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Medical Insurance analyst, a/r

Location:
United States
Posted:
October 06, 2015

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Resume:

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.



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