Customer Service Medical
Resume:
Toni Bethune
Raleigh,NC *****
****.*******@*****.***
Education
CPO
Certified Paraoptometric Raleigh, NC
Centura College Virginia Beach, VA
Associates Degree of Occupational Science in Medical Assisting 09/2012
Concentration: Management
Miller -Motte Technical School Cary, NC
Certificate of Medical Assisting 01/2007
Experience
Duke University Health System Durham, NC
Clinical Billing Specialist 6/2013-Present
• Reviewed bills for patients that are identified and flagged as participating in a
clinical trial.
• Educated providers regarding compliance with government regulations with
special attention to CMS guidelines as they pertain to billing for patients enrolled
in clinical trials.
• Reviewed grants and clinical trials to ensure it is still within compliance.
• Ensured that charges are associated with grants and clinical trials are being billed
appropriately for both physician and hospital services.
• Created a central database for grants and provided instruction to all new users.
MCM Occidental Fire & Casualty Raleigh, NC
COA Medical Review Technician 8/2012-3/2013
Reviewed bodily injuries from the demand package for entry into the COA system.
Entry of the injuries sustained by the claimant or insured.
Entry of the treatment received by the claimant or insured.
Processed the medical treatments and injuries report for a settlement evaluation.
Compared the COA settlement evaluations with settlement evaluations done by
claims adjusters from different offices.
Eye Care Associates Raleigh, NC
Medical Claims Specialist 05/2008 – 03/2012
Manage medical record files for reimbursement and compliance purposes, entering
cpt codes and diagnosis for billing purposes, or compiling and summarizing the data into
usable report form
Process patient accounts for billing and discharge including preparation of charges,
collection of monies, and issuance of receipts for monies collected
Communicate with patients about insurance issues; calculate medical bills and
identifying insurance payments versus patient obligation
Reduced department’s accounts receivable numbers by $200,000 within ninety
days
Increased departmental productivity 25% by implementing electronic reporting
procedures
University of North Carolina Hospital Chapel Hill, NC
Medical Coder/Biller 02/2008 – 09/2008
Researched missing or absent documentation reported and cross referencing
procedures with CPT codes and Medicare guidelines
Compiled excel and access reports for processing through Navigant Consulting
Provided clerical support by filing, creating memorandums and establishing office
automation
Processed upwards of 1400 claims weekly, recoding for insurance and billing
accuracy
Fidelity Cary, NC
H&W Customer Service Representative 07/2007 – 11/2007
Created statistical reports for all call center employees
Processed benefit transactions accurately for employees and employers
Effectively utilized and navigated Internal Resources application to determine the
appropriate solution for the client
Answered customer inquiries concerning healthcare plans and benefits while
adhering to measurable departmental goals
Blue Cross Blue Shield of North Carolina Durham, NC
Claims Specialist 02/2002 - 01/2007
Processed customer transactions including suspended claims, adjustments, and
other customer inquiries
Researched claims with providers to reach a billing agreement in lieu of timely
filing
Processed claims that could be handled at the first point of contact
Returned standard Medicaid/Medicare and private payor claims forms to providers
and subscribers for corrections
Kelly Services Durham, NC
Front End Specialist 11/2001 – 02/2002
Entered insurance claims prior to payment processing, ensuring demographic
information was complete and accurate
Handled complex claims by converting insurance documents within electronic
medical records to paper forms for return to providers for corrections
Trained new employees on electronic medical records applications and proper
procedures for processing insurance claims
Processed complex or difficult to resolve claims and transporting them to the
appropriate department for further research and correction
Computer Skills
MS Office Suite 2007, Mobisys, Misys EMR-All Scripts, Siemens A2k and WebCIS,
Officemate, Epic, Legacy
Contact this candidate