Medical Customer Service

Joyce Jackson

***** ************ **., ***. **** . Houston, Texas 77067

HM: 512-***-**** . EM: ***************@*****.***

CAREER OBJECTIVE: With 26 years of experience in Business

Administration and the health care industry, seeking a challenging

career that will maximize and utilize a superior and broad array of

experience.

PROFESSIONAL EXPERIENCE:

11/11 - Current - Bellaire Medical - Bellaire, Texas - Billing and

Coding Manager/Office Manager

Brought company from 300K of debt to less than 22K in first 6 months of

employment. Establish policies, implement changes, manage staff of 4.

Maintain HIPAA, OSHA, and governmental regulations, train staff

accordingly and ensure compliance. Audit all patient accounts for

accuracy. Manage all aspects of billing, coding patient accounts for

both inpatient hospital, hospital consults, and office. Advise

physicians on best methods of coding to ensure ideal reimbursement.

Advise and counsel patients on insurance plans and education of

benefits. Serve as focal point for all insurance concerns and questions

for all patients, staff and providers including Medicare/Medicaid,

Medicare HMO/Supplemental Plans, Commercial Carriers, Workers'

Compensation Carriers, Indemnity Carriers. Manage collections of

patient accounts and work closely with collections agency and lawyer.

Maintain all office and hospital billing of 3 providers. Manage and

process all EOB's, electronic payments, mailed check payments, etc.

Manage all claims to carriers and carrier payments, claim issues,

appeals, reconsiderations, etc. Manage all hospital consultations for

providers, maintain primary contact with all providers, maintain all

provider credentialing and insurance carrier contracts and terminations.

Oversee, guide, mentor and direct staff. Provide all staff training as

it relates to the overall flow and productivity of the office.

Coordinate all meetings with and for providers between staff,

representatives, etc. Maintain all financial records, process payroll.

Supervision of patient scheduling, patient registration, medical

records, financial counseling, data entry and processing, monetary

posting, promotion of excellent customer service. Account

reconciliation, patient collection reconciliation, delegate

responsibilities to ensure office productivity. Maintain office and

medical equipment, service and maintenance. Oversee prior

authorizations and referrals for all carriers and carrier types.

Insurance verification, chart preparation of all future scheduled

patients, add-on patients, and walk-in patients. Maintain physician

credentialing and CAQH updates.

06/10 - 10/11 - Mwaiwathu Hospital - Blantyre, Malawi, Central Africa -

Medical Billing Coordinator

Managed billing staff of 6. Responsible for resolving billing conflicts

and issues to make procedures and treatments at ease for patients,

clients, and medical staff to achieve the goal of payments. Recruited

able staff and trained employees using the SAGE Intergy medical billing

software and proper billing policies and procedures. Responded to

specific escalated patient calls, visits and taking action and provided

action on complaints. Prepared patient bills, kept record of bills,

prepared all financial reports on weekly, monthly, and quarterly basis.

Evaluated accounts and maintained patient accounts. Payment posting,

adjustments, appeals process, disputes, collections, proper billing

procedures. Implemented all proper procedures and treatments using ICD-

9/CPT to patient accounts to ensure accurate billing of patients.

06/06 - 06/10 - Round Rock Orthopedics - Round Rock, Texas - Workers'

Comp/Credentialing/Billing/Scheduling

Workers' Comp - Management of all Workers' Comp patients including

policies/procedures in accordance with law requirements, Independent

Reviews, Peer-to-Peer Reviews, Utilization Reviews, case management,

served as focal point and resource for the patient, physicians, staff,

adjusters, nurse case managers. New patient intake, referrals, service

and procedural authorizations including surgery, medical

records/dictation/filing/chart creation.

Billing - Insurance verification, billing, account management,

adjustments, transfers of accounts, joining of accounts, separation of

accounts, claim processing including filing and re-filing of non-

payments and rejections, contacted insurance carriers via phone,

website, and correspondence of unpaid accounts, appeals,

reconsiderations, re-submissions, claim follow-up, payment posting from

EOB's and ERA's, contacting patients for payments and/or payment

arrangements, Med Fee Disputes, refunds, collections, EOB payment

reconciliation, identification and verification of adjustments to clear

accounts, notated accounts regarding adjustments and denial codes.

Credentialing - Maintained credentialing for 10 physicians/surgeons,

including obtaining, reviewing, maintaining licensure, certifications,

registrations for appointment, re-appointment, admittance to health care

facilities and insurance plans for participation and privileges.

03/05 - 05/06 - A.S.H. - Austin, Texas - Clinical Services Executive

Assistant

Supported the CEO, VP of Clinical Services, Director of Human Resources,

Education Coordinator, Director of Marketing, Director of Provider

Relations, Director of IT, Director of Credentialing, and clinical

staff. Provided daily/weekly/monthly/quarterly reporting and analysis.

Maintained medical staff licensure, renewals, re-appointments. Created

clinical files for new and existing staff, meeting minute recording for

top level meetings. JCAHO, Employee/Patient Satisfaction Surveys. Held

Mock Code evaluations and provided statistical results in a manner in

which were used for teaching/demonstration efforts. Managed continuing

education and training provided to staff. Created requisitions/purchase

orders for Administration with proper budgeting and allocating of funds

within appropriate cost centers.

Joyce Jackson

12803 Northborough Dr., Apt. 2015 . Houston, Texas 77067

HM: 512-***-**** . EM: ***************@*****.***

ADMINISTRATIVE EXPERIENCE:

16 Years Exp Patient Acct. Mgmt Billing Payment Posting AP/AR

Payroll Reporting/Analysis Purchasing Budget/Fund Contracts

Allocation

Bookkeeping Claims Processing Insurance Appeals/EOB Reconsideration

Processing s

Patient Medical Fee Adjustments Patient Referrals ICD-9 / CPT

Collections Disputes

Surgery Sched. Surgery Treatment IRO's / Peer Workers' Comp.

Authorizations Authorizations Reviews

Patient JCAHO OSHA Credentialing Project Mgmt

Referrals

Office Mgmt Inventory/Supplies Professional Database HR Coordination

Organizer Coordination

Med Support/EMR Asset Management Data Entry Professional Document Design

Researcher

PERSONAL CHARACTERISTICS:

Highly Punctual Altruistic Team Player Dedicated

Motivated

Loyal Self-Starter Multi Tasking Fast-Track Independent

Ability

Professional Excellent Judgment Workflow Conflict Resolution Crisis

Coordination Resolution

Creative Confidentiality Priority / Task Responsible Integrable

Oriented Delegation

EDUCATION:

Professional: Texas Southern University, Houston, Texas

Business Administration, 145 credit hours, GPA 3.2

High School: Lyndon Baines Johnson High School, Austin, Texas

Graduated June 1992, Science/Academic Honors, Awarded scholarship in

Music and Academics

SOFTWARE SKILLS:

ADP, AS400, Athena, Availity, CheckFactory, CitrixXenDesktop, EArchive,

ElDorado, EMR/EHR, EScribe, EZMed, GBAS, HMS Clinical, Intergy, Lytech,

MediSoft, Microsoft ME, Microsoft XP, MS Access, MS Excel, MS FrontPage,

MS Outlook, MS PowerPoint, MS Publisher,

MS Schedule, MS Visio, MS Word, MS Money, MS Small Business Accounting,

MS Small Business Management, Navinet, NextGen, NueMD, OrthoPad,

PeopleSoft 7.60, PulsePro, Quattro Pro, QuickBooks, Quicken,

ReportSmith, SAGE, SAP R/3, WordPerfect 6.0-2000,

Windows 7-8.1, Windows Vista, ZirMed

CLEARINGHOUSE SKILLS:

Apex, Availity, Emdeon, ZirMed, Gateway, McKesson, InstaMed, Relay

Health, Capario, Kareo, Office Ally, InstaMed, iPlexus, Jet Claims,

Navicure, Payerpath, RealMed, Signature Claims, Affiliated Network

Services, Transmedic, Claimsnet,

TECHNICAL SKILLS:

Typing 75 w.p.m., Data Entry, Database Creation, Website Creation and

Maintenance, Document Design, Image Design, Newsletter/Magazine

Creation, Proofreading, Bookkeeping, Dictation, Shorthand, Copier, Fax,

Scanner, Binder, Collator, Laminator

Contact this candidate