy Coordinate day to day referral flow from the agencies to the Case Management team, to include Initial submission of all authorizations to appropriate insurance carriers for each patient upon admission and re-certification Create permanent case files for each clientFunding Specialist/Customer Service Representative National Seating and Mobility-Indianapolis, INSeptember 2014 to September 2018 Created & managed 100+ orders for two branches by: Entering new DME orders received via fax, email and phone Verifying insurance information, initiating requests to physicians to obtain prior authorizations for equipment repair or replacement Work directly with Riley Children's Hospital on special orders Advocating for clients and advising them of out of pocket expenses, also providing financial assistance information as needed Coordinate delivery time/date with ATP or driver once orders were approved Process and post check and credit card payments. Respond to all status inquiries; inbound, outbound, email, or fax Adhere to attendance policy and HIPAA/PHI/PPI guidelines. Employees are HCPCS/CPT code trained(DME)Customer Quality SpecialistCoram Healthcare-Indianapolis, INOctober 2013 to September 2014 Initiate & enter Enteral Nutrition orders Verify insurance (DME specific) Obtain completed paperwork and documentation from physicians for prior authorizations Once patients are discharged, coordinate initial set-up in the patient's home and schedule first refill appointments for formula and all supplies Inform patient of delivery date, time, refill process and answer any questions Adhere to attendance policy by achieving and maintaining a 95% measure of quality Abide by HIPAA regulations. Employees were also HCPCS/CPT code & Medical Terminology trained Nursing CoordinatorExpress Scripts-Indianapolis, INSeptember 2011 to October 2013 Locate and coordinate home health nursing for patients who need home infusion or injections Make patient contact regarding specific need (have nurse administer or to be trained to self- administer) Work with physicians to obtain prescriptions/orders and forward information to the HHA that will be assisting Complete a contract (Letter of Agreement) with the agency - negotiate rate, confirm number of visits needed and if they will be to administer or teach & train Process claims weekly and forward to accounting department for payment in order to meet timely filing regulations Adhere to attendance policy, employees were HCPCS/CPT code & Medical Terminology trained EducationHigh School DiplomaNorth Side High School - Fort Wayne, INSkills Documentation Financial HIPAA regulations Home health Medical Terminology Research Care coordination Medical billing and collections Insurance procedures understanding Insurance coverage verification CPT Coding ICD-10 Insurance Verification Medical Records Accounts Receivable Medical Coding ICD-9 Anatomy Knowledge Data Entry ICD Coding Phone Etiquette |
