PAUL J KEARNEY

**** **** **** ** *** ***

Erie, PA 16506

Phone: 512-***-****

ac1zqe@r.postjobfree.com

Goals

To continue improving and excel in the Healthcare Administrative professional field of Medicine, by achieving maximum profit in minimal time with error free claims processing.

Summary of Qualifications

20 years of combined medical claims billing and claims review experience as an expert in Workman's Compensation, Medicare, Medicaid, Third Party Liability, and all Commercial Insurances including the Affordable Care Act plans.

Processed literally hundreds of millions of dollars in both claim payments and revenue.

Computer literate in Microsoft Outlook, Excel, Word and many software programs.

Ability to read / interpret any and all EOB’s / EOR’s / ERA’s and applicable ANSI coding.

Served as a Admitting / ER Supervisor and a Medical Claims Review Team Leader (1991-2001).

Worked as a Nursing Assistant / Unit Clerk at many Nursing Homes / Hospitals. (1986-1991).

U.S. Army Veteran Medical Section Chief Platoon Sergeant. (1979-1985).

Work History

National Billing Partners, Austin, TX

Medical Charge Entry Specialist Mar 15, 2017 – Jun 12, 2017

Entered daily charges for Central Texas Pediatric Orthopedics (CTPO), which included office visits, surgeries and follow up fracture care in their Centricity software program.

Successfully by working numerous hours of overtime brought their 3 month backlog of charges to be entered to a remarkable 24 hour turn-around time.

Fielded numerous phone calls for patient payments daily.

Easter Seals Central Texas, Austin, TX

Client Account Representative Dec 01, 2015 – Feb 10, 2017

Administration Employee of the Year FY 2016.

Completed the medical revenue cycle timely & cost efficiently starting with referrals, obtaining appropriate authorizations, daily charge entry, Insurance follow-up & appeals so that all claims were submitted clean and processed correctly every time. Averaged 50-100 accounts daily.

Focused on increasing revenue & reduced outstanding A/R to the highest collection totals ever. This was the motivating factor that helped me achieve the March 2016 Mission Mover award. The Early Childhood Intervention program & Family Cost Share accounts were substantially improved financially along with the Rehabilitation & Audiology departments with outstanding results helping Easter Seals to increase the number of clients we could assist to better their lives and provide more care for others in need.

Various Temporary Employment Agencies, Austin, TX & Denver, CO

Professional Temporary Apr 01, 2014 – Nov 30, 2015

Obtained numerous Rehabilitation (PT/OT/ST) & Hearing Aid Authorizations from Insurance Carriers while employed as a Accounts Receivable Specialist for Express Employment Professionals assigned to Easter Seals Central Texas (Jul 2015 – Nov 2015). Reduced a disastrous outstanding A/R to a 2015 manageable level. Posted daily therapy charges, worked clearing house rejections, adjusted charges for the Early Childhood Intervention program & billed family cost share statements. Averaged 50-100 accounts daily. Achieved current ICD 10 Compliancy in less than 30 days.

Promoted from Data Entry Verification Specialist to Quality Assurance Trainer by successfully training associates in verifying Patient Insurance plans for Health Management Services (HMS) while assigned to I-Energizer contracted with TMD Temporaries. This involved step by step instructions transferring data via computer websites such as Blue Cross Blue Shield, Medicare & Medicaid and transferring the Information to HMS. (Apr 2015 - Jul 2015).

Reduced outstanding accounts receivable for Seton Hospitals from over 3000 accounts to less than 500 in 4 months. (Nov 2014 to Apr 2015) while employed with Integrated Human Capital as a courier clerk. This involved analyzing Explanations of Benefits and applying contractual adjustments and billing patients for their financial responsibility.

Premier Group Denver: Hospital Collections for Sisters of Leavenworth Charity Hospitals (April 2014). Snelling and Snelling: Greeter for Denver Convention Center (July 2014). Remedy Staffing: Data Entry for Adams County School District / Denver. (Aug 2014 - Oct 2014).

Cardiology Billing Partners, Austin, TX

Medical Billing Specialist Jan 14, 2013 - Jun 07, 2013

Analyzed orthopedic surgery and rehabilitation claim denials, identified the billing problem & resolved the errors on thousands of outstanding medical accounts for this assignment. Averaged 50-100 accounts daily. This was accomplished by locating/researching the Explanation of Benefits, determining the proper order of insurances & appealing any & all denials by phone, mail, fax and email.

Forte, Austin, TX

Bill Review Analyst II Sep 26, 2012 - Jan 02, 2013

Audited thousands of workers compensation medical claims for payment on this brief assignment. Investigated, analyzed and made recommendations for payment by verifying the work related injury within the scope / guidelines of the Texas Division of Workers Compensation. Daily de-escalated patient and medical provider complaints by active listening and offering options and ways to resolve the specific complaints. Averaged 75 Claim reviews daily.

Corvel Corporation, Austin, TX

Bill Review Analyst Feb 10, 2009 - Aug 31, 2012

Audited countless thousands of workers compensation medical bills (UB04’s, CMS1500’s, Dental, DME and Pharmaceutical billings) at or near 100% accuracy for payment or denial. All bills had to be reviewed for CPT 4 & ICD 9 coding accuracy with relation to the established work related injury and pre authorized approved treatment plans. Major employers covered included The State Office of Risk Management, Southwest Airlines, American Airlines, and Service Lloyds Insurance Group. De-escalating health care provider complaints by active listening and resolving payment and/or denial issues occurred daily. A major portion of my day involved reviewing requests for reconsideration on previously denied medical bills. A key accomplishment was averaging 10-15 hours of overtime weekly for over 3 years. Worked with little or no supervision. Averaged 75 or more claims reviews daily.

JCS Medical Billing, Austin, TX

Medical Billing Specialist Mar 23, 2008 - Jul 04, 2008

Processed hundreds of medical billing payments and appeals of denials for Renaissance OB-GYN Clinic to get outstanding accounts paid. Averaged 75 accounts daily. This was initially a part time temporary job that was to be a full time working from home job, but turned out to be short term due to a lack of work.

Austin ENT Clinic, Austin, TX

Medical Payment Poster Aug 01, 2006 - May 05, 2008

Posted thousands of Medicare, Medicaid, Commercial Insurance, and patient payments weekly. Forwarded explanation of benefit denials to proper collector for review and appeal. Cross trained to process EDI (electronic data interchange) edits for clearinghouse which involved in making corrections to patient's demographics and Insurance plans then resubmitting the claims electronically. Achieved NPI (National Provider Identification) enumeration for all physicians and medical providers as mandated by the Centers for Medicare and Medicaid Services (CMS).

River Ranch Radiology, Austin, TX

Workers Compensation & Litigation Coordinator Apr 28, 2004 - Jul 31, 2006

Processed outstanding workers compensation and third party liability accounts receivable claims. This involved calling Insurance companies for claim status, appealing denied medical claims, and working with Attorneys in getting the facility paid for the X-rays, CT scans, and MRI's rendered on Injured people. Also, cross trained to handle any and all Insurance plans outstanding accounts receivable due and setting up payment arrangements for patient balances due.

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