Data Entry Medical
Resume:
Linda Allison Williams
Philadelphia, PA 19143
**************@*****.***
Professional Summary
Highly skilled and analytical Medical Claims and Billing Specialist has excellent billing formularies knowledge and significant experience working in health insurance environments. Possesses strong chart auditing and application of federal standards for appropriate coding practices.
Experience
Claim Examiner Prosser 09/2015 to 04/2017
AmeriHealth Caritas Philadelphia, PA
Examine claim forms, policies and endorsements, client instructions, company instructions and other documents to determine applicability to claims assigned.
Reviews suspended claims on a daily basis, assuring that all appropriate documentation is completed before resolution. op
Reviews audit results on a weekly basis, correcting errors in the claims processing system within designated timeframes.
Refers high dollar claims as determined by system edits to Supervisor for review
Maintains minimum performance standards as specified by departmental policies, such as claim production and accuracy.
Keeps current with Claims Department policies and procedures.
Performs other related duties as assigned by management.
Working knowledge of CPT, HCPCS, and ICD-9 definitions.
Original Medicare and Medicaid appeal regulations.
Local Coverage Determinations.
Must be detailed-oriented and proficient at time management.
Data Entry Clerk 07/2015 to 08/2015
Medical Alert Bala Cynwyd, PA
Apply credit on invoice to latest dates.
Attach payment to the invoices to close the case out.
Suspension subscriptions upon request of customer.
These action where being used under the program of Sedona Application.
Administration Assistant Position 04/2015 to 06/2015
Catch.Inc Philadelphia, PA
Writing discharge summary after client have been release from the program.
Filing discharge client after paperwork is complete
Answering telephone and connect them to the correct department
Assistant different tasking for different department such as therapists, case manager, house nurse and the directors.
Doing intakes and admission for new clients.
Input client demographic information to update the computer.
Keep up with clients that are still attending the program.
Verification health insurance thru public application CBH and Compass.
Private Home Care 10/2014 to 04/2015
Independent Philadelphia, PA
Feeding and cooking for patient
Bathing patient
Working as a living
Doing laundry
Food and errant running
Scheduling doctor appointment
Administration Assistant 09/2014 to 01/2015
University of Pennsylvania Home Care Bala, Cynwyd, PA
Sorting paper in alphabetical order
Faxing doctor work order
Filing medical records
Input the information into the computer
Assistant other department
Data Entry Clerk 07/2014 to 08/2014
Interact Philadelphia, PA
Input time sheet for staff member
Filing proof of time sheet in staff folder
Update client demographic information
Input change of diagnosis and live situation
Sorting paper to be file accordingly under name of the therapists.
Prior Authorization Representatives 05/2014 to 07/2014
Horizon Independence Blue Cross and Blue Shield Mount Lauren, NJ
Responsible for collection and entry of demographic and service requests information from providers/members into the electronic record.
Receive request for authorization from hospitals, providers, members and vendors
Handle Time, Average Speed to Answer, abandonment rate).
Verify eligibility, enrollment history and demographics of members.
Act as point of contact providing medical management assistance to providers electronic and education/assistance in prior authorization requests.
Facilitate/assist the authorization of benefits for out=of-network providers including completion of appropriate forms that are distributed to physicians’ offices, provider relations and the generation of approval letters.
Complete necessary contact with provide/member to verify newborn information.
Input required data into system for newborns.
Provider authorization number to provider of facility.
Perform any other job related instructions as requested, with reasonable accommodation.
Multiple tasking working with this different application. Using the company data base to pull up information.
Input of work order that need to authorization.
Verified correct doctor order.
Viewing radiology to make sure its attach with order form.
Data Entry Clerk 09/2012 to 11/2013
Drexel University Philadelphia, PA
Attaching document imaging to student I.D. that is have been put through the scanner.
Researching student document through imagine with Drexel University Web page.
Apply GPA score to student profile.
Entering SAT and ACT score while using the Banner Program.
Using the university student portal system to see if the student is active or inactive.
Attending meeting and giving feedback and taking notes.
Verified future student test scores for acceptances into the educational institute.
Education and Training
Medical Office Administration 7/2008 to 4/2009
Thompson Institute Philadelphia, PA
Medical billing and coding Charting
Medical administration duties Medical Terminology
Typing 40 wpm ICD 9 and 10 Coding
Assistant Training 10/2001 to 04/2002
CITE Philadelphia, PA
Philadelphia Regional High School 09/1996 to 06/1998
High School Diploma Philadelphia, PA
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