Debra Franklin

708-***-****

ad49pe@r.postjobfree.com

MY PROFESSIONAL RESUME 114

Remote Retrieval Operations Specialist, United Healthcare, March 04, 2024 (Contract)

• Working for a variety of Hospitals, Banner Health, Rady's Children's Hospitals collecting the necessary information, using the Epic System to look-up patient's

information. Proficient in using Microsoft Teams, Word, Adobe, Saleforce, Sharepoint.

•Print, copied and pulled demographics, Emergency visits, History and Physicals, Admissions, Discharge Summaries, when prompted to do so.

• My duties also included coping, correspondence, handling claims submissions, using Power Charts to look-up the patient's.

• Entering information into Remote Access Log, to keep-up with daily activities for the week.

• Used several applications, Robo Form, ISlet, ILead, and Faucet to preform a variety of assignments.

• Document Direct for Windows, Epic Software, Epic System to handle Claims and Microsoft Access for a variety of project assignments.

UST Health-Proof: Remote Medical Billing Specialist, Nov 2022- June 2023

•Uses two monitors/Laptop to accomplish Claims Processing.

•Process 100 to 150 claims daily, using Health Edge Manager.

•Used Microsoft Excel to pull-up and enter the outcome of claim processing.

•Used Health Edge Manager to search for an Authorizations to pay the claims.

•Denied and paid claims when documentation allowed.

•Checked for participating and Non-participating providers.

•Examined the UB-04 for missed or unclear information.

Paid surgery and Evaluation and Management codes that do not require an Authorization using Excel Direct Access information to accomplish my goals.

Remote Medical Billing Specialist : Opus Health Bridge water New Jersey, October -2021-September-2022 (Contract).

•My duties included calculating and collecting payments for medical

• procedures. Reversing claims, doing Prior Authorizations. Working on outstanding

claims, collecting and calling patient or provider for missed information to re-submit

the claims for reimbursement. Working in account receivable, making sure that all

of the old claims get worked really hard, in order to get them submitted for payment

Updating patient data, developing payment plans, while adjudicating and working on

denials.

• Prepared, processed and submitted claims to commercial insurance carriers

• Examined patient's bills for accuracy, while handling high volume phone calls

•in a fast-pace environment. Using the Epic System to enter insurance payment

•and demographic, guarantor and other information, that pertained to the patient

•Requested missing documentation from the provider, or third party payer

•Checking the EOBs, to determine patient deductible, Coinsurance, and Co-Payments.

• Using the NDC, Registry for information on active and Certified, finish and unfinished drugs submitted to FDA.

•using the NPI Look-up to confirm doctors, specialty or medical entity.

Remote Customer Service Representative/Housing Specialist: Guide-house, Chicago IL. (contract). June 2021 - August 2021

•Supported the insurance of Housing Choice Vouchers (HCV) by coordinating the flow of documents throughout the department according to established procedures

•Worked with people who applied for assistance and tracked issued vouchers through lease-up or expiration.

•Assisted with scheduling and preparing for new admission appointments.

•Worked with clients with vouchers who need assistance overcoming barriers to being housed. Researched options and provided referrals to agencies and landlords as needed.

Remote Call Center Representative: Atrium Health Charlotte North Carolina, (contact) February -2021 - May-2021

•Using the Epic System to enter patient demographic information, check insurance verification, collected payments on outstanding accounts.

•Provided clerical support services in all expertise and knowledge.

• Ensured competent and accurate appointment scheduling, using the Epic System, while maintaining the efficient flow of all incoming, and outbound calls.

•Provided appropriate screening, handling and routing of incoming phone calls, Using Jobber and Web track, while making sure patient messages were taken appropriately with pertinent information. Provided special instructions if needed. Canceled and rescheduled appointments, when requested.

Remote Certified Medical Billing and Coding Instructor: Wyzant Tutor Chicago, IL. January 2019-2020

•Tutored students individually or in a scheduled group study session to review principles, solve problems, and prep for exams.

•Researched and selected learning materials.

•Assisted students with homework, organized and coordinated handouts and study guides, as it related to their curriculum.

Medical Billing and Coding: Elite Treatment Center Chicago, Heights IL. (temp) November -2018- December 2018

•Prepared and submitted Medicaid claims for various insurance companies.

•Used the encounter 1500 Center for Medicare/Medicaid forms to obtain data, to generate the proper coding services, procedures, diagnoses and treatment. Prepared and sent claims for payment. Corrected rejected claims, tracked payments, and followed up with patient and insurance companies, regarding outstanding payments.

Chemistry Lab Assistant: Meriuex NutriSciences Crete, IL. (temp) August -2017 - December 2018

•Collected and prepared samples in accordance with established procedures.

•Helped food scientist with food research, development and quality control.

•Medical Record Abstractor: MMY Consultant, Indiana, (contract) May -2015 - August - 2015

•Used Allscript and the Epic Systems, to review patient files and extract key data and information. Entered the detailed data/information into the Electronic Medical Record System. Responsible for completing thirty-two or more charts daily.

ORC Pro Tel Marketing: Call Center Representative, Lansing, IL. (Contract) January 2014 - November - 2016

•Helped customers with any complaints and questions.

•Gave customers information about products and services, took orders, and processed returns. Resolved complaints via phone and email.

•Verified accounts, collected payments and resolved issues.

Medical Records Clerk: Medical Office Building, Chicago, IL. August -2009 - July - 2013

•Medical Records Department: Medical Office Building (Chicago, IL) August 2009-2013

•Used analytical skills, to prioritize charts, for nine primary care physicians. Coded HCC

•condition using ICD-10-CM coding guidelines

•Scanned, copied, faxed, documents into the Electronic Medical Records System to different entities by request.

Education: Taylor Business- Associate Degree Medical Billing Specialist

Northwestern College - Medical Coding Specialist

University of IL. Practicum, Chicago IL.

HEDIS Certificate

AHIMA ICD-10-CM/PCS Coding Proficiency Exam (Passed)

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