Medical Insurance

}Serena Davis

***-** ***** ***. #* Springfield Gardens, NY 11413

Phone: 347-***-****

E-mail: ************@*****.***

Education

Interboro Institute – Business Administration/Computer Science (2/2000- 2/2001)

Samuel J. Tilden H.S. (6/1997)

Experience

Medical A/R Representative (7/2016 – Current)

CHE Psychological Services/NCN Management (Melville, NY)

Responsible for analyzing explanation of benefits (“EOB”) data and resolving denials and/or underpaid Medicare and Medicaid (NY,NJ,CT,PA) claims for psychological practice, submit secondary and tertiary insurance bills; Correct and resubmit rejected Medicare and Medicaid claims; Correct and resubmit rejected Third Party Insurance claims according to individual insurance plan requirement, Work with medical authorization/referral staff to verify insurance eligibility, Sort and file paperwork (electronically or manually). Worked A/R spreadsheet using MS Excel/Google Sheets, Maintained a working knowledge of all health information management issues such as HIPAA and all health regulations, ICD-9,10 transition, LCD and maintained strict confidentiality and Coordinate with other revenue cycle departments for follow up on claim denials

Revenue Services Coordinator (7/2015 – 7/2016)

Advanced Care Inc. (Farmingdale, NY)

Reporting to the Revenue Cycle Manager; responsible for supporting management in maintaining, improving, processing, and evaluating the billing and collection of accounts receivable for the Health System and/or resolve complex payer issues to completion daily for Home Care/Infusion company. Encompass working the receivable of multiple facilities for the states of CT and NY and comprised the receivables of multiple payers such as workers comp, no fault and facility to facility billing as well as negotiated letters of agreements for non contracted/out of network practices, as well as supporting management in the overall execution of Revenue Cycle collection duties. Understanding of a hospital, nursing home, hospice and patient revenue cycle including registration, charge capture, billing, collection, utilization management, and account balance resolution.

Collections Coordinator/Accounts Payable Specialist (1/2012 – 3/2015)

Avanti Healthcare Services/Alexander Infusion LLC (New Hyde Park, NY)

Responsible for Coordinating Billing/Collections/Payables Department for major home care Infusion Company. Duties include but are not limited to: Prepared and generated accurate clean medical claims for submission to all payer types including PBM, Major Medical/Commercial/ N/F and Government, Submission of claims to be done electronically as well as hardcopy CMS-1500 and UB-04. Monitor open claims and the overall A/R aging report. Process all Explanations of Benefits and follow through with payers/patients for collection on claims. Obtain information from carrier/patient when services billed are denied for reasons of insurance, demographic information and/or authorization. Appealing denials when necessary; Generated collection reports using MS Excel, performed end of the month closings, transmitted electronic and pharmacy claims for adjudication daily, scrubbed claims to ensure proper clean claim submission, worked closely with the CEO and billing and collections manager, entered invoices in QuickBooks, reconciled cash and check payments daily, performed all bookkeeping activities, recorded daily deposits, deposited check payments using desktop software, assisted in QAPI-PHI reporting quarterly. Responsible for reporting monthly results to the Director of Billing including claims submitted, write-offs, problem payers, documentation hold and ending A/R. Completed and managed all paperwork or supportive documentation required for performing effective billing as needed, assist with initial intake, insurance verification and prior authorizations, negotiated and executed letters of agreement. Highly efficient in all billing and collections procedures.

Sr. Medical Biller/Collections Specialist (6/2008-11/2009)

Island Professional Billing/Neurological Associates P.C. (Rockville Center, NY)

Prepare medical and professions claims for billing for surgeries and office visits via super bill and surgical notes, verify and confirm accurate insurance eligibility and patient demographics, verify and obtain insurance authorizations, review monitoring and analysis of all reimbursements from Medicare, Medicaid and all managed care contract sources, prepare patient balance, tracking/collections according to group specifications, follow up on unpaid/denied claims or unprocessed claims within 12 days of submission, assisted with month-end report preparation, updated current information on CPT, ICD-9, DRG codes, prepares and submit patients statements, well trained in practice analysis through reporting, Transmitting of Electronic Billing and Secondary Claims, Auto Accidents and Workman’s Comp Cases, Payments and Posting.

Sr. Medical Auditor (2/2007-5/2008)

Business Dynamics LLC (Mineola, NY)

Responsible for collections and reimbursements for Orthopedic and Spine Surgeries for third party billing company from Medicare, Medicaid and all managed care contract sources via AR Spreadsheet, appealed denied and underpaid claims, follow up on unpaid/denied claims, filed state complaints for claims unprocessed by state processing timeframe. Confirmed and obtained claim receipt and claim status within 10 days of submission, provided administrative support for claims manager, verify updated insurance and patient information troubleshoot any problems encountered in the verification process thus lessening potential payment and collection issues.

Medical Biller/Collector (6/2004-11/2005)

Jzanus Professional Services (Floral Park, NY)

Responsible for billing and collections; collected and followed up on commercial insurance and HMO’s for medical and dental billing, managed denials, posted charges and payments, ordered medical records for appeals, submitted electronic and paper claims, assisted with daily and monthly closing, credentialed physicians, coordinated departmental meetings, monitored supplies and equipment

Medical Biller/Collector (5/2003-6/2004) [Contract]

South Nassau Communities Hospital (Oceanside, NY)

Responsible for inpatient billing and collections for hospital; collected and followed up on commercial insurance and HMO’s, managed denials/underpayments, entered and submitted claims manually and cued for electronic submission, posted charges and payments, ordered medical records for appeals, verified patient demographics and insurance eligibility.

Skills

Workers Compensation/No Fault

Multi-Specialty Billing/Collection Practices Procedures and Coding

Commercial, Managed Care, Medicare/Medicaid Billing and Collections

MS Office

Medical Administration/Secretarial Skills

QuickBooks

PHI/QAPI Reports

Knowledge of payer websites

Contact this candidate