Customer Service Insurance
Resume:
Rondeanda Williams
Houston, TX 77083
********.*********@*****.***
Objective: To utilize, compile, process, and maintain medical records of hospital and facility in a manner consistent with medical, administrative, ethical, legal, and regulatory requirements of the health care system.
Summary of Qualifications:
•Electronic Billing and Scheduling
•Appeals and Reconsideration and Appeals
•Claims Processing and Rejections
•Knowledge of CPT and ICD-10 Coding
•Knowledge of Medicare, Medicaid, Humana, Blue Cross/Blue Shield, Aetna
•Knowledge of In Network and Out-Network
SOFTWARES
Epic
Citrix
NextGen
MediSoft
Kinnser
NaviNet
Zirmed
Availity
Gateway EDI
Emdeon
Work History:
GetixHealth (Support Team/Customer Service) July 2016-CURRENT
Houston,Texas
-Review patient disputes and forward to central billing office for review.
-Review posting to patients accounts for accuracy
-Research missing payments made by patients and send to central billing office
-Follow-up with patients in regards to delinquent account
-Post patients payments and insurance payments and adjustments
-Educate patient about co-insurance and deductibles
-Provide patients with resources which may help them with medical expense
-Coach other representatives on how to resolve patient accounts, how to read EOB’s, how to apply
discounts and adjustments to patients accounts
-Train new hires on clients policy and procedures, Getix policy and procedures, customer service and
insurance
-Checked posting at the end of the month for unapplied monies
Universal Surgical (Billing Cooridnator ) October 2014-July 2016
Sugarland, Texas
-Supervise billing department staff. This includes training and evaluating staff in accordance with policies
and procedures.
-Managed and optimized the revenue cycle, from processing encounter forms through payment entry, denial management and account write-off.
-Reviewed, adjusted, appealed and /or monitor all denied claims for all third payers
-Overseen billing of payers on a daily basis. Submitted all information required by payers in order to
process claims.
-Established and maintained appropriate manual and automated billing systems to provide complete, timely and accurate recording and reporting of billing information.
-Ensured the integrity of the Accounts Receivable aged trial balance report by assuring that payments are
posted on a timely basis.
-Liaison with payers, including managed care plans and insurance carriers, Medicaid, Medicare and other
State and Federal agencies.
-Contacted payers and responsible parties in an effort to collect on denied claims
-Ensured compliance with all eligibility requirements for third party payers.
-Ensured compliance of managed care plans with contracted reimbursements.
-Established and ensured compliance with policies and procedures for billing and collections.
-Provided interdepartmental reports on the basis of daily and monthly billing.
-Perform audits.
-Special projects and other duties as assigned
Healix (Collector) August 2013-October 2014
Sugar Land. Texas
-Verify insurance benefits by phone and online, document in electronic files
-Follow up with patients regarding billing and payment issues by phone and in person
-Coding of claims using patient chart information (electronic files)
-Electronic claims submission
-Work EOB’s, send claim corrections and appeals electronically
-Follow up to ensure proper claim payment
-Obtain operative reports for facility and physician’s office
-Close account at the end of month, by balancing payments and deposits
-Post payments electronically and manually
Allied Covenant Home Health December 2011-October 2014
Houston, Texas
-Improved revenue for most recent provider over 32% with same patient load.
-Responsibilities include: Billing for medical and all commercial carriers, following up on unpaid accounts
or denying claims for their status, heavy data entry tasking, answering phones, filing, faxing and copying
documents.
-Post and reconcile insurance and patient payments. Research and resolve incorrect payments, EOB
rejections, and other issues with outstanding accounts.
-Keep the records such as the prepaid vouchers, overpayment and incorporate charges shown on customer
account.
-Verify all insurance and obtain pre-certification/authorization
Special Care Health Services April 2009-November 2011
Stafford, Texas
-Maintained awareness of advances in medicine, computerized diagnostic and treatment equipment, data
processing technology, government regulations, health insurance changes, and financing options.
-Reviewed records for completeness, accuracy and compliance with regulations.
-Entered data, such as demographic characteristics, history and extent of disease, diagnostic procedures
and treatment into computer.
-Verified accuracy of billing data and revise any errors.
-Ensure that all necessary signatures are obtained for treatments
C &O Health Care August 2008-April 2009
Stafford, Texas
-Entered, transcribed, recorded, stored and maintained information in written or electronic/magnetic form
-Processed patients' admission and discharge documents
-Entered data, such as demographic characteristics, history and extent of
disease, diagnostic procedures and treatment into computer
-Assigned and posted correct diagnosis and procedures codes to records and
report codes to insurance companies
-Process patient charts according to paperwork flow needs and established productivity standards
Education:
Houston Community College February 2007
Health Information Specialist
Current: University of Phoenix, Bachelor in Health Care Administration
Certification
Certified Billing and Coding Specialist (CBCS)
HIPPA
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