Customer Service Medical Billing

Harold Evans **** Gathering Lane

209-***-**** Manteca, CA 95337

408-***-**** *****.*******@*****.***

Summary of Qualifications:

Successfully completed an intensive Medical Billing program and Business Administration. Demonstrated

the ability to work productively and accurately in a detail-oriented environment. Outstanding communication

and interpersonal skills. Self-starter, team player and independent worker: Good follow-up procedures.

Professional Profile:

the claims processing operations and assists in

documenting claims processing procedures

Medical Terminology

Prepares and reconcile monthly claims

expense analysis reports to database reports and

Billing and Collection

ensure all necessary corrections are

ICD-9 CPT

made

HMO and PPO knowledge

Reconcile monthly capitation payments and

Medicare, Medi-Cal, Champus,

Champva update database accordingly and provide

Ensures timely adjudication and payment of monthly report

claims

Determines and implements changes to

Microsoft Word Microsoft Excel Meditech Quickbooks Pro Payroll Accounting Principles

Excellent Organizations Skills

High sense of integrity Ability to Prioritize work load

Extensive customer service background

Extremely conscientious individual

Exceptional time management techniques

Experience: Johnson Controls Inc, Fremont CA

9/07-to Current Material Handler/Purchasing

Issue PO’s to venders for purchasing material to be delivered to our shop or to the

site. Keeping in close contact with field foreman to ensure those materials

requested be delivered correctly. Stays in close contact with our venders to ensure

all material is delivered in a timely manner. Enters all data into the Oracle

database to ensure payment of PO’s to venders. Research and resolves issues

regarding any discrepancies and ensure accuracy of PO’s

Experience: Tuolumne General Hospital, Sonora CA

4/-02-9/07 Patient Account Representative

Inpatient hospital billing, Medicare, Medi-Cal, using 1500 and UB92 forms. Bills

both primary and secondary commercial insurance, and private payers. Prepares a

variety of statistical and financial reports relative to the maintenance of patient

accounts. Assists patients by explaining charges and payments for service.

Communicates with insurance providers, Medicare, Medi-Cal and patients

regarding differences between amounts billed, paid and/or denied. Submits follow

up billing on unpaid or partially paid accounts, crossovers and R/A.

Experience: Sonora Employment Agency & Temp-Help Services, Sonora, CA

1/02-2/02 Tuolumne General Hospital

Researches any discrepancies in past due payments. Providing necessary

information to insurance carriers for collection of medical services rendered.

Using 1500 and UB92 forms.

Experience: Computer Career Training, Sonora, CA

10/01-1/02 Attended classes in: Excel, Microsoft Word, Payroll Accounting and

Accounting Principles.

Experience: Cal-Air, San Jose, CA

4/01-7/01 Accounts Payable

Matches invoices to POs for payment to outside venders. Researches and

resolves any discrepancies to ensure accuracy of payments

Experience: Cal-Air, San Jose, CA

7/00-4/01 Material Handler/ Driver

Ensures timely delivery of material to job sites through out the bay area.

Outstanding, hardworking, organized individual. Proceeds with

minimal supervision, keeping in close contact with field foreman to ensure the

materials requested be delivered correctly.

Experience El Camino Hospital, Mountain View, CA

10/98-4/00 Plan Administrator

Ensures timely adjudication and payment of claims with Claims Analysts.

Researches and resolves issues regarding claim payments, benefits, contracts,

eligibility and denials. Audits claims payments for accuracy and contract

compliance. Prepares expense analysis reports and prepares summary of claims

data. Reconciles monthly capitation payments and updates database.

Responsible for regulatory reporting requirements and audit compliance. Has

good working knowledge of capitation operations and managed care system

Experience: El Camino Hospital, Mountain View, CA

02/96–10/98 Claims Analyst

Perform daily operational functions to effectively adjudicate claims and enter

encounter data into the encounter databases. Researches and resolves problems

with capitation accounts or claims. Audits claims payments for accuracy and

contract compliance. Analyzes and prepares summary of claims data.

Experience: Pacific Health Dimensions/Mission IPA, Monterey, CA

08/95–01/96 Claims Processor

Insure physician adherence to contract guidelines. Managed claims for HMO`s,

PPO`s Medicare and Medi-Cal carriers

EDUCATION:

Computer Career Training, Sonora, CA

Computerized Business Applications

Computer Training Academy, San Jose, CA

Medical Billing program, Diploma

REFERENCES AVAILABLE UPON REQUEST

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