Reimbursement Specialist

Latasha Spates

Phone: 862-***-****

Email: ********@***.***

Objective:

In search of a challenging and growth oriented position in a progressive company, where I contribute to the organization's success with my billing expertise through my innovative ideas and desire to achieve excellence.

Qualifications Summary:

-Experience in collections, accounts receivable operations, and credentialing

-Ability to troubleshoot and problem solve in any setting

-Create financial reports, budgets and forecast revenue

-Knowledge of third party reimbursement and EMR systems

-Advanced knowledge of Microsoft Excel, Word, Access, PowerPoint and Project

-Excellent communication skills and pays strong attention to detail

-Results driven while meeting strict work deadlines

-Professional and shows accountability

-Willing to extend my experience into other industry’s

Education:

Katherine Gibbs College, Montclair, NJ – Bachelors in Business: Office Administration, Class of 2004

Irvington High School, Irvington, NJ – College Preparatory Program, Class of 2001

Work Experience:

Billing Team Lead, August 2015 – Present, Mednax, Livingston, NJ

-Oversee staff of 25 employees within departments: accounts receivable, charge entry, charge correction and customer service.

-Verifies all productivity and quality measures are met regarding aged A/R and 75-100 accounts worked daily.

-Ensures that required insurance precertification, authorization and documentation is obtained for billing and medical record processing.

-Create insurance projects on high dollar claim denials, reimbursement issues, payment rate negotiations, appeals and denied authorization requests for Medicare, Medicaid, Manage Care and Commercial carriers.

-Prepare information for complex insurance audits regarding diagnosis coding and cpt recoding. (UB04 and HCFA1500)

-Work electronic denials thru an electronic billing system and develop procedures that prevent reoccurring rejections.

Download Electronic EDI transactions and ERA files, including reconciling carrier submissions, edits and rejection reports.

-Responsible for monitoring all correspondence related to our insurance contracts or patient accounts, as needed, to identify issues or changes to payer rules and policies.

-Prepare financial reports to balance reconciliation logs, credit balances, underpayments, overpayments and month end close revenue.

-Audit billing invoices for accuracy while maintaining a good working relationship with internal and external clients.

-Audit contract rates and update system matrix to identify problems with rate discrepancies or system loading issues.

-Audit and investigate payment deductions, adjustment entries, write-offs, charge backs and insurance discounts.

-Credentialing physicians, verify the licensing, certifications, process applications and update shared databases, as needed.

-Works closely with coding manager to develop additional edits and rules to streamline the revenue cycle reimbursement process.

-Oversee collections: setting up payment plans, negotiating settlements with patients on past due account and referring accounts to collection agencies and attorneys.

-Meet with staff on a biweekly basis to discuss quality of work, productivity standards and carrier issues also communicate job expectations for quarterly bonus budgets.

-Assist management with assigning projects, scheduling, coaching, counseling, disciplining employees, monitoring daily accounts, appraising job contributions, recommending compensation actions, and creating policies and procedures.

Claims Representative I: October 2008 – August 2015, Origin, Rutherford, NJ

Ensures accuracy of physician and hospital claims for all insurance carriers.

Monthly reporting for aging, adjustments and evaluation of payment by cpt /procedure codes for each payer.

Prepare and reconcile all necessary billing cycle activities, heavy monthly invoice processing and ensuring all necessary

documentation, including contracts, addendums, service changes, price schedules are received.

Review and approve all billing cycle investigations and resolves billing operations issues in the billing process.

Recommend accounts for bad debt write off and collection agency assignment.

Identify and resolve any claim delay issues that impact collections.

Resolve underpayments/overpayments discrepancies and generates reports through an audit process.

Review and resolve balance billing fee negotiation inquiries in accordance with departmental policies and procedures.

Communicate with a high volume of members, attorneys, and collection agencies via phone and written correspondence regarding

payment status and other balance billing inquiries.

Recommends litigation to legal department when settlement cannot be negotiated.

Settlement agreements, and fee negotiation discounts with non-participating providers.

Research, analyze and review member correspondence by verifying eligibility, claim history, and Coordination of Benefit.

Contacts insurance carriers and other facilities as needed to get maximum payment on accounts.

-Reviews EOBS, audit lockbox payments and EFTs for incorrect payments, unposted or missed bank deposit batches.

Review hospital and medical claims to determine if the claim was processed and paid correctly; return claim errors to the payer for

correct units with instructions for payment adjustments.

-Assist with the maintenance of information in various databases, example: updating new CPT and Diagnosis codes to our system.

Compiles and enters payroll data then computes and posts wages, and reconciles errors to maintain payroll records.

Prepares computer input forms, enters data into computer files, and posts to payroll records.

Ensures that payroll-related transactions are processed in compliance with external and internal policies.

Process new applicants, update time sheets, maintain spreadsheets and helping with insurance enrollments.

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