Objective
To obtain and uphold a position in an organization that has growth and stability, where my customer service and billing experience will both beneficial and rewarding for myself as well as the company. More importantly; become a team player amongst my peers.
Professional Skills
Skilled in customer service, reviewing claims (HCFA 1500 & UB92), disputing billing discrepancies such as denials and payments from insurance carriers.
Experienced with proprietary software for data entry and retrieval; familiar with general office equipment including copiers, fax machines, and 10-key calculators.
Efficient in Microsoft Office (Word, Excel, Lotus Notes), Web Md, Availity, Microsoft Outlook, Noble House, Passport, Focus, Medi Soft, Athena.
Certificates in HIPPA, Compliance, Medical Terminology, ICD-9 & CPT Codes.
Experience
Davita Laboratory 09/ 2007-07/2010
Collection Specialist
• Reviewed ATBs and CPU reports every other week, establishing goals and prioritizing workload.
• Handles Medicare invoices either via phone calls or tracer claims submissions. This includes calling for status, appealing claims, requesting medical records, researching payments, adjusting claims for non-payable procedures and time limits, updating insurance and financial classes in the system.
• Processes Medicaid invoices, either via phone calls or internet. Processing includes making phone calls for claim status, or internet claim verification status, preparing extension forms or crossover forms, filing appeals.
• Processes non-Medicare and Medicaid carrier claims according to policies and procedures.
• Processes Medicaid payment denials, including posting rejections, conducting appeals, and requesting medical records as needed. The payment denials are worked within seven working days after receipt.
• Reviews non-payment vouchers from insurance companies to determine steps necessary to resolve the claim.
• Analyzes month end financial reports to identify potential problem carriers for each assigned facility.
• Prepares weekly report identifying invoices completed and issues identified during the week.
LogiMedix 9/2005 – 09/2007
Government Collector/Medicare and Medicad
• Review all Government and Non-Government denials to ensure all denials are reviewed timely and accurate. Review accounts and verify if denial is actual or an error,
• Validate patient’s most current insurance information via Reggie, DDE, WEBRIMS LSO and/or the clinic. Update insurance information if applicable and resubmit claims to correct Carrier.
• Contact Carrier to verify if claims were received and have them adjusted / reprocessed. Verify with Carrier filing limits (appeal time limits as well), claims address and if patient policy information provided is correct.
• Document accounts and obtain any necessary information such as labs and physicians orders to have claims reprocessed.
• Request refunds, post payments, and make any necessary adjustments required.
Medical Collector ...
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