Customer Service Insurance
Resume:
Jacqueline Bob
Houston, TX *7088
Experienced Medical Coordinator with 17+ years of experience specializing in Healthcare Billing, Insurance Claims, EPIC, Accounting, Scheduling, and Management, within an office setting.
SKILLS
ICD-9 & ICD-10
CPT-4
HCPC procedural coding
ADA Dental codes
DHMO
PPO
CDT-7
EOB interpretation
Healthcare & Insurance terminology
Insurance Claims
Microsoft Word
Excel
Power Point
PDMS/Core
SMS Care & IDX System
Thin/Availity Billing Software
Cirius/Prebill Billing System
ImagineNow6
Remit Data
Easy Print
OnBase
People Soft
Core IPayment
EPIC
PROFESSIONAL EXPERIENCE
DNJ Insurance Solutions July 2017 -Present
Licensed Insurance Agent
Develop positive working relationships with clients
Approach clients via cold calling and direct mail to inquire their insurance situations and future needs
Deliver policy proceeds after a claim is filed and approved
Communicate with Insurance Adjusters about the life cycle of each claim
Explain the differences in policy specifics so clients can make informed decisions about their purchases
Assist with obtaining underwriting approval
Respond to clients’ questions and complaints
Follow up with clients after initial meetings or conversations
Participate in continuing education programs in both insurance and sales
Acclara Solutions LLC; Houston, TX Mar 2017-July 2017
Lead Insurance Specialist
Reviewed accounts regularly for insurance and patient billing issues.
Performed various collection actions including contacting insurance companies and patients by phone, correcting and resubmitting claims to third party payers etc.
Follow up on unpaid claims within standard billing cycle.
Checked insurance payments for accuracy and completeness and obtain missing information.
Verified insurance companies regarding any discrepancy in payments if necessary.
Identified and bill secondary or tertiary insurances.
Assisted with entry of patient payments.
Assisted with other business office work as needed.
MD Anderson Cancer Center; Houston, TX Jan 2009 – Jan 2017
PBS Lead– Revenue Billing /General Ledger Reconciliation
Billed physician & hospital claims & follow-up/claims collection according to governmental billing regulations.
Monitored accounts, calls, processes and procedures for Quality Assurance for the finance, customer service and billing departments.
Analyzed and resolve all account discrepancies including credit balances
Provided analytical support and specialized billing processes for Patient Business Services (PBS).
Performed Medicaid collection activities including appeals.
Completed daily response and rejection reports for denials.
Performed insurance verification functions to expedite insurance billing & payments.
Maintained general ledger conversion table process.
Developed transaction flow maps and maintains general ledger conversion table process.
Assisted in resolution of billing and coding issues related to conversion master.
Consulted and assisted clinicians regarding patient service revenue issues and reviews to ensure completeness and accuracy of charge description masters.
Responded and resolved patient inquiries, both over the telephone and in person.
Managed incoming patient calls regarding the status of patient accounts for both professional and facility billing.
Received and responds to correspondence from patients, providers and representatives from insurance companies.
Responded to questions regarding the status of insurance claims, requests for itemized statements, patient balances due, payment processes and requests for audits of accounts.
Advised patients regarding claims correction and appeals.
Identified and/or corrects erroneous processing in a timely manner, to include any research and correction requests.
Requested information as required to expedite the claims adjudication process.
Analyzed complex claims management issues and problems and makes corrections.
Documented and updated SMS and IDX clearly and appropriately with patient inquiries and resolution of concerns.
PBS Associate – Customer Service/Payment Posting Jul 2000 – Jan 2009
Provided analytical support and specialized billing processes for Patient Business Services (PBS).
Scoped Impacts Patient Business Services and the patient population.
Performed account analysis, maintenance, and follow-up activities and appeals on insurance, self-pay, bad debt, and charity care accounts, as appropriate.
Posted payments and resolves credit accounts.
Reconciled and analyzed various payments for accuracy.
Tracked account statuses and reports issues to management.
Generated and reconciles system generated reports, providing statistical data/trends to management.
Processed primary and secondary claims and late charges.
Provided customer service support by resolving account inquiries, reconciling vendor invoices, and generating itemized statements.
Memorial Sisters of Charity; Houston, TX Oct 1999 – Jul 2000
Claims Processor
Pre-Processing of claims with appropriate accept/denial codes.
Processing of Medicaid invalid claims on-line.
Verification of Medicaid invalid provider numbers using state files.
Maintenance of correspondences and production reports.
Almeda Dental Group; Houston, TX Jan 1999 – Oct 1999
Front Desk -Insurance Follow-up
Performed medical history lookup.
Verification of Insurance coverage.
Appointment confirmation.
Spectera Dental Insurance; Houston, TX May 1997 – Jan 1999
Customer Service/Utilization
EDUCATION
DeVry University, Houston, TX
Business Administration
2005
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