Demeta Murphy

Leesburg, Fl *****

Telephone: 352-***-****

Email: acn3no@r.postjobfree.com

EDUCATION

Medical Management Institute

Medical Coding

Lake Sumter Community College

Office Management Technology/Health Information

Associate Degree

Lake Area Vocational Technical Center

Data Processing

Certificate

Experience

July 20, 2011 – Presently

Florida Hospital Waterman Patient Financial Service

Answer patient’s questions regarding problems with their accounts

Calling insurance representative regarding payment and problem with patient accounts

Confer with insurance companies for overdue payments and to review the terms of services on contract

Locate and monitor overdue accounts, using computer and a variety of automated systems

Post payments to correct accounts-patient or insurance

Communicating to supervisor, peers or subordinates- providing information to supervisors, co-workers, and subordinates

by telephone, in written form, email or in person.

Work denials and rejection to ensure payments daily

Review, correct and update claims with discrepancies for transmission

Reviewing claims and making sure insurance companies paid correct percentages by contract

Identify claim denials where appeals are not needed and adjust appropriately

Maintain days in A/R, aging of accounts and collections with defined goals weekly

Make appropriate decisions for resolutions of unpaid claims

Process correspondence and emails in a timely manner and complete necessary actions

Consistently use online resources for claim follow-up and payor policy changes

Work collection follow-up maintenance effectively to collect payments due, maintaining current daily follow -up dates

Documentation on account is clear and includes information essential for future follow-up

July 12, 2010 – July 12, 2011

The Centers Outpatient Insurance/ Medicaid Contract Specialist

Creating the initial audit Medicaid billing documents for each Medicaid provider number

Performing system sweeps and rebills for any events not billed previous weeks

Confirming the prepared claims is valid for submission through HIPAA compliance software

Transmitting the final validated claims to Medicaid via electronic format

Review, correct, update and rebill any claims with discrepancies before submission

Produce the supporting billing report and create or update the client insurance file.

Submit electronic claims files

Work monthly accounts receivable trail balance to resolve outstanding issues

Process BCBS/UBH claims through availity system, including updating provider and client profiles.

Work denials and rejections to ensure payment of all submitted claims

Conduct insurance verifications

Interact with patients to answer financial questions and set financial arrangements

Monitor daily posting of insurance and patient payments

Monitor daily claim submissions

Credentialing

Develop and implement mechanisms and controls to ensure appropriate billing and payment cycles and accurate and

Timely billing, in accordance with established internal and third party payer requirements

1

Establish, record in writing and implement appropriate billing policy procedures, and procedures for all billing activities

including follow-up on third-party approvals and collection of overdue patient accounts.

Manage actions relating to delinquent accounts, collection agencies, special adjustments, and/or write -offs.

Request, prepare, and/or maintain requested reports on billing and collection activities.

Maintains up-to-date expertise and knowledge of healthcare billing laws, rules, regulations, and developments

necessary for the organization to make informed business decisions.

Prepares and submits clean claims to various insurance companies either electronically or by paper.

Answers questions from patients, clerical staff and insurance companies, Identifies and resolves patient billing complaints

Prepares, reviews and sends patient statements

Reviews accounts for possible assignment and makes recommendations and prepares information for the collection

agency.

December 28, 2009 – July 1, 2010

Lakeview Terrace Home Health Data Processing/Clerical

Produce and monitor accounts receivable reports

Weekly analysis and follow-up of all patient accounts to ensure accurate and timely insurance company, attorney

and patient payments

Accurately projecting future collections based on accounts receivable

Work to achieve monthly collection goals

Type patient charts for home health

April 6, 2007- 02/02/09

Lake Neurology Clinic Billing Office Manager

Tracked team and individual performance

Managed the daily operations of each department

Coordinated work activities and schedules to accommodate business flow

Experience as an Account Rep within a business office setting

Leadership and supervisor and project leading experience

Managed employees on collection process to insurance companies

Consulted with provider billing department on proper billing for services rendered

Coordinated and resolving problems related to system implementation for providers

Conducted interviews and hiring of new employees

Prepared monthly management reports to help determine success of business

Posted and adjusted medical payments from insurance companies

Coordinated contracts for new providers for services

Audited records for missed and under billed charges for services rendered by providers

Resolved coverage issues on claims that were denied by the insurance

Submitted medical claims for Medicare/Medicaid and Commercial Billing

Verified patient benefits, pre-authorization for services rendered

Provided follow-up on accounts via phone and mail

Coordinated input of A/P, A/R and collection accounts.

Third Party Insurance Collections/Insurance follow up and appeals

Successfully handled specific account issues/complaints

Educational planning, performance consulting, interpersonal and communication skills

Skilled in exercising initiative, judgment, problem-solving and decision making

Managed multiple projects simultaneously with excellent time management

Excellent human relations and interpersonal skills necessary for interacting with management

April 2006- April 2007

Advanced Imaging Center of Leesburg Billing Specialist

Answer phones and assist patient with account

Prepare letter of appeal to insurance companies if the company refuses to pay contracted claims/or denies a claim

Submit documentation to support claim

Resubmit claims with corrections if needed for payment for all insurance payers

Post payment to patients accounts

Identify, research and resolve billing discrepancies

Manage accounts by working with and responding to carriers, patients and internal staff to insure timely follow up and

account resolution

Process worker’s comp, third party and PIP auto claims with correct documentation

Work aged patient account

Contact this candidate