GLORIA WILSON-BAILEY

Raleigh, NC ***** 919-***-**** ac48om@r.postjobfree.com

Summary of Qualifications

Driven professional with a demonstrated track record of maximizing business opportunities and consistency in achieving performance goals utilizing 5+ years of supervisory experience, combined with over 10 years of healthcare industry experience, Looking use my creative and analytical skills with extensive knowledge in the fundamental principles of finance, data management, training/mentoring, and contract negotiations by developing and implementing successful process flows, and project management.

Education and Training

Master of Human Resource Management

Keller Graduate School of Management of DeVry University, Morrisville, NC

Bachelor of Science in Business Administration-Healthcare Management

DeVry University, Morrisville, NC

Graduate Certification Public Policy

Liberty University, Lynchburg, VA

Affiliations

President of Hope Charter Leadership Academy Parent/ Teacher Organization

North Carolina State Youth Coordinator, Zeta Phi Beta Sorority, Inc.

Member of Association of Professional Medical Billers & Administrators

Member of American Association of Professional Coders (AAPC)

Skills:

Microsoft Word Advance Microsoft Excel Clinical Trials Billing (2013) SAP EPIC Microsoft Access DME Billing MediSoft Practice Fusion Allscrips Leadership Accounts Receivable Budgeting Managing Staff Conflict Resolution Training Diversity Training Revenue cycle.

Professional experience

Assistant Director of Finance

October 2017 - December 2017

The Mariposa School for Children with Autism Cary, North Carolina

●Spearhead and implementing a new clinical EHR and billing program to successfully track A/R and A/P for children tuition.

●Training on new EHR.

●Billing of major insurance payers for Autism services.

●Obtain pre-authorizations for initial assessment for children services.

●Insurance Panel Credentialing of billing providers.

●Offer guidance to parents regarding billing issues.

●Collaborating with the school’s Executive Director and Clinical Director to oversee the billing of tuition in it's various payment forms including establishment of best practices for collections, insurance approvals, coordination of grant funds and assisting parents in understanding their payment options.

●Working with the Administrative Assistant and Executive Director to assure payroll, accounts payable, banking and other financial responsibilities are accomplished timely and accounted for correctly.

●Supervised the office staff.

Billing Specialist April 2017 - October 2017

Legacy Healthcare Raleigh, North Carolina

●Follow-up on aged accounts 180 days more.

●Contacted major insurance payer to resolve billing issues.

●Resubmitted corrected claims CMS-1500 for payment.

●Utilizing Casaba and Med Soft to post insurance payments.

●Meet daily and monthly payment posting deadlines.

Billing Administrator January 2017 - April 2017

Silver Linings for Seniors Cary, North Carolina

●Assuring smooth and efficient workflows in daily operations of the medical setting.

●Function as administrative support and provides back-up support in various administrative areas.

●Training of Front Office Staff.

●Coordinate all IT/Electronic Health Records actions.

●Providing excellent customer service to patients in person and via phone.

●Provider Credentialing.

●Extensive knowledge of medical billing/coding, electronic recordkeeping, provider credentialing

●Knowledge of Medicare, Medicaid, MCO and private insurance.

●Experience with Electronic Medical Records.

●Request/maintain prior authorizations for Government and Commercial Insurance reimbursements

●Reconcile EDI payment remittance advices, ensuring proper posting of insurance payments to patient accounts as well creating and submitting monthly patient invoice statements.

●Demonstrates knowledge of management and leadership in carrying out office policies and procedures.

● Demonstrated ability in analyzing various financial data

●Experience with accounting principles and practices

●Experience preparing financial report

Processing Assistant IV August 2015- December 2016

Department of Health and Human Services, Public Health Raleigh, North Carolina

●Administrative processing, manual review, coding and official registration of approximately 7,000 deaths and 100 fetal deaths monthly.

●Uses current federal coding instructions and other related reference materials to maintain documentation of the received and processed.

●Performed data analysts and Quality Assurance of confidential data..

●Created database files using Microsoft Excel and backup files daily.

●Assist with death coding activities as needed so that contractual deadlines can be met.

●Experience with Excel software and creating spreadsheets

Administrative Assistant II January 2015- August 2015

North Carolina Department of Commerce Raleigh, North Carolina

●Spoke with and interviewed claimant filing unemployment claims as per House Bill 4 statue.

●Entered personal and confidential information in a Mainframe program.

●Provided basic information regarding requirements for filing a claim, penalties for fraudulent claims, re-employment service, and eligibility status and appeal procedures.

●Severed as a liaison for the customer and the adjudication team.

●Analyzed and abided by guidelines of legislative House Bill 4.

●Responded to email inquiries regarding military, civilian and interstate unemployment benefits and claims.

●Possessed clear and concise communication skills, both verbal and written, interpret and apply State and Federal laws and policies with utilizing SOP’s.

●Experience with researching and resolving problems

Customer Service Representative/ Billing November 2014 - January 2015

LinCare Inc. Cary, North Carolina

●Trained new Customer Service Representatives of existing and new federal and state insurance guidelines as it pertained to durable medical equipment.

●Stayed abreast and implemented the policies and regulations for medical billing and coding of durable medical equipment.

●Provided front end customer service to referral sources, patients, and administrative departments; coordinate new patient delivery schedule within the service area.

●First point of contact for referral sources and patients; make determination of required action.

●Administer internal Durable Medical Equipment orders from physicians or other referral sources.

●Process patient information with accuracy and timely processing.

●Verify insurance coverage and advise collections department of required actions for billing.

●Respond to new and existing patients' requests as well as instruct patient in the safe and proper use of equipment.

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