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Insurance Medical

Decatur, Georgia, 30030, United States
19.00 hr
January 31, 2018

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Janet Myrick

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

Decatur, GA **032



Working knowledge of ICD/CPT/HCPCs medical coding guidelines and Medical Terminology.

Extensive knowledge of commercial health insurance plans and managed care provider contracts.

Medicaid and Medicare billing experience.

Experience in reading and interpreting insurance explanation of benefits.

Aptness in the navigation of multiple insurance carriers, GAMMIS, and Medicare web portals.

GE Centricity Business billing practice management system experience.

EMDEON Payment Management software experience.

Microsoft Office (Outlook, Word, EXCEL) software experience,

Excellent written and verbal communication skills.

Effective time management and ethical decision-making skills.


GENTIVA HEALTHCARE (Accounts Receivable Specialist: October 2015 – July 2017)

Ensured the coordination of claim activities and timely reimbursement of receivables.

Researched, resolved, and prepared claims that have not passed the payer edits daily.

Determined and initiated action to resolve rejected invoices.

Analyzed each agency's outstanding monthly accounts receivable, and processed claims to obtain zero balances

Researched and resolved patient accounts with credit balances.

Validated and processed third party payer refund requests.

Reviewed and communicated with agencies to educate them about expectations for clean claims.

Prioritized and worked on accounts

in assigned work queues to ensure all accounts are submitted and resolved timely.

Worker Comp


PSA HEALTHCARE (Medical Insurance Collector: June 2014 – May 2015)

Worked aging A/R reports daily, following up on accounts with outstanding balances and credits (i.e. non-payments, overpayments, underpayments) by contacting insurance carriers and documenting findings in the revenue cycle management system.

Verified and updated patient insurance information for billing/collections purposes.

Processed claim denials that include EDI rejections, claim edit reports and unbilled encounters.

Submitted appeals by obtaining retro-active pre-certifications, forwarding additional clinical documentation, and corrected claims for payment reconsideration.

Cleared payment variances for overpayments by completing and submitting refund requests to upper management for approval as well as resolved underpayment

discrepancies by working with insurance carriers and Provider Contracts to collect monies owed,

SHEPHERD CENTER (Medical Insurance Collector) Temp: June 2013 – February 2014

Review, collect on Medicare advantage and Commercial accounts

Updated patient and insurance information and refilled claim to correct carrier

Review contract for the correct payment and codes that would require authorization

Write-offs and adjustments as appropriate

Payments MD (Medical Insurance Collector): December 2011- May 2013

Manage and follow up on all assigned accounts 120 days for Medicare advantage and Commercial

Updated insurance and patient information as needed reissued claim to correct carrier

Appeals on claims as needed

Reviewed claims for incorrect coding and routed back to coder for review and correction

MAG MUTUAL (Medical Insurance Collector: September 2001 – April 2010)

Followed-up with insurance companies or third-party payors to ensure correct and timely processing and payment of claims.

Reviewed Explanation of Benefits (EOBs) and remit advices to verify claim payment/denial as well as research reasons for denials and underpayments to make appropriate follow-up.

Verified all primary and secondary insurance information including effective and termination dates, type of plan, timely filing dates, and special filing requirements prior to routing to the appropriate department for approval/update.

Communicated claim related changes (e.g. coding, reimbursement, and provider contractual issues) to the appropriate Revenue Cycle Management department.

Adjusted patient demographic and account balances.

Workers Comp


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