ROSALIND WARING

POB ******

BRONX, NEW YORK

****5

718-***-****

SUMMARY

Specialist with HMO Insurance and Contracts, Workmen's Compensation, No-

Fault and Third Party and Commercial Insurance. Collections Manager.

Knowledgeable of Human Resources and Hospital Policy and Procedures.

EDUCATION

Manhattan College, Bronx, New York 1979 -

1983

Associates of Science Degree

EXPERIENCE

Jewish Home Life care

2014-2015

Bronx, NY

. Nursing Home billing

. Following up on outstanding claims

. Reviewing UB04

. Reviewing denial rev code, level of care, Rug score

. Responsible for submission of claims

. Review and make corrections on incorrect billing

. Review of providers contract for reimbursement

Total Orthopaedics

2012 - 2013

Massapequa, NY

. Resolved any claims delay in reimbursement.

. Confirm patient's insurance verification and eligibility on worker's

compensation and No fault. Maintaining medical records and charts for

duplicate records.

. Payment postings, authorization obtained for procedures.

. Meet deadlines in preparing cases for outside collections agency.

. Responsible for daily claims submission process to clearinghouse,

print paper claims and submission of secondary claims.

. Responsible for physician billing and coding utilizing CPT, ICD-9 and

HCPCS codes and applications of CMS regulations and third party

requirements.

Healthy Kids Pediatrics

2008 - 2011

Port Washington, NY

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Billing Manager

. Effectively and accurately reviewing demographic information in

practice management system, update insurance.

. Prepare/submit medical claims electronically (and when applicable by

paper) to governmental, private pay and commercial insurance carriers.

. Identify and resolve any claim delay issues that impact billing and

collections.

. Resolve credit balances and account issues.

. Post denials/co-pays and deductibles. Follow up on payment errors, low

reimbursement, denials.

. Accurately interpret EOB and collections report. Initiate and track

appeals as necessary.

. Resolve COB discrepancies post cash and reconcile daily receipts.

Confirm patient insurance verification and eligibility

North Shore University Hospital 2004 -2008

Forest Hills, New York

Billing Manager

( Verified insurance for all new patients and established patients who have

new insurance

( Follow up on all outstanding bills

? Assigned collection cases to staff members; renewed aging reports;

recorded stats on all billing

( Re-bill insurance companies when necessary

( Processed EOB's and Billing correspondences

( Generated appeals after review of EOB's

( Follow up on insurance claims with participating carriers

( Prepared monthly patient follow up letters

( Responsible for generating collection reports via the Collection Module

software

( Prepared memorandums and patient charts for review by physicians prior to

submission to collection department

( Interacted with patients, via phone or in person, in reference to billing

inquiries

SUNY Downstate Medical Center 1998 - 2003

Brooklyn, New York

Collections Department Manager

( Responsible for ensuring all pre-admissions were completed and fully

registered into the database

( Review inpatient, same day admissions, elective and ambulatory cases.

Ensured that cases were appropriately billed.

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( Obtained benefit information and authorization with 24-48 hours of

admission. Collected necessary signatures for all admissions and

appropriate coding for all carriers to secure timely reimbursements.

( Provided assistance to other staff members with the proper Medical Review

process

( Secured necessary documents for inpatient billing to ensure timely

submission to insurances

( Responsible for inpatient, out-patient and third party billing.

( Supervised eight staff members

( Reviewed all retrieve of funds

( Contact with Physician Insurance and Main Hospital Record/Credentialing

New Physicians

( Extensive use of ADS and Human Resources Policy

( Pre-determination of treatment

( Electronic filing

( Worked in the Accounts Receivable Department to recover outstanding and

no-fault claims

( Forwarded medical records to insurance companies. Submitted daily

deposits, pre-determination of treatment plan and CPT codes, verified

benefits, obtained pre-authorizations, scheduled surgery and additional

visits.

Margolin & Meltzer, Esq. 1996 - 1998

New York, New York

Medical Biller/Collector

( Responsible for the collections of outstanding medical claims and

contracted accounts

( Developed new methods and systems to improve collections

( Reviewed daily Aged Trial Balance to determine the necessary course of

action on each outstanding account

( Served as physician and hospital collector for a staff consisting of

nineteen (19) doctors. Managed their medical billing, no-fault claims as

well as pre-authorizations and all other accounts receivable with ICD-9 and

CPT medical codes.

( Identified the time lag factors for payment by insurance carriers.

Estimated the amount of bad debt write-offs, calculated third party

contractual allowance

( Ensured that physicians were appropriately credentialed

( Posted insurance payments

( Informed attorneys of lien balance and prepared them for medical court

cases

( Scheduled appointments for independent medical exams

The Door of Alternative 1989 - 1996

New York, New York

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Duties included:

( Billing services for twenty-eight (28) doctors, medical and obstetrics.

Submitted Medicaid Claims and assisted patients with medical assistance

applications.

ADDITIONAL

( Possess extensive knowledge in Medical Manager, Eagle 2000, IDX and ADS,

LYTEC

( Proficient with Medicaid, Medicare, HMO's, Commercial and Third Party

electronic claims Transmission

( Competent in several word processing applications such as Microsoft

Office

REFERENCES:

Furnished upon request.

ROSALIND WARING

P.O. Box 753159

Bronx, New York 10475

718-***-**** (H)

Dear Sir/Madam:

I am extremely interested in seeking a career opportunity within a stable,

yet progressive organization such as yours. I feel confident that I possess

qualities that mirror both your organization's current and long-term goals.

As a diligent and personable individual with vision, I am enclosing a copy

of my resume for consideration. I am accustomed to diverse work conditions

and I am capable of working independently or as a team player. I am

certain my tenacity and aggressiveness to new challenges, coupled with my

communicative skills and keen attention to detail, my medical background

(which extends 30 years), would prove advantageous to your company.

I am anxious to learn more about your organization and how I can contribute

to its prosperity and therefore look forward to hearing from you in the

near future.

Thank you for your time and consideration.

Respectfully,

Rosalind Waring

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