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Medical Customer Service

Location:
Carrollton, Texas, United States
Salary:
$23.00
Posted:
January 29, 2018

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Trena L. Willis

HIM Professional

Dallas, TX ****7

www.linkedin.com/in/trena-willis-123bbb143

ac38wb@r.postjobfree.com 469-***-****

Associate of Applied Science Degree in Healthcare Information Management with specialized training and certification in Medical Coding and Billing/Collections, and over 18 years’ experience in the Healthcare Industry; researching, monitoring, expertly managing medical accounting needs, inpatient and outpatient records, patient monitoring, as well as collaborating with physicians, radiologists and researching data.

Resolved outstanding debt and achieved goals set for the month at 3million by consulting with clients for coding issues and reduced A/R by 80% by completing the work directed to special projects such as: credentialing, credit balances and medical collections.

Currently pursuing a career in Health Information Coder/Manager role, with having extensive experience in the Revenue Cycle arena. Also preparation in getting my RHIT, for personal fulfillment and towards servicing the health needs of my country and community. Authorized to work in the US for any employer.

WORK EXPERIENCE:

Reimbursement Coordinator

Amerisource Bergen’s 08-2017 to 12-2017

Investigated on all Medicaid/Managed Care accounts for all 50 states, regarding the payor fee-schedule, LOA’s, Contracts, contingent upon payer.

Collected reimbursement on Claims submitted, per SOP on pharmaceutical billing, requested for adjustments that needed to be applied, in collaboration with proper departments etc.

Utilized software such as: Excel Spreadsheet, Script Med, Path-Point RX, Navicure, PRX, Availity, J-drive, M-drive, etc.,

Initiated processes for completion of denials, credits, over/underpayments reports, adjustments, researched payments in Lock-boxes etc.

Licensed Independent Agent

Liberty National Insurance 03/2017 to 08/2017

INSURANCE COLLECTIONS SPECIALIST

Texas Oncology, TX 08-2015 to 08-2016

In collaboration with the clinics, management, physicians, reviewing patient's diagnosis and procedures and thoroughly documenting all findings for clean claim submission.

Researching outstanding balances and taking necessary collection action to resolve in a timely manner.

Identifying billing errors, appealing payments, over payments, unpaid claims, and resolving issues accordingly.

Utilizing most efficient resources to secure timely payment of open claims or invoices.

Interacting with third party collection agencies as necessary, qualifying patients with assistance, if needed.

Coordinating patient plan care in compliance with protocol requirements.

Securing a safe working environment at all time through compliance with all HIPPA, federal, state, and professional regulatory standards.

Competed the Medical Coding program-received certificate from Texas Oncology.

RESEARCH VERIFICATION SPECIALIST

AmerisourceBergen’s Insight Global Staffing Project - Frisco, TX 11-2014 to 04-2015

Examined patients' insurance coverage, deductibles, possible insurance carrier payments and remaining balances not covered under their policies when applicable.

Monitored the drug for Eylea patients, financial status and established appropriate payment plans.

Precisely evaluated and verified benefits and eligibility on Medicare/Medicaid primarily.

Determined prior authorizations specialty drug, medication and outpatient procedures.

REIMBURSEMENT SPECIALIST (Contracted)

Conifer (Healthcare Support Staff) AMBULANCE BILLING PROJECT - Frisco, TX 06-2014 to 12-2014

Ambulance Billing-Project, MVA Billing/Collections, verified HCPC, CPT coding issues for ambulance procedures, daily logging of production on Excel spreadsheets, billing, rebilling, code-correcting, adjustments, missing payments etc. Software utilized; Onbase, AS400, Navinet, CMS websites, etc.

Contacted Medicare, Medicaid, HMO's, payers regarding payment, redeterminations, reconsiderations, appeals and timely filing adjustments, when needed.

PATIENT ACCOUNT REPRESENTATIVE (Contracted)

Cn Staffing Ameripath- Addison, TX – 12-2012 to 06-2013

Collected on BS/BC claims pertaining to cytologist and pathologist claims, Centricity/Excel spreadsheet implemented data.

Investigated and managed to get physicians licenses that pended credentialing.

Trouble-shot problems regarding claims submissions and placed on problem log for tracking purposes.

CLAIMS SPECIALIST

State Farm (Catastrophe Management Solutions) - Dallas, TX 04- 2012 to 10-2012

Received in-bound calls from claimant’s due to Hurricane Sandy Catastrophe.

Implemented first hand response regarding checking policy to create claims for adjusters for follow-up, trouble-shooting. On Call Roster.

PATIENT ACCOUNT REPRESENTATIVE III

GE Healthcare - Plano, TX – 06-2006 to 01-2010

Submitted electronic billing and manual hard copy claims by initially troubleshooting coding errors or edit resolutions, medical records, charge corrections.

Resolved outstanding debt and achieved goals set for the month at 3million by consulting with clients for coding issues.

Credentialed inquiries, medical records request, ICD-9, CPT codes, modifiers, that resulted in submitting clean claims.

Reduced A/R by 80% by completing the work directed to special projects such as: credentialing, credit balances and aged accounts.

Pre-certification acquired on all Government, Commercial, and Managed Care claims.

Generated revenue on all Kaiser Claims and Managed Care claims for CHO totaling 1800 invoices, completed project at 100%.

Successfully appealed claims due to timely filing issues, pending authorization, medical necessity, and received 85% reimbursements.

EDUCATION

Texas Life/Health License-Dallas, TX.75287-03/2017-03/2018

Associate of Applied Science in Healthcare Information Management HIM

RHIT (Pending)CCS

Collin County Community College - Plano, TX 05/2015

Billing/Coding Course/Certificate of Completion

Sanford Brown Institute - Dallas, TX 2007

Medical Office Specialist

International Business College - Lubbock, TX 1992

SKILLS

MS Office (10+ years), Computer Skills (10+ years), Billing (10+ years), As400 (1 year), Excel (8 years), Medical Terminology (18 years), Customer Service (10+ years) Salesforce One- app. Commercial, Medicare/Medicaid some Workers-Compensation claims.

ADDITIONAL INFORMATION

KNOWLEDGE AND SKILLS:

ICD-10 (International Classification of Disease Systems) ICD-9, HCPCS Coding Guidelines Hospital Inpatient and Outpatient Records Medical Billing and Collection Procedures Expert Familiar with Commercial and Private Insurance Carriers Medical Terminology Expert Insurance and Collections Procedures Accounts Receivables Filing 3rd party billing

Computer: PC & MAC On base AS400, Navinet CPT coding CMS websites Word Excel PowerPoint Electronic Medical Records Iknowmed, Mysis, Mosaic, Software JP Morgan Software Easy Print for Medicare, Centricity, Experion, Availity, Script Med, Path-Point RX, Navicure, PRX, Availity, Lock boxes, J-drive, M-drive,

Personal/Interpersonal: Time Management Team Playing Proactive Positive Language Persuasive Willingness to Learn Excellent Problem Solving Professional Mannerism Excellent Human Relations Critical & Analytical Thinking Reliability & Resourcefulness Detail Oriented Attentive Very Sensitive Proficient



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