Jessica Sikes
** ****** **** ** ******** Springs, WV 25411
***/***-**** acrzih@r.postjobfree.com
Professional Summary:
Highly efficient Medical Biller with experience in anesthesia, neonatology, inpatient care and emergency room care. Excellent multi-tasker and demonstrated team player with a positive attitude. Strong attention to detail and extensive knowledge of medical terminology. Familiar with commercial and private insurance carriers and I am well practiced in and strictly adhere to HIPAA regulations. I have worked with medical systems including; Kredo, Nextgen and Realmed. I am also very familiar with Excel and Word. I am organized, diligent and proficient and also fully understand the need to adhere to strict time constraints. Seeking a position of increased responsibility and authority.
Professional Experience:
EOB/Appeals Analyst
September 2010 to January 2014
Emergeny Medicine Associates – Germantown, MD
-Demonstrated analytical and problem-solving ability by addressing barriers to receiving and validating accurate information.
-Carefully reviewed medical records for accuracy and completion as required by insurance companies.
-Strictly followed all federal and state guidelines for release of information.
-Examined diagnosis codes for accuracy, completeness, specificity and appropriateness according to services rendered.
-Ensured compliance with medical/legal requirements.
-Consistently ensured proper coding, sequencing of diagnoses and procedures.
-Demonstrated knowledge of HIPAA Privacy and Security Regulations by appropriately handling patient information.
-Thoroughly reviewed remittance codes from EOBS/AR's.
-Evaluated the accuracy of provider charges, including dates of service, procedures, level of care, locations, diagnoses, patient identification and provider signature.
-Completed appeals and filed and submitted claims.
-Carefully prepared, reviewed and submitted patient statements.
-Meticulously tracked and resolved underpayments.
-Ensured timely and accurate charge submission through electronic charge capture, including the billing and account receivables system and clearing house.
-Remained up-to-date with all insurance requirements, including the details of patient financial responsibilities, fee-for-service and managed care plans.
-Maintained record of all accounts/claims I worked on to ensure they processed correctly.
-Attended regular meetings wherein new issues with insurances, procedures and practices were addressed and resolved.
A/R representative
January 2008 to September 2010
AHMA – Frederick, MD
-Thoroughly investigated past due invoices and minimized number of unpaid accounts.
-Demonstrated analytical and problem-solving ability.
-Carefully reviewed medical records for accuracy and completion as required by insurance companies.
-Strictly followed all federal and state guidelines for release of information.
-Accurately entered procedure codes, diagnosis codes and patient information into billing software.
-Consistently ensured proper coding, sequencing of diagnoses and procedures for anesthesia charges.
-Acted as a liaison between the business department, billers and third party payers in resolving billing and reimbursement accuracy.
-Demonstrated knowledge of HIPAA Privacy and Security Regulations by appropriately handling patient information.
-Appropriately and correctly identified errors and re-filed denied/rejected claims as they were received from the Patient Account Representative.
-Added modifiers as appropriate, coded narrative diagnoses and verified diagnoses.
-Thoroughly reviewed remittance codes from EOBS/AR's.
-Completed appeals and filed and submitted claims.
-Remained up-to-date with all insurance requirements, including the details of patient financial responsibilities, fee-for-service and managed care plans.
Supervisor/Customer advocate
July 2001 to May 2005
United Healthcare – Frederick, MD
-Assisted members and call reps in resolving claims issues.
-Received and handled escalated calls from sometimes irate members, in a professional and proficient manner.
- Assured claims were entered properly and adhered to system and insurance regulations.
-Recognized trends that may cause problems in processing future claims.
-Maintained a follow up log to ensure members were having issues resolved properly and timely.
-Acted as a liason between patient and doctors ensuring patients were not being improperly billed.
-Entered data to update and maintain member accouts.