Customer Service Insurance
Resume:
Susan M. Wallace
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Professional Experience:
Accounts Receivable Specialist 05/2012-Present
21st Century Oncology Jacksonville, Florida
• Research and finalize unpaid Medicare charges.
• Contact Medicare for payment resolution.
• Utilize online websites to check payment status/ coverage.
• Make corrections to claims and resubmit within a timely manner.
• Request/review and submit medical records as requested from insurance companies.
• Respond to all correspondence from Medicare and their subsidiaries.
• Prepare and submit 1st and 2nd level appeal letters for all denied charges.
• Write off and make adjustments to charges using correct adjustment codes.
• Assist patients with account balances to ensure an understanding of insurance reimbursement.
• Update patient account data including but not limited to insurance information.
Financial Specialist 05/2011-04/2012
The CSI Companies, Inc. Jacksonville, Florida
• Follow up on unpaid claims utilizing the AthenaNet billing system.
• Utilize online websites to check claim status/ coverage.
• Make corrections to claims and resubmit through AthenaNet with correct kickback codes.
• Request and submit medical records as requested from insurance companies utilizing hospital EMR
system.
• Respond to all correspondence from various insurance companies
• Write and submit appeal letters for all denied claims.
• Assist patients with account balances to ensure an understanding of insurance reimbursement.
• Update patient account data including but not limited to insurance information.
• Post payments from numerous insurance companies.
• Work front check in desk, answer phones, balance money and create deposit.
• Provide prompt and courteous customer service in multi-line office setting.
Patient Financial Services Rep/Customer Service Rep 09/2004 -10/2009
Baptist Medical Center Jacksonville, Florida
• Collect on delinquent accounts from patients and provide financial counseling.
• Negotiate prompt pay discount or payment plan for delinquent accounts.
• Work from and complete various reports in a timely and efficient manner.
• Verify Medicaid eligibility and confirm the effective date.
• Obtain credit report on high dollar account to determine capability to pay.
• Monitor bank debit and wage deduct accounts to ensure current activity.
• Transfer noncollectable accounts to an outside collection agency.
• Assist callers with accounts in a high volume call center.
• Adjust account balances to reflect contractual agreement.
• Properly document and adjust bankruptcy accounts.
• Transfer accounts from primary to secondary collection agencies.
• Review credits and issue refund to patient and/or insurance company.
Account Representative 04/2003 – 08/2004
Fletchers Medical Supplies Jacksonville, Florida
• Billing and collecting for all miscellaneous insurance claims.
• Post payments from miscellaneous insurance companies.
• Obtain authorizations.
• Review denied claims and make corrections to ICD-9 and/or CPT coding.
• Appeal denied claims to ensure correct and maximum reimbursement.
• Assist patients, doctors and insurance reps with account inquiries.
Insurance Follow Up Specialist 10/2000 – 04/2003
Linville Management Services Jacksonville, Florida
• Responsible for collecting on delinquent hospital claims from various insurance companies.
• Calculate expected reimbursements and adjustments according to contract.
• Appeals; Review and make corrections to ICD-9 and CPT coding.
• Obtain and interpret information from medical records for claim processing.
Education:
Florida Community College, Jacksonville Florida
April 1987- High School Diploma
Florida College of Medical and Dental Careers, Jacksonville Florida
October 1987- Registered Medical Assistant Diploma
Radiology Tech Program - Basic Radiology License Certificate
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