Bennettsville, SC *****
Professional experience and outstanding skills in Healthcare Insurance, Customer Service, Billing Analyst, Medical Case Management, Retail, Hospitality, and child care. I am competent to successfully work in a in a fast paced environment with the ability to think quickly. I have excellent interpersonal skills, solid decision making skills, hard-working, and a result-driven attitude.
Able work in a pressurized environment with continuous deadline and capable of making quick decisions in time constraint situations. I get the job done with an upbeat, positive attitude.
Proficiency in, Microsoft Office programs, (Word, Excel, PowerPoint, and Outlook).
Ability to work with several operating systems, including Windows, Mac OSX and Linux.
Experience with LexisNexis and various other search programs.
Medical Claims Specialist:
Validate the information on all medical claims received and follow on lapsed claims.
Assisting members with account issues, and providing knowledge about the accounts.
Coordinating with Hospitals, AP companies, Medical and claims team. Re-confirming & assuring smooth flow of documents for all transactions processed and registered. Resolving the queries of the clients related to payable.
Handling all incoming & outgoing emails to re-confirm & assure a smooth flow of documents for all transactions processed and registered.
Resolving the queries of the clients related to payable.
Contact customers in order to respond to inquiries or to notify them of claim investigation results and any planned adjustments.
Review insurance policy terms in order to determine whether a particular loss is covered.
Late Stage Claim Analyst: (Call Center Environment)
Review late stage accounts
Prepare collection letters
Investigate disputes and effectively resolve them
Investigated using Accurint and Google to locate assets and people.
Prepare legal binding settlement agreements payment agreements.
Provide support to the corporate office and all sub locations
Prepare spreadsheets for monthly reporting
Contact Corporations in effort to resolve outstanding invoices
Participate in creating ideas to benefit my team and company
Refer accounts for further actions
Communicate via telephone, email, and fax.
Responsible for monthly goal of $70,000
Set a record in collecting 185,000 in 30 days with being tenured for 7 month
Capital City Ambulance, N. Augusta, SC
Received denied claims, investigated denial reasons, corrected claims via telephone,
electronically, and/or paper for processing.
Responsible for verifying eligibility with various insurance companies, setting-up payment
arrangements for private pay patients.
Was also responsible for skip tracing and staying updated w/ HIPPA.
I was able to shrink our outstanding balances through skip tracing and collections
RBH, Inc, Washington, NC
Medical Biller/ Office Manager
Prepared and submitted clean claims to NC Medicaid
Examined denials and investigated to find solution
Reviewed patient files and assign codes to each service given
Examined claims for Medicaid guideline compliance and completion before submission.
Filed all claims in a timely manner to get payment quickly
Reviewed daily billing reports and keeps up with submission dates
Answered questions from clerical staff and NC Medicaid
Prepares invoice for the supervisor's review
Participated in educational activities and attended monthly staff meetings.
Conducted myself in accordance with RBH'S manual
Maintained the strictest confidentially; adhered to HIPPA guidelines
Managed a crew of seven case managers
Made schedules, settled complaints, order supplies, submitted payrolls, trained employees
Electronically billed Medicaid for nonprofit organization leading to fewer denials and more
payments managed a staff of seven providing the training the needed.
I attended training earning CEUs that was required by NC State.