Customer Service Insurance
Resume:
Michael Joseph
Delray Beach, Fl *3444
352-***-**** cell
***********@*****.***
Summary:
Enthusiastic professional with 18 years of experience. Exceptional leadership skills in Management.
Having strengths in Billing, Collection, Appeals, Coding, Posting, Customer Service, Clerical Support, Credits & Refunds,
Insurance verification in Medicare, Medicaid, Managed Care, Commercial insurance, Private pay, while attributing outstanding
quality in the healthcare profession.
Synopsis of Skills
Office Management Techniques Special Projects Contract Interpretation/Negotiation
Medical Terminology ICD-9 CPT Coding Appeals Claims Disputes
HIPPA, ERISA, ADA Regulations OSHA Regulations Patient Records Management
Credits and Refunds Collection Techniques Patient Financial Counselor
A/P & A/R
Professional Experience:
3/22/10 to 9/29/10
Florida Woman Care Delray Beach, FL
Operations Coordinator
*Travel to train office staff on the billing system, how to find patients, schedule/cancel appointments, check pts in/out post
copays/charges, balance tos money, how to submit deposit.
*Create schedule templates; create user id & roles in the system. *Helped the office staff with billing questions and how to do
functions in system.
*Called insurance companied to question denials, processed refunds to the insurance company.
*Worked denied claims in workflow dashboard.
4/17/06 to 3/1/10
BRCH Oncology FKA Center for Hematology Oncology Boca Raton, Fl.
Collections/Payment Specialist
* Set up primary collections, such as follow up on unpaid accounts pertaining to chemo drugs denied through phone
contact and using online services.
* Transferring patient balances, submitting adjustment forms to validate balance write offs.
* Review accounts to verify that payments are posted correctly.
* Pull Medicare, Managed Care and Commercial EOB’s and file to 2ndary insurance and re-bill to insurance carrier when claim
is not on file.
* Post daily charges for office and hospital.
* Post patient and insurance payments while correcting front-end edits.
* Review correspondence to determine when to drop balances to patient and if refund is due. Write up refund request.
* Write up refund request with back up documentation EOB’s (Copy of patient checks, copy of credit card receipts.)
10/04 - 11/05
Tenet Regional Business Office Boca Raton Fl.
Overpayment Representative
* Reviewed accounts to determine if the insurance carrier or patient was due a refund. While reviewing contracts to verify if paid
per contract, request adjustment upon findings.
* Perform end of month process to retrieve money that may have been found.
* Work off of daily sheets by e-mail.
* Write up refund request with back up documentation EOB’s. (Copy of patient checks, copy of credit card receipts.)
* Request adjustment to put a debit balance back on account.
* Request a re-bill of claim to primary and secondary insurance and or to patient.
11/02 - 4/04
HCA Palm Harbor, Fl
Appeals Specialist
* Draft appeal letter based on type of denial.
* Establish phone contact to insurance carrier and request a verbal appeal when denials are due to no authorization, medical
necessity.
* Submit P-line request for adjustment when the denial is upheld.
* Request medical records to attach to written appeal.
11/98 - 10/02
Tampa Bay Women’s Care
A/R Collection Specialist
* Prepare aging reports, then follow up via phone call to insurance carrier for status of claim.
* Request claims to be reprocessed due to denials for no authorization, claim not paid per contract, timely file.
* Determine when insurance carrier and or patient are due a refund from credit balances.
* Process patient incoming phone calls.
* Send claim to secondary with attached EOB from primary insurance.
12/97 - 11/98
Columbia Healthcare Tampa, Fl
Billing/Collections Specialist
* Balanced daily receipts from all charges incurred & patients co-pays.
* Generate paper and electronic claims to insurance carrier and via patient statements.
* Review and correct front end edits.
* Keep track of claim totals for benchmarking.
* Submit month end reports.
* Review A/R accounts for numerous physicians’ practices.
* Follow up calls to insurance carriers for status of claims.
* Requested claims to be reprocessed via phone contact.
* Drafted written appeals for denials received in no authorization, medical necessity, timely file etc.
* Pulled & process ageing reports with follow up call to verify status of claims.
* Review Correspondence, correct any errors when adjustment were requested.
8/97 - 11/97
Med Pros Tampa, Fl (Company was sold & was laid off)
Billing/Payment Poster
* Posted Medicare, Medicaid, Managed Care, Commercial insurance, Workmen's Compensation, private pay.
* Processed ER Medical charts for data entry.
* Verified patients insurance with their insurance carrier.
1/92 - 8/97
ISDM North Miami Beach, Fl
Manager Pathology
* Managed 11 employees.
* Reviewed employees job performance annually in writing.
* Delegated to all employees to adhere to all company policies and procedures.
* Responsible for training all employees to be cross trained in billing, Collections, Coding, Posting, Data entry, Insurance
verification, Credits & Refunds, and Appeals, Florida Workmen’s Compensation.
* Performed audits & reimbursement functions for Medicare, Medicaid, Managed Care, Commercial & patient accounts.
* Generated follow up on unpaid aged A/R through telephone contact or by mail. (No Internet at this time and date)
* Reviewed collection documentation was precise and clear.
* Set guidelines to follow federal law pertaining to confidential information.
* Coordinated Clerical Support Department & Customer Service Department in data entry, Correspondence and Mail
Room techniques. This included any probates that needed to be filed and any aged accounts 180 days old were sent to
outside agency collections.
* Set up monthly department meetings with employees to enlist any additional training, specific trends, projects, overtime, dress
code, time requested off, employee of the month recognition.
* Responsible for personal accounts payable for several Physicians within practice.
* Kept track of their personal checks posted & wrote up Physicians personal deposits weekly.
* Set up separate job descriptions for Billing, Collections/Appeals, Posting payments, Insurance Verification, Credits & Refunds.
* Maintained ongoing knowledge of 1500 and mandatory billing forms and filling requirements.
* Updated and maintained insurance contracts.
* Attended and required all employees to continuing education seminars.
* Meets productivity standards.
* Recruited possible new employees by reviewing resume and setting up interviews.
Medical Software/Computer Software:
Computer literate, including PAR, Medic, Medical Manager, Medic Vision, HCA, IMACS, VI,
On Demand, ACE, Invision, Fl. Med., Star, Isuite, Boca Raton Hospital portal as well as Delray Medical Hospital and Bethesda
Hospital, Easy Print, MSW, Excel, MS, Outlook, as well as various other computer software.
Education:
8/89 - 6/92 Hollywood Hills High School Received Diploma
5/96 - 8/96 EMT Certificate, Broward Community College
Interest:
Bowling league Boca Community Hospital Volunteer Shuttle Bus Driver
Softball league Volunteer Leukemia & Lymphoma Society Bake Sale
Volunteer Cancer Walk Tampa, Fl. Volunteer Cancer Walk Hollywood, Fl.
References Available Upon Request
Contact this candidate