Post Job Free

Resume

Sign in

Patient Financial Serivce Representative

Location:
Atlanta, GA
Posted:
July 29, 2015

Contact this candidate

Resume:

Claudia Turner

**** ********** *****

Atlanta, GA 30058

770-***-**** 609- 963-8292

acqzmv@r.postjobfree.com

SKILLS

•Medical Terminology and ICD9/CPT Coding.

•Comprehensive knowledge of Professional and Hospital claims.

•Accounts Receivable, Claims, Customer Service & Precert-Insurance Verification

•Billing on multiple systems including IDX CENTRICITY, NEXGEN, EPIC,EMDEON

•Respond to written and oral patient billing inquires.

Education

Atlantic Cape College Medical Billing & Coding 2008

Kaiser Permanente-Contract Position

January 2015 to Present- Patient Financial Service Representative

Responsible for receiving and responding to oral and written patient account inquiries. Exercise courtesy and patience to maintain positive patient relations.

Accurately interpret, explain and clarify benefits, and billing issues that arise in reference to coordination of benefits; copay amounts; dates, and statement details.

Resolve patient phone calls in a timely manner, which may require making accurate determination of financial obligation based on the financial policy, including collection of insurance, co-payments, self-pay deposits, and assessing the need for other financial counseling and/or charity assistance.

Process year end medical financial statements.

McKesson/Relay Health (Aerotek) - Temporary Position

May 2014 to December 2014- Claims Processor

•Analyzed insurance claims to determine extent of Insurer's obligations. Settled claims with first and third party claimants in accordance with policy provisions and applicable laws.

•Evaluated each claim in light of facts; Affirm or denied coverage; investigated to establish proper reserves; and settled or denied claims in a fair and expeditious manner.

•Thoroughly understood coverage, policy terms and conditions for broad insurance areas and products.

Continuum Health Alliance

October 2012 to April 2014- Precertification Representative

•Reviewed authorization request and make determination on correct authorization process which could be auto approved, referred to precert nurse or medical director.

•Determined authorization requirements based on company policy, member benefits and provider status.

•Received request for authorization from hospitals providers, members, and vendors.

•Notified responsible parties prior to issuing denial letter and ensured that member and responsible party understood details of letter and appeal process.

•Completed review of all non-authorized medical claims.

Centene Corporation

May 2012 to October 2012- Provider Service Representative (Temporary Position)

•Received incoming telephone inquiries from providers with claim payment and patient responsibility information.

•Documented all activities for quality and metrics reporting through the Customer Relationship Management (CRM) application.

•Researched and identify any processing inaccuracies in claim payments and route to the appropriate site operations team for claim adjustment.

•Processed written correspondence and provided the appropriate level of follow up.

HCA Parallon

December 2011 to May 2012- Billing Specialist (Temporary Project)

•Worked and identified insurance edits through the electronic billing system.

•Submitted required paper billing to insurance carriers, attached I-bills, ER records and implant invoices to paper billing.

•Communicated issues with patient access and facility departments.

•Researched information maintained and followed up on a daily/weekly basis on transmitted pending claims.

•Transmitted all electronic claims to the billing vendor using SSI to send directly to the insurance carriers.

Children’s Health Alliance

April 2009 to August 2011- Claims Processor/ Account Receivable

•Reconciled account disputes and processed claim adjustments to ensure proper A/R balances.

•Determined if claims should be rebilled due to incorrect procedure codes or diagnosis submitted.

•Ensured claims are refilled and or billed to the secondary insurance in a timely manner.

•Followed up on aged accounts and maintained current documentation on each assigned patient account.

Amerihealth Keystone Mercy

September 2008 to April 2009- Claims Examiner

•Processed and evaluated medical and dental claims.

•Reviewed and correct data on medical claims along with submitted necessary adjustments.

•Verified procedure and diagnostic codes to ensure accurate billing.

•Corrected system edits and payer rejections.

Atlanticare Health Plan

September 2004 to June 2007- Member Service Representative

•Handled incoming calls from members and providers for PPO, HMO and traditional plans.

•Verified and explained benefits based on Employers plan.

•Interpreted benefits based on services provided.



Contact this candidate