Customer Service Insurance

COLETA SHEPHERD

SUMMARY +** years of experience as a Administrative Assistant, skilled in transcribing physician orders, charting lab results, filing and typing confidential documents, accurate data entry, insurance verification, HCPC codes, precertification and collections

May 2016 to Dec 2016

Collections/Denials Gaffey Healthcare, Plano Tx

Follow up on submitted claim

Resubmit HCFA 1500 CC

Follow up on denied claims

Familiar with Medicare/DDE

Sept 2015 to Mar 2016

Medical Biller/Collector Christus Health, Irving Tx

• Working with inpatient/outpatient hospital claims

•Working primarily Medicare claims

•Submit clean claims and follow up with Medicare/ Hospice or SNF for overlapping claims, collect payments

•Follow ups and adjustments

April 2015 to

Conifer, Frisco, TX

Sept 2015

•Utilizing UB04s working with inpatient/outpatient hospital claims

•Working primarily Medicare claims including Managed Medicare/Medicaid claims

•Submit clean claims and follow up with the insurance companies to collect payments

•Performs denials/appeals

October 2014 to Amerisource Bergen, Lewisville, TX

December 2014 Reimbursement Counselor

•Collects and reviews all patient insurance information needed to complete the billing, collections, appeal, and/or cash processes

•Completes and submits all necessary insurance forms and electronic claims to process the claims in a timely manner as required by all third party payors

•Researches and resolves any electronic claim denials

•Effectively utilizes various means for collections, including but not limited to phone, fax, mail, and online methods

•Provides exceptional customer service to internal and external customers; resolves any customer requests in a timely and accurate manner; escalates complaints accordingly.

•Maintains frequent phone contact with provider representatives, third party customer service representatives, pharmacy staff, and case managers.

•Independently analyzes, reports, resolves, and communicates any reimbursement trends/delays (e.g. Billing denials, claim denials, pricing errors, payments, etc

•Processes any necessary insurance/patient correspondence

September 2010 to Parallon Business Solutions, Irving, TX

October 2014 Clinical Appeal Analyst

•Monitored insurance denials by running appropriate reports and contacting insurance companies to resolve claims denied for clinical reasons.

•Used the UB04s and primarily worked Commercial claims but also handled Managed Medicare claims.

•Researched and identified coding or clinical documentation issues and works to correct the errors in a timely manner

•Identified problem accounts and escalate them as appropriate

•Updated patient account records to identify action taken on the account

•Composed letters to explain reason for appeal

•Maintained professionalism at all times, phone etiquette, notate accounts in a professional manner with less typos as possible

April 2009 to Atrium Medical Center, Corinth, TX

May 2010 Multi-skilled Secretary

•Greet general public, answered multiple phone line, transcribe Physician orders

•Ordered floor stock

•Filled the charts with Physician orders and progress notes

•Filed all confidential paper work

•Made sure lab results were on the chart

•Admit and discharge patients

January 2008 to Radiant Home Healthcare, Southlake, TX

April 2009 Receptionist/Data entry clerk

•Open and close office

•Answered multiple phone lines

•Meet and greet the public, passed the mail, order supplies and stocked supplies

•Intake all the field staff time and confidential information

•Created care plans for patients that were admitted, discharged patients

•Verified some insurance

September 2004 to Medical Center of Lewisville

November 2007 Administrative Assistant

•Multi Skilled role when doing patient care and VS.

•Answered telephones

•Transcribed Physicians' orders,

•Scheduled outpatient appointments

•Ordered food trays and floor stock

•Twice a week I was the Telemetry Tech-mandatory to keep up interpreting skills.

Contact this candidate