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Medical Insurance

Location:
Fairburn, GA
Posted:
June 26, 2015

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Resume:

Wanda Ray Brown

Medical Billing and Collection Spec

**** ********* **** - ********, ** 30213 acqf0f@r.postjobfree.com - 224-***-****

Challenging position in the Medical Financial Department

WORK EXPERIENCE

Revenue Cycle Specialist

University of Illinois Medical Center - Chicago, IL - November 2013 to June 2014

Responsibilities

Responsibilities for thoroughly investigate denied claims to ensure timely and proper follow up. Contact insurance carriers through website, email, telephone to resolve outstanding accounts.

Appeal and resubmit unresolved claims.

Post denial codes and adjustments in the systems also corrected registration information.

Research and obtain required documents to resolve misdirected payments issues.

Refer non-posted Explanation of Benefits to the posting Manger also Coding Error to the billing manger.

Responsible for the denied claims in the work queue corrected error and transmit claims to all payer.

Accomplishments

All the payer A/R down each month locating un-posted EOB.

Explain to manger the reason for the denied claims. Skills Used

Investigate denied claims also medical coding errors, posting payment, working the work queue.

Cash Application Specialist

Northwestern Medical Faculty Foundation - Chicago, IL - April 2013 to October 2013

Responsible for posting payment and adjustments per the explanation of benefits for various payer’s as well as processing denials from different payers.

Investigates and reconciles patients for refunds.

Post manual bank deposits in different software Epic, CLMSA Athena, Tiger, and IDX.

Billing Specialist Supervisor

Friend Family Health Center Federally Qualified Health Center - Chicago, IL - November 2010 to March 2013

Manage billing and collection operations to ensure timely reimbursement.

Manage accounts receivable by developing staff work flow that will ensure appropriate coding of services, timely filing of claims, refund processing and effective follow up on outstanding accounts.

Credentialing new providers and monitor all providers licenses and certifications.

Monitors posting of any contractual adjustments also employee performance.

Generate reports and compare actual to budget variances.

Quality Assurance Supervisor

Access Community Health Network Federally Qualified Health Center - Chicago, IL - 2007 to 2010 Document error rate improvement processes in scheduling, registration and charges posting through exception reporting. Record statistical data from exception records to investigate documents at occurrence by type location and provider and/or staff.

Research claims denials and underpayments and contact insurance carriers for claim statuses.

Correct account transaction and post all insurance and self-pay payment.

Conducts financial assessment interviews with clients to ensure proper identification of payment sources.

Updated Medicaid and Medicare rules and regulations for FQHC.

Monitoring employee performance.

Team Leader Billing Specialist and Benefit Specialist

Access Community Health Network Federally Qualified Health Center - Chicago, IL - 2004 to 2007

Responsibilities

Regularly reconciles daily electronic billing report with mainframe billing report to assure that all claims eligible to be billed.

Audits patient registration information and performs quality management activities. Ensure that all duties are performed in a timely manner and accordance with policy.

Meeting regularly with staff to inform of work in process.

Responsible for accurately posting manual and electronic batches, adjustments and denials and reconciling posting error.

Skills Used

Strong analytical and problem solving skills.

Ability to plan and organize work in an efficient manner.

Ability to run various reporting that supports role.

Good initiative and assertiveness.

Medical Billing/Collection Specialist

The Wish Center - Downers Grove, IL - 2000 to 2004

Performed billing for Midwest trauma and General Surgery, ensures that

Accurate claims are transmitted in a timely matter either

Electronically or hard copy. Performed daily billing functions

Including coding super bill, utilized the current ICD-9 and CPT

Procedure codes, analyzes account detail to ensures that proper

Reimbursement has been received. Interacted with patient, insurance

Companies, attorney regarding physician's liens. Also work with

Patients with financial needs making decisions on monthly payment

Arrangements and related matters. Taking appropriate action related to

Payments delay and denials, counsel's patients regarding appeal letter

To insurance companies and negotiation with auto insurance regarding

Medical pay on auto claims also working with worker's compensation

Carriers. Knowledge of Medicare, Medicaid, managed care, fair debt Collection practices.

Lead Medical Biller/Collector

Advanced Management, Inc. - Orland Park, IL - 1998 to 2000

Responsible for billing claims for infertility practice, reviewed

Denied claims, corrected coding problems and refilled back to insurance Companies. Documented coding issues and errors and reported problem to Consultant in charge of correcting accounts receivable backlog.

Responsible for posting payment and closing the system at month end. • Utilize Medical Manger software.

Billing Supervisor

Monroe Medical Associates - Munster, IN - 1990 to 1998

Responsible for overseeing the day to day billing functions for

Oncology Hematology practice also running electronic billing, payment

Posting, Mailed and picked up and bank deposit and refund over payments

Back to insurance companies. Followed up on all outstanding denials

While working with patient with financial needs. Developed and monitoring employee performance ensuring that claims are sent out in a Timely and accurate fashion.

Claims Adjuster

Corporate Systems - Lisle, IL - 1994 to 1995

Claim Adjuster

Compass HMO/PPO - Chicago, IL - 1991 to 1994

RIM, Medical Manger

Rush Anchor HMO - Chicago, IL - 1982 to 1991

Florida Share, Millbrook, and Excel, Microsoft offices, spreadsheets and word processing, IDX, Meditech, HBOC, Allegra, Mysis, SMS, NEBO, Epic, Medicom, Ecare, Meditech-LSS, Centricity.

Also online Insurance provider claims status.

Billing Specialist

St. Francis Health Care - Skokie, IL - 1987 to 1990

Responsible for collection for all location following up on all outstanding accounts.

Working with patient with financial needs.

Correspondence with insurance companies regarding outstanding accounts,

Complete injury reports also input encounter forms also posting payment from the collection agencies.

Strong effort in payment recovery.

EDUCATION

Basic Subject

Du Sable High School - Chicago, IL

1979 to 1982

ADDITIONAL INFORMATION

SKILLS PROFILE

Excellent communication skills, strong negotiation skills, diplomacy, tenacity and effective decision making also problem solving skills. Knowledge in claims processed all types of medical claims Dental Claims, Auto claims, Worker's Compensation claims, and Medicare A/B claims

Pension claims, DME claims, Home health claims, Infusion, Managed Care/HMO/PPO, Nursing Home,

Inpatient Coding, Medicare A/B

Medicaid claims also Third party claims, Reading skills E/R reports

Radiology reports, strong medical terminology. Medical Physician's billing on CMS1500, Hospital Billing CMS04, COB, and TPL Subrogation.

Good customer-relations background.



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