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Customer Service Representative

Baltimore, Maryland, United States
February 18, 2018

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Sharon Kerley

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

Elkridge, MD *1075



To further my experience in the administration aspect of the health care field using current knowledge, as well as expanding my knowledge through positions I may hold throughout the field. Medstar Health: Centralized Billing Office (Medix Staffing Solutions) Nottingham, MD 1/2016-6/2016

Review and work any claims on the PX Reports (Debits & Credits from Insurance payments) Work Monthly HealthCare Queries Report daily, initial claim submission, requesting reprocessing of claims, request Adjustments, Claim Follow Up, Refund request, etc. Gather & Submit Claims and necessary documentation to Nursing Homes for Consolidated Billing Request and Submit Medical Records for medical review of claims for Tricare and the VA. Handle incoming correspondence for Tricare, SNF’s & Champ VA. Balance Nursing Home Lab Billing spreadsheet with payments received from billed lab invoices. Bill ancillary services to patient accounts using billing/charge sheets received. All other miscellaneous work needed to be completed in order to assist the Billing/Guarantor Team. Optum – United Health Group – Customer Service Representative - Elkridge, MD 11/2015-1/2016

Call Members to schedule Comprehensive Medication Reviews with company Licensed Pharmacists. Document and Review all key points of “Call Script” for proper calls according to Quality Assurance policy and procedure.

Source Medical – Insurance Collections Specialist: - Ft. Myers, FL 10/2014-1/2015:

Maintain updated claim status from claim creation to denial and claim paid. Correct any errors and resubmit claims if necessary, electronically & paper. If claim paid, contact patient regarding payment from insurance company (Out of Network providers) Submit appeals to insurance if allowable was less then 60% of claim’s total charge. Communicate with Surgery Centers to request additional documentation or information needed for claims, appeals, or adjustments on a weekly basis.

Millennium Physician Group - Resource Reimbursement Rep - Ft. Myers, FL 5/2013-3/2014

Review rejected and "Held" Medicare claims for correction and resubmission. Work closely with the Coding Department for claim corrections. Review A/R for possible refunds to insurance companies, complete and Submit refund requests to management.

Review all incoming correspondence and handle accordingly. Assist Management with any special, time sensitive projects and/or communication with the physician offices.

Maintain an average of 80 claims/day worked.

Sleep & Pulmonary Center of Florida - Front Desk Specialist - Port Charlotte, FL 5/2011 - 3/2012

Check In:

Check in patient's for their appointments.

Verify Insurance and patient information

Collect Co-Payments

Answer all incoming calls and direct to appropriate staff on six line phone system. Check Out:

Schedule Follow Up Appointments.

Schedule patients for referrals to other specialty physicians. Schedule Imaging Tests - X-Ray's, CT Scans and PET/CT Scans. Schedule surgical procedure through local hospitals. Coordinate with In House Sleep Center staff to schedule all phases of Sleep Studies. Create claims for office visit, enter charges and appropriate diagnosis codes. Other Duties:

Take incoming consults and messages to relay to the physicians. Obtain Pre-Authorization for imaging services and surgical procedures. Complete weekly "Recall List" to schedule future appointments for patients. Mail all New Patient paperwork weekly.

FutureCare Irvington - Patient Account Manager - Baltimore, MD 1/2008-10/2010

Complete daily census report for 200 bed facility. Manage and update all ancillary logs using daily census report. Manage and update Medicare Tracking log daily.

Attend daily Morning Report and PPS Meetings.

Complete monthly collections.

Manage all Resident Fund accounts.

Create refund log based off review of private A/R aging. Assist patients and families in applying for Long Term Care Medical Assistance benefits. Complete all yearly re-determination applications for Medicaid patients. F utureCare Health & Management Corporation: - Pasadena, MD 7/2006-1/2008

Vendor Liaison:

Generate and distribute vendor reports weekly.

Generate and distribute a monthly batch of approx. 20 vendor reports. Receive and code all vendor billing statements according to patient's payer source and distribute to appropriate billing specialist.

Manage and update Vendor Report sheet as needed.

Supply patient information to vendors and providers as needed. Medicaid Billing Specialist:

Update daily census once report is received from Patient Account Manager at facility. Prepare and transmit monthly Medicaid claims for payment. Apply all vendor charges to patient's account.

Review Medicaid payment remits every week for payment discrepancies and non-payment. Monthly A/R review.

Managed Care Billing Specialist:

Identify and track Managed Care patients monthly.

Collect information from facility case managers to ensure correct billing. Create UB-92 and UB-04 claim forms based upon the information collected throughout the month for each managed care patient.

Review managed care A/R weekly for payment and non-payment discrepancies. Education

Catonsville High School - Baltimore, Maryland 2002-2006 Software






Microsoft Office Programs

Outlook Express

Answers on Demand

Lotus Notes

Resident Fund Management System




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