Customer Service Insurance
Resume:
Deresha Black
San Antonio, TX. 78230, United States
ac10ub@r.postjobfree.com
Objective
To find employment with an office that will allow me to utilize my skills and grow within the corporation. I am a self-motivated, a fast learner, and a multitasking individual. Professional Experience.
Paramount Health Care Company/ Senior Care Centers San Antonio, TX. Reimbursement Analyst
8 /2016 to current
● Prompt and thorough submission of skilled nursing facility claims and follow-up of accounts to obtain payment or final disposition of claims
● Timely submission of claims, invoices, correct procedure codes as well as diagnosis codes and other related responsibilities necessary to the continued success of the department
● Essential Duties and Responsibilities include the following: Collection experience with all Insurance Payers; Medical Billing including Medicare, Medicaid, Insurance, and Governmental Sources, Contract, and Private Pay Reconcile accounts.
● Post payments as well as research and review payment discrepancies
● Process billing correction forms and adjustments and ability to manage accounts receivables for multiple facilities and payers
● Other duties assigned to meet goals and needs of the company. Regent Care Central Business Office
Reimbursement Analyst
10/2015 to 8/2016
● Prompt and thorough submission of skilled nursing facility claims and follow-up of accounts to obtain payment or final disposition of claims
● Timely submission of claims, invoices, correct procedure codes as well as diagnosis codes and other related responsibilities necessary to the continued success of the department
● Essential Duties and Responsibilities include the following: Collection experience with all Insurance Payers; Medical Billing including Medicare, Medicaid, Insurance, and Governmental Sources, Contract, and Private Pay Reconcile accounts.
● Post payments as well as research and review payment discrepancies
● Process billing correction forms and adjustments and ability to manage accounts receivables for multiple facilities and payers
● Other duties assigned to meet goals and needs of the company. Medical Management Headquarters
Medical Billing and Coding Specialist 7/23/2015 to 10/2015
● Follow protocol to ensure appropriate billing and payment cycles
● Accurate and timely billing in accordance with established internal and carrier requirements
● Third party approvals
● Maintain appropriate internal controls over accounts receivables /cash receipts, and standards
● Review charge tickets and resolve problems concerning the recording or provision of services rendered which impact on ability to collect charges
● Evaluates medical record documentation and charge ticket coding to optimize reimbursement
● Ensure that diagnostic and procedural codes and other documentation accurately reflect and support the evaluation and management visits & outpatient visit
● Ensures that data complies with legal standards and guidelines, diagnostic descriptions and procedures for a given visit in order to accurately assign and sequence the correct ICD 9-CM, HCPCS and CPT codes
● Confer with clients regarding delinquent accounts, special adjustments, and/or write-offs; prepare and maintain required records, files, and reports on billing and financial activities
● Billing/coding for orthopedics physicians for outpatient procedures and internal medicine physicians for inpatient procedures.
Alpha Nursing & Therapy, LLC
Medicare Billing Specialist
March 2015-July2015
● I am responsible for the various day-to-day account functions for Home Health and Hospice receivables from Medicare.
● Claim submissions to Medicare, processing the Medicare remittance advice, problem resolution, and monthly reconciliation of the outstanding Medicare receivables to ensure timely claim payment
● File claims electronically, or manually, directly into the Medicare Fiscal Intermediary Shared System (FISS)
● Work in the DDE system by identifying Rejections, Adjustments and necessary corrections to claims
● Data Entry of OASIS
● Post payments/remittances accurately to patient accounts
● Monitor claim payment and adjudicate payment errors
● Manage all aspects related to timely filing of claims, including correcting claim errors and re-submissions
● Maintain working knowledge related to Medicare programs and regulations
● Assist with ongoing Accounts Receivable review process, including identification and resolution of specific claim issues
● Monitor aging reports and take such steps as necessary to secure payment of claims
● Participate in take back, overpayment and refund process
● Perform denial management for claim issues by adjusting, correcting or resubmitting claims back to Medicare
● Reviews accounts and makes recommendations to the owner regarding uncollectible accounts
● Monitor all claim activity through the use of accurate spreadsheet tracking
● Provide analysis for multiple departments within the organization
● Meets production goals and month end processing requirements. Paramount Health Care Company San Antonio, TX.
Reimbursement Analyst
July 2013-March 2015
● Prompt and thorough submission of skilled nursing facility claims and follow-up of accounts to obtain payment or final disposition of claims
● Timely submission of claims, invoices, correct procedure codes as well as diagnosis codes and other related responsibilities necessary to the continued success of the department
● Essential Duties and Responsibilities include the following: Collection experience with all Insurance Payers; Medical Billing including Medicare, Medicaid, Insurance, and Governmental Sources, Contract, and Private Pay Reconcile accounts.
● Post payments as well as research and review payment discrepancies
● Process billing correction forms and adjustments and ability to manage accounts receivables for multiple facilities and payers
● Other duties assigned to meet goals and needs of the company. CGI Federal San Antonio, TX
Medical Claims Specialist: Caseworker
April 2013-July 2013
● Contracted by CMS to a large Medicare Secondary Payer project.
● The mission of the MSP Project is to recover payments that were paid by Medicare when another insurance should have had primary payment responsibility
● Followed up on leads provided by CMS
● Confirmed which insurer should have been the primary payer
● Initiated a demand process with insurance companies including evaluation of beneficiary information
● Tracked correspondence through demand process to ensure timely response with Service level Agreements
● Facilitated and documented communication with insurers and employer groups
● Answered incoming queries via the telephone, email, and hard copy
● Provided accurate and timely responses to queries
● Escalated outlying queries that have special circumstances to supervisors in alignment with prescribed processes.
Shannon Clinic Business Office San Angelo, TX
Medicare Clerk
August 2011 – April 2013
● Worked with the Medicare claims, the follow up and denied claims, an average of 150 to 300 claims per week
● Followed up on all unpaid claims, as well as researching all denied claims, and finding resolutions to the denied claims in order for the claims to be paid
● Ensured that the appropriate procedure codes and ICD-9 are the appropriate codes by reviewing the dictation
● Managed care plans, which includes Care Improvement Plus, Humana, Scott & White Senior Care, Aetna Medicare
● Claims are also worked and researched to find resolutions to receive payment from insurance
● Sent appeals to all insurance on claims that were denied incorrectly
● Insurance adjustments on claims that were processed and discount was given but not adjusted on claims
● Moved payments that were made by the insurance to the correct claim that was paid
● Sent HCFAS statement balances to all Skilled Nursing Facilities, Hospice, and Home Health agencies
● Worked all explanation of benefits
● Checked patient coordination of benefits for Medicare daily
● Verify whether Medicare is secondary to other insurance
● Set up the appropriate insurance type code for Medicare being the secondary payer
● Refund overpayments that were due to Medicare due to coordination of benefits Dr. John Hunt (oncologist) Angelo, TX
Office Manager
January 2011 - August 2011
● Worked closely with billing clearinghouse and handled all daily functions with billing
● Handled all incoming paperwork for hospital and made sure that the billing firm has all necessary CPT codes and ICD 9 codes by reviewing the doctors dictation
● Followed up on all Medical denials, verified insurances prepare all bank deposits, oversee office, filing charts, scheduling appointments, and going over patient's billing statements Accounts Control Technology, San Angelo TX C ollections August 2010 - January 2011
● Handled student loans for Dept. of Education, collected on accounts that were in default, negotiated all defaulted accounts and made payment arrangements with consumers. Kelly Services San Angelo, TX
Temp. Customer Service Rep.
May 2010 - July 2010
● Contracted out to Blue Cross Blue Shield, handled all benefits, claims, customer service, verified provider diagnosis and procedure codes to see if they were billable, checked and followed up on referrals for out of network visit. Titanium Billing Services Wichita Falls, TX
Medical billing
July 2007 - November 2009
● Provided medical billing for 13 physicians with all different specialties: cardiologist, PT/OT/ST physicians, bariatric surgeon, and E.R physicians Fred Loya Insurance Wichita Falls, TX
Insurance Rep.
March 2004-April 2006
● Managed & trained staff, provided auto quotes over the phone as well as in person, wrote auto insurance policies, daily deposits, submitted monthly business reports and attended monthly meetings in Lubbock, Tx.
SITEL Corp. San Angelo, TX
Customer Service rep.
January 2001-March 2004
● Responsible for taking incoming calls for Mitsubishi Motors Credit of America, handling customers’ auto loans, and taking supervisor calls for any situation. Education
Central High School San Angelo, TX - 1998
Northwest Vista College, San Antonio TX
Advanced Hospital Coding course completion June 2015 to December 2015, Medical Coding Academy Completed July 2017
Certificates:
CPC
Summary of Skills
Computer Skills: M icrosoft word, Excel, Windows, Keyboarding speed 50+ words per minute. Medical Skills: CPT-4 and ICD-9 coding
Office Skills: F iling, 10 key by touch, scheduling appointments, answering phones, and customer service.
Billing Skills: C ompleting monthly reports A/R Summaries post and apply all financial payments where necessary, post charges for physicians, follow up on denials and all medical claims, verifying insurances, going over explanations of benefits, looking up procedure codes and diagnose codes, and providing them when necessary to billing firms and closing out all financial areas at end of the day and preparing bank deposits.
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