Objective
To obtain a challenging position which will utilize my expertise in the medical industry while allowing for advancement opportunities as my understanding broadens.
Experience
09/2011 to 06/2012
Ameripath, Inc
Palm Beach Gardens, FL
Regional Provider Relations Coordinator
Responsibilities include but not limited to:
• Enrollment of new and existing providers and facilities to all commercial health plans
• Follow-up with the health plans
• Obtain provider numbers and effective dates; notifying Billing offices and Lab Managers
• Manage and maintain facility profiles
• Assist Director of Health Plans with maintaining databases, spreadsheets and special projects as needed
• Work closely with the Billing Department on a regular basis to assist in resolving billing issues
• Perform various audits upon request or as deemed necessary
• Assist with various IntelliCred task; including but not limited to:
o Data Entry
o Mapping
o Scanning
11/2008 to 09/2011
Ameripath, Inc
Addison, TX
Billing Analyst
Responsibilities include but not limited to:
• Monitoring all Emdeon / Claim Master Customer Service Alerts for any notifications of changes related to AmeriPath which would require modification our file maintenance dictionaries or claim logic
• Add, update and/or deactivate entries in Centricity 4.3 Dictionaries (Facilities; Commercial Lab; Provider and Insurance)
• Review Manage Care Executive Summary on new contracts for any changes which would require modifications to the claim logic and notify the responsible billing sites
• Creating the Billing and/or Attending Provider Templates for the addition of LBN in Claim Master
• Complete/submit the credentialing application for physicians and facilities with Palmetto GBA; follow up on the status of the application and report to all concerned once completed
• Verify CLIA information and status and NPI information on new reading and/or performing locations prior to set-up in the billing systems
• Perform license, NPI and Specialty Code verification on new physicians’ set-ups
• Assist in the 5010 ANSI Implementation Project – creating the templates which will send the Loop 2010AA information according to the each payers credentialing profile
• EDI enrollment for all AmeriPath / DermPath providers under Emdeon clearinghouse
• Assist the sites in resolving electronic claim issues per the payers requirements
• Verify claim logic changes per payers mandates
• Attend all necessary conference call regarding the set up of new providers
• Assist on various Blackbelt Projects
• Any other duties as assigned by the Management Team
11/11/2006 to 11/2008
Ameripath, Inc.
Dallas, TX
Billing Specialist
Responsibilities include but not limited to:
• All IDX claim edits and Claim Master clearinghouse edits
• Claim Master rejected claims from the payers EDI system
• Electronic claims submissions from Claim Master
• Complete/submit the credentialing application for physicians and facilities with Palmetto GBA; follow up on the status of the application and report to all concerned once completed
• Correcting the patient demographics (registration & insurance) in BAR
• Charge correction of invoices in BAR in order to rectify various claim keying errors
• Train, audit and monitor all staff correcting BAR claim edits and Claim Master edits
• Coordinate, administer and assist in all Claim Master Projects
• Work closely with Management and Senior Management to ensure proper billing procedures
• Perform other office duties as assigned
03/03/2006 to 08/11/2006
Ameripath, Inc
Dallas, TX
Collection Specialist
Responsibilities include but not limited to:
• Review, follow up and collect A/R for Government, Commercial and Worker’s Compensation accounts
• Analyze accounts and correspondence on a daily basis
• Identify trends within accounts; Resolving the issue or elevating the issue to the supervisor
• Re-file accounts as needed
• Properly documenting accounts in their appropriate system (IDX or Antrim)
• Ensure that accounts are being paid at the maximum reimbursement
• Review, recommend and perform adjustments of accounts
• Issue refund request with appropriate documentation
• Exceed Ameripath productivity standards while working accounts according to the company’s policy and procedures
• Perform other duties as assigned by management
03/19/2005 to 03/02/2006
Ameripath, Inc.
Dallas, TX
Biller
Responsibilities include but not limited to:
• All paper claims filing and electronic claims submission
• Resolve all front end and clearinghouse edits in order to submit clean claim to payers
• Correcting patient demographics and char...
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