LaShai Daniels *** Louisiana St Apt. B Vallejo, CA 94591 510-***-**** ac3at5@r.postjobfree.com

Skills:

**-*** (12,000 KPH)

ICD-9, CPT Codes, HCFA 1500

CPR & First Aid

Medi-Cal/Medicare

General Human Resources (Payroll, Hiring)

Admitting Clerk

H.I.P.A.A. Regulations

Electronic Payments

Patient Financial Services

Private Insurance

Intake Coordinator

Cash Posting

QuickBooks

Cost Control

Accounts Payable/Receivable

IFS

Medical Software & Database Experience:

Human Resources Payroll, Retirements, New Hires, Orientations, Recruiting, Counseling, Evaluating, Terminations, Staffing

Medical Insurance Medi-Cal, Medicare, CCS, GHPP, CMSP, BCEDP, PACT

Software QuickBooks, Zeus, IDX, Medical Manager, Merritt, Opus, HBOC, Rev Codes, HCPS, ICD-9 & CPT Coding, Medical Terminology. Lawson, Kronos, EPIC, Meditech, Plus, Star and Advanced MD, Claims Manager Pro, Verscend.

Medical charting systems components or accessories Barcode attachment equipment

Billing Authorization Authorizations, Referrals, Payment Posting, Refunds, Follow-up, Appeals, CIF’s, Scheduling Appointments

Experience:

Affinity Medical Solutions, Oakland, CA (Contract) 10/2017-Present

Quality Coordinator

Assist in the capture, recording, review, and submission of medical record information for use in clinical quality measure reporting and quality gap closure.

Collect and identify medical records and review them to gather information which will be entered into an electronic database (may include converting electronic medical record information into PDF).

Upload documentation to SFTP sites and monitor an e-fax inbox for incoming medical records/ forms.

Review forms for completeness and keep track of files via Excel.

Contact physician offices to gather missing/ incomplete medical information; contacting patients to ensure appointments or care services are being scheduled.

Alta Bates Summit Medical Center, Berkeley, CA (Behavioral Health) (Aerotek Contract) 7/2016-8/2017

Payroll Specialist

Process payroll for between 150-200 employees within behavioral health for the Herrick campus.

Utilize Kronos and Facilities Scheduler to input and verify time and scheduling.

Complete payroll for non-exempt, union, and non-union employees for all shifts and differentials.

Update credentialing information including expiring licensure, continued medical education, and combative training programs.\

Filing and database management for all payroll and patient care files within behavioral health.

Data entry and administrative support to the department as needed.

SyMed Corporation Napa, CA 12/2015- 06/2016

Account Analyst

Performs Claims follow-up by working assigned aged trial balances under the direction of the team lead Associate.

Coordinates resubmission of claims to third party payers electronically or via hard copy mail when follow-up indicates such an action is necessary.

Identifies denial trends and works with claims representatives in third party payer offices to resolve issues. When situation warrants, enlists support and approval of team Lead Associate in escalating issue/concern to provider representative in third-party payer’s office

Ensures process issues (incomplete and/or incorrect data entry upon patient registration) resulting in denials and/or claims delays are brought to the attention of the team Lead Associate’s attention to bring about necessary process changes in data entry or with client staff

Shares updated information from third-party payers with Lead Associate to assist in ongoing training of department personnel.

Proactively communicates with Lead Associate throughout the month regarding A/R follow-up activities and workflows priorities

Prepares account adjustment write-off request forms when follow-up activities indicate no further reimbursement can be obtained. Forwards to Lead Associate for approval.

Works credits balances related to third –party by notifying payers that suspected overpayments exist, obtaining refund request letters from payers, filling out refund request forms, pulling support documentation, and forwards to Lead Associates for approval.

Various Contract Assignments 1/2014-11/2015

Alta Bates Summit Perinatal Center, Oakland, CA (Aerotek) (09/2015-11/2015)

Children’s Hospital Oakland, CA (Aerotek) (9/2014-09/2015)

John Muir, Walnut Creek, CA (3/2014-9/2014)

Bay Medical Management, Walnut Creek, CA (1/2014-3/2014)

Medical Biller/Payment Poster/Authorization Specialist

Audit and Code patient’s charts for proper billing process daily.

Request and maintain patient’s authorizations for prescriptions and DME.

Set appointments when necessary to review patient’s insurance.

Prepare and maintain monthly no-show and consult reports.

File all charts or re-route after billing.

Maintain and upload daily lockbox spread sheets for HB along with undistributed/credit accounts as directed by management.

Post payments daily for HB legacy and sites in EPIC.

Posting and maintaining daily ACH payments from bank.

Maintain missing payment accounts.

Reconcile batches daily.

Correspondence from collection agencies, request for validation of debt from facility to include signed financial agreement, bankruptcy’s – noting account and forward to agency if applicable, hardship applications, collection agency calls.

Multi-plan & UHC Denials faxed back – all others forward to appropriate supervisor per the financial class.

Workers Compensation Hold Report/Calls, Hold Client Review report, disputed accounts report, capario rejections.

Mistras Services, Benicia, CA (Contract-to-Permanent) 3/2013-1/2014

Payroll Specialist

Processes payroll (weekly, all non-exempt employee and union employees).

Bills and credit accounts within the accounts payable system; properly process payroll deductions, including union dues and payments as well as wage garnishments, child support payments and reconciliations.

Knowledge of federal, state and local wage and hour laws; compiled statistical data to report payroll allocations: bi-weekly, weekly data entry for all call out jobs and evergreen accounts building files/invoicing, track submittals and reconciliations.

Processed wage and payroll adjustments; general office support; filing, faxing, copying.

Processed Employment Verification; processed Vacation and Paid Time off Request.

CUE/IBT Local 2010, Berkeley, CA 03/2010-08/2012

Payroll Representative

Took calls from union employees if they were going to be missing shifts and scheduled relief staff

Send out seniority lists for strike coverage and relief staffing

Followed union seniority when placing employees on shifts during call-offs.

Processed payroll (weekly, bi-weekly, exempt, non-exempt employees and commission earnings).

Processed Seasonal payrolls, which tipped employees and utilization of, blended overtime rules.

Multi-state experience including California; accurately prepare payroll documents for up to 700 union and non-union employees.

Billed and credit accounts within the accounts payable system; properly process payroll deductions, including union dues and payments as well as wage garnishments, child support payments and reconciliations.

Worked closely with HR department to ensure accurate benefit deductions and employee record keeping.

Processed wage and payroll adjustments; general office support; filing, faxing, copying.

Processed Employment Verification; processed Vacation and Paid Time off Request.

UCSF Medical Group Business, San Francisco, CA 03/2006-03/2010

Senior Medical Biller

Protects the security of medical records to ensure that confidentiality is maintained; Process patient admission and discharge documents.

Compiles and maintains patients' medical records to document condition and treatment and to provide data for research or cost control and care improvement efforts; reviews records for completeness, accuracy and compliance with regulations.

Enters data, such as demographic characteristics, history and extent of disease, diagnostic procedures and treatment into computer.

Plans, develops, maintains and operates a variety of health record indexes and storage and retrieval systems to collect, classify, store and analyze information; responsible for the processing accounts, managing the records information, billing etc.

Responsible for communicating with the insurance companies for the payment of the claims.

Answered the patient's queries, problem and complaints and also identify the solutions.

Per-Se Technologies, Novato, CA 08/2000-03/2006

Senior Medical Biller and Coder (Rehired Twice)

Responsible for assigning ICD-9-CM/CPT-4 diagnosis and procedure codes for all patients records.

Followed and reported status of delinquent accounts; inpatient/outpatient experience as a Medical Records Coder in an acute care facility with knowledge of ICD-9-CM & CPT Classification Systems; prepared and submits clean claims to various insurance companies either electronically or by paper.

Answers questions from patients, clerical staff and insurance companies; identifies and resolves patient billing complaints.

Prepared reviews and sends patient statements; evaluates patient's financial status and establishes budget payment plans.

Performs various collection actions including contacting patients by phone, correcting and resubmitting claims to third party payers.

Processes payments from insurance companies and prepares a daily deposit.

Participates in educational activities and attends monthly staff meetings; Conducts self in accordance with Employee Manual.

Maintains strictest confidentiality; adheres to all HIPAA & JCAHO Guidelines/Regulations.

Manages Care Systems and Special Plans & Third Party Reimbursement, Medicare, Blue Cross-and Blue Shield Plans, Medicaid and other Programs, CHAMUS and CHAMPVA, Worker’s Compensation, Disability Income Insurance and Disability Benefit Programs.

Education:

CONFIDENTIALITY OF PATIENT RECORDS - Code Section l-B, Oakland, CA 2006

PRINCIPLE: NONMALEFICENCE (“do no harm”) – HIPPA & JACHO Medical Regulations - Federal Health & Safety Regulations

NAPA VALLEY COLLEGE (BUSINESS) 2013

Obtained GED Fairfield Adult School 1997

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