Quality Assurance Insurance

Kristen Williams

*** **** *** ******, ************ PA, 19428

Home: 610-***-**** *****************@*****.***

OBJECTIVE

To enhance my capabilities and qualifications so that I have the opportunity to prove myself as a knowledgeable

employee

Experience

Physicians/Hospital Billing Specialist

May 2013 to July 2013

University of Pennsylvania Philadelphia, PA

Ensured maximum reimbursement to medical groups by actively managing the billing of healthcare insurance claims

and follow up on those claims for payment

Reviewed claims that are denied payment for root cause and attempted to correct the situation through follow up

activities and formal appeal

Interact with specific internal and external business partners to resolve account receivables

Assess correspondence from patients and payors and worked to resolved issues in a accurate and timely manner

Adhered to all internal and external regulations and ensured compliance with all federal, state and institutional

guidelines

Gained knowledge in the application SMS and EPIC

Project Billing Analyst

October 2011 to February 2013

Towers Watson – Philadelphia, PA

Provides support to consultants for the end to end billing generation process

Enter events into Project Accounting as imported from system sources (e.g. Oracle OTL, AP)

Processes invoices and revenue adjustments (e.g. write ups, write downs, gains & losses) off Work in Progress (WIP)

report edits from consultants

Calculate to be invoiced amounts / carry forward balances

Ensure draft and final bills are generated, approved by the consultants, contain supporting documentation

attached if necessary, and dispatched in a timely manner

Respond to and investigate/resolve billing inquiries from consultants and client; route to other parties when

necessary

Ensure revenue is recognized accurately (e.g. in the right accounting periods, to the correct project locations,

correct practice, etc.)

Successfully handle most non routine issues, and escalate to management issues that cannot be resolved

Ensure all work is performed in accordance with targets

Plan and organize work so that Service Level Agreement objectives are realized

Contribute ideas and actions towards the continuous improvement of processes within area of influence

Understand and apply Towers Watsons Accounts Payable processes, policies, procedures and internal control

standards

Interface with other TWFS teams to ensure compliance with cross team responsibilities

Make strong contributions to the productivity of the team.

Work effectively within the team dynamic

Recognize and communicate potential issues to team leader as appropriate; suggest viable solutions for

improvement

Actively assisted in the quality assurance (QA) process to ensure accuracy during the monthly billing process

Participated in the entire EPM invoice bursting process for Towers Watson

Billing Coordinator

September 2010 to November 2010

Trizetto Group – Linthicum, MD

Completed billing functions for group premiums including group set up and maintenance

Prepares and analyzes daily, weekly and monthly billing reports; reconciles and resolves payment discrepancies for

clients

Posted premium payments daily, researched and resolved premium discrepancies

Performed late payment collection related duties including telephone contact with appropriate parties

Maintained a 100% accuracy to meet daily production quota

Gained knowledge in the application Facets, Emdeon and Macess used by Trizetto

Billing Analyst

May 2008 to July 2010

CardioNet – Conshohocken, PA

Managed the flow of patient intake and orders processing to accurately schedule patients and bill insurance carrier

Performed all aspects of initial patient's enrollments by entering patient data from various sources into the

appropriate business applications

Confirmed financial data & benefits from payers along with obtaining authorizations and/ or pre certification as needed

from insurance carriers; as required from coverage and payment

Billed claims through proper billing system, work FA reports, and correct claims issue received on the rejection

reports and have claims re billed

Responsible for error reports oh Heart Access and identification of missing enrollments

Submitted Medicare claims to Medicare and call to verify if claims were received through Medicare claim

submissions

Provided submissions for third party insurance through ECP system

Entered data of billing mnemonics and all required billing information that appears on imaged requisitions

Gained knowledge on ICD 9 and CPT codes

Proficient in the application Nterprise, Webholter and NexGen used by CardioNet billing

Billing Analyst

April 2005 to April 2008

Quest Diagnostics – Norristown, PA

Provided third party, Medicare and Medicaid billing processes in a call center environment

Resolved escalated processes to insure patient/client satisfaction

Trained new employees on the billing process

Verified insurance information and validation and removed patients from collections

Refunded patients if there was overpayment on claims • Submitted Medicare claims to Medicare and call to verify if

claims were received through Medicare claim submissions

Researched and processed duplicate claims by a weekly deadline

Effectively communicated with patients, physicians office and insurance companies via phone, fax, email

andcorrespondence • Gained knowledge on ICD 9 and CPT codes

Post manual cash

Knowledgeable in the application Power Term used by Quest Diagnostics billing

EDUCATION

Strayer University Anticipated graduation date: 2014

Business Administration

Code of Business Achievement rewards

Youth Track & Field Head Coach for C.E.F

Proficient in Medical/Finance Billing

REFERENCE

References available upon request

Contact this candidate