Insurance Customer Service
Resume:
DeShaun Mack
Charlotte, NC 28269
Objective: To secure a challenging position within the medical field, in
which prior experience, education, professionalism and ambition can be
utilized to achieve any task with profitable results to the company.
Professional Skills:
IDX, Groupcast, Onbase, BTC, Freedom systems, 10-key calculator, multi-line
telephone, fax, copier, Freedom, scanner
Windows 95, 97, 98 & 00': MS Word, Excel, PowerPoint, and Internet
Education:
1996-2000 Summerville High School, Diploma Received
Employment:
October 2008 - present: PSA (Pathology Service Associates) Billing
Specialist/Team Lead
Train new and existing employees. Assist staff and/or management with
questions or concerns. Act as liaison between staff and upper management.
Post patient charges, research patient demographic information. Create
spreadsheets. Account for all payments received from insurance carriers.
Post payments, denials received from insurance carriers. Maintain excel
spreadsheets of accounts receivable. Reconcile accounts receivable reports.
Process correspondences received from insurance companies and perform
pertinent follow up calls. Place outbound calls to insurance companies,
patients, doctor's offices and/or facilities as needed to research and
resolve patient accounts. Answer incoming calls from patients, insurance
companies, doctor's offices while utilizing proper customer service
protocol. Document all actions on patient accounts. Add/remove/update
insurance information on patient accounts. Assist with coding and error
resolution. Run QA reports to detect any cash flow issues from insurance
carriers. Research all information needed to complete billing process
including getting charge information from physicians. Follow through entire
billing process to have claim paid. Develop and keep a working relationship
with clients.
October 2007-October 2008: PSA (Pathology Service Associates)
Electronic Denial Interchange (EDI) Associate /Audit Associate
Ensuring that every electronic claim is making it to the payer and that
payment is received on a majority of the patient accounts within each run.
Balance EDI spreadsheet. Validate payment(s) or rejection(s).Work Edit
reports via Task Management daily .Process Second level rejections via
TrackEdit, and process all other formats via paper or image daily. Work
patient accounts found on the scrubber report and rejection queues. Open
work orders for payment reports missing after 72 hours of the files being
sent for both 997's and second levels reports. Contact insurance carriers
on an as needed basis to resolve the more difficult rejections. Assist in
working the QC Claim Delay custom and claim group reports monthly. Comment
all actions taken on all patient accounts. Work with fellow staff members
and other offices to expedite insurance carrier, format, and/or run issues.
Communicate any potential issues/problems with management to avoid any
decrease in cash flow. Work with EDI programmers to resolve any format
issues. Work with billing system coordinators to set up rules in the
system. Validate through the Edmeon website all commercial insurance
carriers that can go electronic and cross reference the billing system
monthly. Call insurance carriers to get good policy number in order to
submit a clean claim. Run audit journals in order to monitor and minimize
billing errors or duplicate CPT codes.
March 2007-October 2007: PSA (Pathology Service Associates) Payment
Associate/Audit Associate
Process payment batches within 24 hours of receiving. Post all payment
remit deductions, adjustments and denials in the order they appear on the
EOB, rejection report, or payment coupon. Process electronic remittances,
including creating EOBs, payment reports, and rejection report in
conjunction with dropping payments electronically. Process lockbox and
credit card payments. Call insurance companies to resolve any issues such
as: withholdings, missing patient information, request duplicate
remittances. Send complete batches to Onbase. Daily balancing of all
payment batches, checking doctor codes, payment dates and batch totals on
audit journals. Compare client deposit logs with deposit tickets. Run audit
journals in order to monitor and minimize billing errors or duplicate CPT
codes.
October 2005-March 2007: PSA (Pathology Service Associates) Medical
Billing/Audit Associate
Enter all billing information required to create a complete patient
account. Enter additional CPT codes into IDX/Groupcast accounts. Submit
completed batches to IDX.Work error reports for the Charge Departments.
Research missing patient information. Monitor client charge goals. Keep
accurate log of updated client information. Run audit reports in order to
monitor and minimize billing errors or duplicate CPT codes.
References available upon request
Contact this candidate