SHELIA FRANCIS accgew@r.postjobfree.com

**** ******* *******, *************, ** 30043 Cell: 678-***-****

ACCOUNT RECEIVABLE SPECIALIST

Dedicated healthcare professional with extensive years of diverse experience in the fields of Home Health and DME billing and

claims cycle. Experienced in analyzing denial trends, interpreting all Medicare, Medicaid, and Private Insurance guidelines and

regulations. Excel in analyzing payment resolution. Ability to effectively manage multiple projects and provide exemplary customer

service. Unique analytical problem-solving ability.

CAREER SKILLS

Customer Service – Inbound / Outbound Calls

Effective Communication Skills

Time Management – Deadline Sensitive

Continuous Quality Improvement

Confidential Correspondence & Data

Productivity Improvement

Multi-tasking and Organizational Skills

Troubleshooting and Problem Solving Skills

PROFESSIONAL EXPERIENCE

Advanced Home Care (formerly ExtraKare), Norcross, GA 10/2012 – Current

Physician Services PAR II

Specializing in obtaining medical documentation needed to qualify patients for Home Oxygen Therapy, Sleep Therapy, and

Durable Medical Equipment;

Contact physician’s office, pulmonary clinics, and hospitals for medical records showing pulse oximetry levels and a qualifying

International Classification of Diseases (ICD-9 and ICD-10) code(s) that meets Medicare criteria in order to secure a valid

Certificates of Medical Necessity (CMN);

Insurance verification to assure In-Network Provider coverage for the services provided;

Contact patients to inform them of their financial responsibility for services provided. Educated patients of waiver of liability by

way of Advanced Beneficiary Notice (ABN) form;

Educated Sales Representatives on what medical documentation their need to obtain from the Referrals/Hospitalists why on site

that will qualify patients for services needed.

CCS MEDICAL, Lawrenceville, GA 8/1999 – 9/2012

Specializes in Medicare Part B reimbursement and billing; Consistently achieves productivity goals with a 98% - 100% monthly

average; Reduced Days Sales Outstanding from 88 days to 45 days; Assisted in company improvement initiative by reducing patient

order turn around time by 67%; Proficient and well versed in communications with Recovery Audit Contractors (RACS) and

responding to federal requests for additional documentation requests (ADRS); Assisted in identify patients enrolled in home health

agency to resolve shipping error.

Account Receivable Specialist

Financially secures patient accounts by reviewing accounts and medical record documentation in effort to collect every

dollar owed to the organization;

Review Certificates of Medical Necessity (CMN) and International Classification of Diseases (ICD-9) codes for accuracy;

Monitors compliance and HIPAA regulations and actively stay abreast of current regulatory requirements;

Analyzes and researches denied claims (Medicare Remittance Notices and Explanations of Benefits) in order to rectify the

claim and retrieve payment due to the organization;

Experienced in organizing and facilitating Medicare and commercial medical claim dispute appeals;

Working knowledge of commercial medical policies and Medicare local coverage determinations;

Patient education and coordination of financial responsibility.

Customer Service Specialist 1999 - 2000

Performed insurance verification and explained benefits coverages to patients;

Effectively assessed and resolved customer concerns and complaints;

Consistent and accurate processing of customer orders and proficient in data entry;

Maintained communications between referring physicians and processed medical record documentation requests.

SHELIA FRANCIS

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Apria Healthcare, Roswell, GA 1/1992 – 7/1999

Lead Cash Clerk

Insured timely receivables and posting thereof;

Researched all unidentified payments;

Posted contractual adjustments;

Maintained account – proficient in excel spreadsheets;

Trained and mentored team members regarding job responsibilities and customer service.

EDUCATION

Nicholls State University, (Thibodaux, LA) – Mathematics Major

Young Memorial Vocational – Technical School (Morgan City, LA) – Accounting Major

REFERENCES FURNISHED UPON REQUEST

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