Insurance Medical
Resume:
PAM HORGAN
San Antonio, Texas 78228
OBJECTIVE A challenging position where my skills and background can be an asset
and new skills can be learned.
PERSONAL Organized, dependable and confident... good listener who learns quickly...
high energy level
STRENGTHS Take pride in accomplishment... enjoy learning new skills.
-Able to handle multiple tasks and set sensible productive priorities
-Good communicator with training and supervisory skills
-Determined and resourceful problem solver
PROFESSIONAL -Computer skills and systems used in Windows
SKILLS MediSoft Rescue Net DAVID/QS1
MS Works / MSWord / Excel
Aldus PageMaker / Adobe PhotoStyler / Photoshop
Type 40-50 WPM / Keyboard 10 key by touch
EMPLOYMENT HISTORY
March, 2009 - May 26, 2011 INTERMEDIX / ALEXANDER BILLING AND CONSULTING,
6243 IH 10 West, Suite 555, San Antonio, TX 78201
Data Entry
Company provides billing services for EMS/ambulance and air life providers using
IMX System or Rescue Net/Zoll billing software. Work is assigned by supervisor as
needed and included: setting up new accounts to be coded and billed. Enter information
from hospital face sheets, such as insurance or other missing patient demographics to
every bill. Verified insurance coverage on line using TMHP, TrailBlazer, EVA and Zirmed
sites. Attach all documentation by bar code to the patient’s account; process credit card
payments as needed; verify patient signatures or CMNs are attached to the patient’s
account for MCR & MCD billing. If required information is missing notify supervisor to
request for any missing documents from the client. Pick up mail from the Post Office.
April, 2005 - July, 2008 SAN ANTONIO INJURY REHABILITATION, 5410
Fredericksburg Rd, #102, San Antonio, TX 78229
Medical Billing Coordinator
Working in MediSoft billing software, enter new patient information already verified
by front desk personnel as correct and complete. Compare daily appointment list, sign-in
sheets and superbills to assure all bills have been received and keep a list of what is
missing to be billed at a later date. Enter all charges for chiropractic, physical therapy,
work hardening, Psychotherapy and Chronic Pain Management Program. Download
doctor’s dictation from transcriber, make corrections and print for final proofing. For
workers compensation claims, complete HCFAs, attach required documentation and send
to the appropriate insurance carriers. Copy and file all HCFAs and payments received.
Audit patient files for unpaid bills and resubmit as necessary. Research and resubmit all
denied bills. File requests for MDR (medical fee dispute resolution) or IRO (independent
review) on work comp claims when necessary. Upon completion of treatment of personal
injury claims, compile bills and medical records from all referral providers for submission to
the representing attorney for payment. Enter information into a log for payment tracking
purposes. Pick up mail, prepare bank deposits, post payments and fill medical records
requests. Strong knowledge of TDI-DWC billing rules and requirements, personal injury
claims, and some private insurance.
Jan., 2004 - Jan., 2005 HEALTHSTATS MANAGEMENT, San Antonio, Texas 78216
Work Comp Collections/Billing
Working in MediSoft billing software, appeal Work Comp denials for payment.
After receiving insurance denials, audit the complete patient account for all denials or
unpaid amounts. After ascertaining the extent of all unpaid or denied bills, continued with
research as to why treatment was denied, what was the medical necessity for the denied
treatment, if there was pre-auth when necessary, and secure any missing documentation.
Submit reconsideration letter to the insurance carrier along with any TWCC rules and/or
reasons for the treatment and/or referral. In some cases sending missing documentation
or correcting claims with billing errors was required. Occasionally contact an adjuster to
find out what the problem was so it could be corrected. Post private insurance payments
(group, Medicare, Medicaid, etc), this allowed me to bill co-pays/deductibles not collected
at the time of service and collect payments from patients that may have been paid directly
by their insurance. When current denials were completed I audited patient billing files in
an effort to collect older unpaid work comp accounts that were still collectable or reviewed
by my supervisor for adjustment in an effort to keep the billing files current. In some cases
denied files would have to be sent to dispute or to collection and I would make the copies
of all documentation for that process. Assisted the billing person when necessary to
insure current billing was sent in a timely manner.
Aug., 2001 - July, 2003 SPECTRUM MANAGED CARE, (formerly a division of Ward
North America) San Antonio, Texas 78229
Bill Review Technician
Working in DAVID/QS1 system, receive and process HCFA's for Texas workers
compensation claims. Review insurance adjuster information for correct treating or
referral doctor on each individual claim. Verify diagnosis codes for compensable injury.
Read Peer reviews and/or IME's to assess reasonable and necessary treatment for each
doctor or pharmacy claim. Up date file notes, when necessary, to reflect results of this
research to aid in future bill review. Enter diagnosis (ICD9) codes and CPT codes from
HCFA's into computer program (DAVID/QS1) that is set up to assign payment or override
to deny payment per TWCC guidelines. Print EOB's which are returned to the insurance
adjuster's office for issuance of payment.
1998 - 2001 AMERICAN PHARMACEUTICAL SERVICES, San Antonio, Texas 78247
Accounts receivable / Medicare Coordinator
Enter new patient information, receive weekly Medicare census' to verify correct
billing information from 30+ nursing facilities. Calculate quarterly perdiem rates, and bill
same to appropriate accounts. Update billing information, including insurance or Medicaid
to reflect and bill correct party. Help post payments, run reports, reconcile payments to
invoices and assist in printing invoices.
1997 - 1998 SOUTH TEXAS ASSET RECOVERY SERVICE, San Antonio, Texas 78211
Office manager
Coordinate activities of recovery personnel. Computerized and helped organize
the successful day to day operations, setting up and logging of new accounts, making out
invoices, keeping accounts receivable records and printing weekly reports on accounts
status - open, closed, billed, paid, etc. Responsible only to the owner for individual
business decisions.
1990 - 1997 INNER HEALTH GROUP, INC., San Antonio, Texas 78238
1995 - 1997 CREATIVE PRESS
Typesetter
Responsible for maintaining, creating and updating all master files for MICHAEL'S
three product lines. To include weekly label and Self Care News orders, designing
literature, flyers, catalogs and special order forms.
1990 - 1995 MICHAEL'S NATUROPATHIC PROGRAMS
Warehouse supervisor
Duties include bottling and labeling product, stocking of product inventory,
compiling back order lists for order entry personnel, verifying customer orders to include
product and printed matter.
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