Insurance Customer Service

Donna Cihak

SUMMARY

Over ** years extensive experience of full scope medical billing and collections; commercial and government accounts.

Ability to consistently meet all production goals consisting of 100 accounts or more to be touched per day.

Working knowledge of researching, appealing and overturning denials, obtaining pre-authorizations, EOB follow-ups, and month-end duties.

Software skills: Word, Excel, and various custom billing software packages. WORK EXPERIENCE

Novartis Genoptix Hospital Roster Collector 10/2013 – 09/2015 Medical Collection Representative II

Novartis Genoptix Hospital Roster Collector

Collected $5 million/month

Correcting Insurance assignment to patient accounts

Insurance eligibility, verification review and update demographics

Investigating all denials and the reason for the denial of service, appealing when appropriate

Working aging reports and reviewing reports to work

Collected 5 million per month on hospital client roster Atlanta Women's Health Group 10/2011 – 10/2012

OB-GYN Biller/Collector

Completed full cycle billing/collections for 29 doctors on Blue Cross Blue Shield dedicated accounts.

Quota driven environment touching 150 accounts per day between billing and collections activities.

Performed medical collection activities as per established guidelines; worked aging from oldest to most current.

Monitored all delinquent accounts and managed all collection activities.

Assisted in resolving billing issues for customers through regular inquiries and follow-up.

Corresponded with third party companies and patients in order to collect on delinquent medical accounts.

Administered credit balances for all patients and payers.

Corrected and updated patient insurance information.

Verified eligibility and completed HCFA CMS 1500 forms.

Investigated denied claims for appeals, adjustments, and secondary billing when applicable.

Provide information and documentation in a timely to ensure accuracy of reimbursement.

Submitted correct insurance claims and coding doctor's visits with proper ICD-9 codes.

Submitted a prior authorization form on behalf of the patient during the back-end process.

Billed insurance claims in a timely manner and appropriately and post insurance payments accordingly.

Ensured compliance to HIPPA laws and federal regulations. CBIZ-MMP 01/2011 – 09/2011

Radiology Biller/Collector

Reconciliation of accounts, analyze and process adjustments, process of appeals & denials.

Ensured compliance to state and federal regulations for all medical collection process.

Completed investigation of all denied claims and clearing house electronic submitted claims.

Monitored and processed collection correspondence as necessary.

Researched and resolved all complex telephone and written inquiries.

Answered 70 patients calls per day inquiring about co-pay coverage and services provided.

Assisted with month-end duties such as balance write-offs and adjustments updated in the system.

Reviewed patient accounts directly and on conference calls, between health professionals, while maintaining and providing excellent customer service.

Established payment arrangements on outstanding or delinquent account with responsible parties.

Advised customers of necessary actions and strategies for debt repayment.

Upon reviewing the account, it was my responsibility to update/expire new and old insurances.

Billed the correct insurance at the time of the call, to provide same day courtesy billing. Medical Billing Specialist/Collector 02/2003 – 01/2010 Owner

Managed full cycle billing and collections for nine physicians.

Completed extensive claim follow up on all denied services for mental health and pediatric claims.

Evaluated denials and submitted appeals; contacted patients regarding denials and appropriate next steps.

Provided full explanation of benefits to patients and verification of services.

Made up to 200 calls per day for aging bills to research denials on unpaid claims.

Documented recorded calls on the insurance end to ensure proper steps were taken for appeals. Villa View Community Hospital 05/2001 – 10/2003

Business Office Biller/Collector

Performed the tasks of collecting on delinquent medical accounts by making payment arrangements with patients and/or insurance companies.

Handled the responsibility of securing outstanding balance payments from insurance companies and Medicare.

Billed, rebilled, followed-up, and collected on third-party accounts to obtain final payment from insurance

agencies.

Audited and worked various aging reports, adjustments, and credit balances.

Processed denied reports for emergency room services with "no pay" and composed appeals.

Made necessary corrections to claims when appropriate and requested additional information needed for billing.

Contacted patients for AR regarding unpaid and underpaid accounts to resolve aging accounts.

Set up payment plans and self-pay accounts to avoid referral to an outside collection agency.

Obtained referrals and pre-authorizations and ensured that all emergency room services were verified.

Assisted with proper CPT, ICD-9, and HCPCS coding.

Billed all office and hospital consultations and followed up visits for several physicians in the hospital.

Inpatient, outpatient and emergency hospital consultation/rehabilitation visits.

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