Case Manager

NORELL STOVALL

****Lettia Road

San Pablo, CA. **806

Phone 510-***-****

Email: *************@*****.***

Summary

** ***** ******* *** ****** experience

Accounts Receivable

Medical Assistant -Bryman Career College San Francisco CA

Strong Medical Coding

ICD-9 and CPT4 Billing

Electronic Claims Filing

B.A. Human Service Management -University of Phoenix Walnut Creek CA

Patient Billing

Proficient in MS Word, Excel, Outlook, and PowerPoint

Excellent Problem Solving Skills

Typing 55 wpm

Financial Reporting

Excellent Customer Service Skills

Excellent Verbal Interpersonal Skills

High Call Volume

Cash Posting

Medical Credit Refunds

Government Billing/ Follow Up

Insurance Collection

EPIC

Respond to Patient Grievances/ Complaints

Reconciliation

Professional Experience

Alta Bates Summit Medical Center (Oakland, CA)

February 2014- July 2014

Patient Relations Coordinator

Investigate, coordinates, and resolves patient grievances concerning quality of

care through a formal grievance process.

Serve as a liaison between patients and physicians to maintain open lines of

communication and ensure the delivery of quality care.

Adheres to healthcare regulatory laws - CDPH, CMS, ADA, AND HIPPA

Ability to work independently and handle volatile situations.

Provides strategic support to managers that relate to continuity of care and

patient satisfaction.

Respond to daily influx of telephone and written communication from patient and

staff complaints.

Works discreetly with high confidential information in a high pressured

environment in a calm and effective manner.

Work with Risk Management Director to report and resolve issues that may result

in potentially compensable medical -legal events.

Assist social service department in complex grievances.

Ensure legal claims are filed and submitted properly.

Consults with Ethics, Quality Management and Peer Review Committees on complex

care issues.

Highly developed complaint management skills.

California Pacific Campus (San Francisco, CA)

April 2013 - December 2013

Contracted Financial Counselor

Prepares and submits clean claims to various insurance companies either

electronically or by paper.

Knowledge of basic medical coding and third-party operating procedures and

practices.

Evaluates patient's financial status and establishes budget payment plans.

Follows and reports status of delinquent accounts.

Resolve credit balances and initiate refund requests.

The Financial Counselor/Insurance Verifier Rep interviews and provides patients

with specialized financial payment arrangements.

Identify all potential financial concerns, assists patients, family members or

representatives with State, Federal, local and other entitlement programs

available to them including SDMC's Charity Care program.

Responsible for securing financial responsibility which includes obtaining

authorizations, eligibility and verification of coverage to ensure accurate and

timely billing.

Works closely with Case Management, Social Services, Providers, HIMS, Coding,

Regional Patient Financial Services and vendors.

Responsible for conducting extensive financial screenings for both inpatients

and outpatients, enforcing and explaining the financial policy, ensuring that

all requirements are met in order to optimize reimbursement, and completing all

necessary manual and automated documentation necessary for admission.

Ability to utilize conflict resolution techniques and defuse situations.

Respond to patient grievances in accordance with Medical Center policy.

Review patient satisfaction results and investigate patient complaints.

Department of Veterans Affair (Vallejo, CA)

November 2011 - August 2012

Contracted Financial Accounts Technician

Review, analyze, and monitor accounting transactions for accuracy.

Knowledge of Physician Coding using CPT, ICD-9, HCPCS Modifiers.

Knowledge of third party carrier operating procedures and practices.

Skilled on defining problems, collecting data and interpreting billing

information.

Monitor claims through payment cycle to ensure accurate payment by payers.

In depth knowledge of payer regulations and reimbursements to ensure accurate

reimbursement

Communicate with third-party payers to process claims and reimbursement.

Research and reconcile discrepancies associated with patient accounts and

third-party bills.

Adjust budgetary data in automated patient accounting systems and third-party

billing systems.

Apply knowledge of ICD-9-CM and CPT/HCPCS coding terms to interpret and resolve

medical billing issues.

Advise on and submit billing forms to third-party payer.

Monitor customer accounts for delayed and nonpayment; maintain accounts

receivable customer files; investigate and resolve customer queries

Performs analysis and reconciliations of accounts in accordance with accepted

standards, analyzes results, evaluates trend and reaches specific conclusions

which form the basis of recommendations for subsequent actions.

Research, audit, and process insurance denials, payments and follow- up course

of action.

Collect deposits/cost shares, reporting, service estimates for

patients/providers and participation on work groups training.

Anthem Blue Cross (Sacramento, CA)

March 2011- September 2011

Contracted Medical Assistant

Responsible for assisting with medical records review projects, data collection,

chart copying, and clerical assistance.

Traveled between Alameda County, Santa Clara County, and Contra Costa County to

copy medical records.

Ability to lift 50lbs and stand for long period of time.

Assist with medical examinations, take vitals.

Great medical terminology, maintained an organized daily log of records.

Responsible for mentoring and training of all office personnel.

Held regular meetings with staff to go over policies and procedures.

Coordinates scheduling, approves time off, employee coverage.

Conducted employee reviews and monitor performance of all personnel.

Maintained facilities, equipment, & office supplies.

Marin General Hospital (Greenbrae, CA)

November 2010 - January 2011

Contracted Radiological Support Specialist

Maintained and retrieved Radiology files and result reports.

Provided Radiology receptionist duties.

Performed patient scheduling and completion of all demographic and

protocol-specific information.

Insurance verifications and authorizations.

Great attention to detail and excellent customer service skills.

Negotiate payment arrangements with patients.

Update demographic information on accounts.

Verify the patient's identity prior to disclosing information.

United Behavioral Health (San Francisco, CA)

September 2009 - May 2010

Contracted Sr. Data Entry Clerk

Monitored expenses and ensure project delivery without crossing the set budget.

Entered alphabetic, numeric data for documents in to computer databases.

Reviewed error reports and enter corrections.

Filed and route documents after entry is appropriate.

Responded to inquiries regarding entered data.

Kept track of received data and documents.

Coordinated mail and distribution.

Directed and coordinated project planning and tracking.

Supervised employees for various work projects to ensure project delivery on or

before the scheduled date.

Delivered the project with minimum errors and high quality using appropriate

risk management techniques and process controls.

Responsible for the accurate and timely posting of all insurance /patient

payments and contractual adjustments.

Process and post all refund checks.

Bay Medical Management (Walnut Creek, CA)

July 2006 - December 2008

Scheduler/ Receptionist

Answer phones, schedule appointments, obtain insurance authorizations, copied

documents.

Greet and register patients for CT/MRI appointments.

Strong data entry and PC skills.

Familiar with Star, RIS, Excel and Power Point.

Ability to manage multiple priorities, utilize time effectively and meet

deadlines.

ICD-9 and CPT4 billing.

Identifies and communicates reimbursement issues with management.

Identifies credits and write-offs and provides documentation for approval by

management.

Prepares and reports proper application and policies for overpayment and/or

refund requests.

Interacts with supervisor or manager for approvals and actions needed to resolve

outstanding refund request.

CCRMC (Martinez, CA)

January 2005 - June 2006

Hospital Operator

Ability to handle multi-phone lines and assist with transferring calls.

Accurately connect callers to their requested destination.

Provide appropriate information and assistance as needed.

Accountable for operating the telephone switchboard console.

Excellent public relation skills, oral and written communication skills.

Announce all over-head pages such as emergency codes.

Familiar with SQL, Intel Desk, organized a daily manifest for all codes

announced.

Answer calls in a courteous and timely manner, accurately connect callers to

their requested destination, and provide appropriate information and assistance

as needed.

UCSF (San Francisco, CA)

January 2001 - December 2003

Medical Administrative Assistant

Schedule appointments, answer phones, filing, insurance authorizations and

copied documents.

Scheduled all surgery cases.

Collected co-payments and maintain accurate demographic information.

Demonstrated the ability to take initiative, organize and prioritize workload.

Back-office medical assistant duties.

ICD-9 and CPT4 billing, familiar with EZ Cap, Meditech, Medical Manager,

Horizon, Power Point and Excel.

Review patient account ledgers and billing statements for accuracy.

Research and process patient refunds and account adjustments as needed.

Evaluate claims for accuracy, completeness, timeliness, and compliance with all

applicable requirements.

Process requests for additional information, remittance advice, denials,

tracers, error correction reports, appeals, void and replace transactions as

needed.

Research and provide information to appropriate department or agency for further

consideration and/or for adjustments as required by the Midi-Cal, Medicare,

Insurance, CBHS Policies and procedures.

Technical Skills

MS Office, Access, Medical Manager, Excel, IDX Shed, Horizon, EZ Cap, GE,

Meditech, Power Point, Facets, Linx, Vista and CMM, Computerized Patient

Records System, Sunrise, Live OR Manager, IVERS, Epic, Midas,

Education

Medical Assistant - Bryman College (San Francisco, CA)

B.S. Human Services - University of Phoenix (Concord, CA)

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