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Customer Service Insurance

Location:
Houston, Texas, United States
Posted:
December 29, 2017

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Resume:

Rondeanda Williams

***** ******** ****

Houston, TX 77083

832-***-****

ac3uly@r.postjobfree.com

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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