Customer Service Insurance

Shakita Malkia Louther, CPC

**** ********** ******* ***, *********, NC

980-***-****

*******.*******@*****.***

Objective: A hard charged motivated professional seeking a position in a

progressive medical organization. I am a leader who enjoys being part of a

winning team and having the opportunity to advance to higher levels of

professionalism and likes to make a difference in how successful an

organization becomes.

Experience:

The Outsource Group, Charlotte, NC (10/09-03/10)

Physician Follow-Up Representative

. Work closely with insurance groups, on behalf of physician practices

to resolve outstanding issues and secure payment on unpaid claims,

process payment information via the telephone, resolve disputes and

maintain accurate records within various practice management systems.

. Enter physician charges, post payments and obtain claim status to

resolve outstanding insurance balances for multiple healthcare

clinics.

. Analyze each patient account for accuracy in billing, follow-up and

payments. Assist patients in regard to their accounts, and research

payments and accurately post to accounts.

Aerotek (Lash Group), Charlotte, NC (10/08- 03/2009)

Seasonal Site Coordinator (Reimbursement Counselor)

. Demonstrate a comprehensive understanding of complex benefit

structures and reimbursement issues for physician-administered

products across all payer types.

. Called payers to retrieve patient specific benefits relating to

REMICADE.

. Provide support to both physicians and patients with reimbursement and

care coordination services for an infused product.

Provide assistance to providers and patients that include, but not

limited to:

. Patient-specific benefit investigations

. Prior authorization research

. Assistance in locating coverage options for uninsured and

underinsured patients

. Customer service outreach

. Billing and coding support

. Participates on a customer specific Access One sub-team

Bayview Physicians, Chesapeake, VA (07/05- 02/08)

Coding and Reimbursement Specialist

. Assigned diagnostic, procedural, and complication codes to all

outpatient records using CPT/ICD-9 classification for a multi-

specialty group.

. Handled all aspects of claim submission and claim follow-up to include

Tricare, BC/BS, Worker's Comp, Medicaid, and Medicare. Prepared Title

18 claims for reimbursement.

. Reverse and rekeyed charges, post insurance and patient payments,

performed adjustments where needed.

. Increased monthly revenue by working with payer's and attorney's daily

and preparing payment plans patients could adhere to.

. Assist with credentialing of providers

. Performed appeals and reconsiderations.

. Displayed strong attention to detail and a positive solution oriented

approach to the work in the billing department. Communicated in a

positive manner with patients, family members, and hospital staff

. Assist in monthly audit of physicians

Urology of VA, Norfolk, VA (09/03-03/05)

Patient Account Representative

. Verified CPT/ICD-9 coding via database edits

. Electronic and third party billing.

. Monitored collection accounts.

. Performed patient registration and surgery scheduling.

. Pre-certifications and approvals.

. Handled patient's inquires regarding statements received.

. Insurance follow-up and collections.

. Performed claim run, payment posting, and positively interacted with

patients, family members, visitors, physicians, and other staff.

. Ensured adherence to established policies and procedures.

. Answered multi-line phone system.

. Set up payment plans

. Exceeded monthly quotas

. Interviewed patients that needed financial assisting with payments

. Assist in monthly audit of

physicians

Education:

Kaplan University- Online (09/09-Present)

Health Information Management

Skills:

Certified Professional Coder, Medical Terminology, Medical Manager, Medic,

Epic, AS400, IDX, Misys Tiger, Allscripts Enterprise & Touchworks PM,

Citrix, Signature, Misys CompuSystems, Emdeon, EHR

Contact this candidate