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Customer Service Medical

Location:
Plano, TX
Posted:
March 16, 2018

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Resume:

Kathryn D. Reaves **** Northcrest Drive • Plano, Texas 75075 • 469-***-**** ac4ty3@r.postjobfree.com

Profile

Goal-directed, results oriented professional with strong medical background and education, skilled communicator, persuasive and adaptable. Self motivated with high energy, initiative, and focus on detail and time management.

Texas Oncology Jan 17 to Present Insurance Specialist II Richardson, Texas

Responsible for claim resolution for Hospital/clinics in regards to governmental, commercial insurance companies and patient accounts, obtaining all documentation required for resubmission/ obtains all documentation required for appeals. Working the over 120 claims and filed appeals for denials. Working many special projects within the department as needed. Charge entry as of April for Proton center.

SURGICAL COORDINATOR/REIMBURSEMENT TEXAS REGIONAL SPINE Jan. 16 – Aug 16 Plano Texas

Surgery Scheduler/Reimbursement analysis, Performs contract negotiation, organizes regular office meetings and set agendas. Responsible for credentialing of physicians with hospitals and facilities. Design and implement policies and procedures for HR dept. Responsible for developing and implementing the clinic’s mission and strategic vision. Provides leadership in developing planning and implementing the clinic’s business plans to the Physicians. Recommends, develop, implement improvements for the practice. Manage all practice managed care relationships, including monitoring of related reimbursement, negotiation with third party payers, and liaison between the hospitals, health plans, insurance companies and regulatory bodies. Maintain professional affiliations and enhances professional development to keep current in the latest health care trends and developments.

MEDICAL OFFICE MANAGER 03-2013 – 12-2015 INTERNAL MEDICINE SPEC OF GARLAND Garland, Texas

Staff supervision duties included hiring and training, as well as conducting regular performance reviews and resolution of personnel issues. Patient duties included new patient registration, appointment scheduling and follow-ups, and financial counseling and promotion of excellent customer service. Back office responsibilities included accurate medical record data entry, medical billing coding and collection, cash posting. Management responsibilities included

development, implementation and maintenance of office policies and procedures. Additional responsibilities include the selection and ordering of supplies, the development and implementation of a marketing practices and maintaining a professional office environment.

REVENUE CYCLE SPECIALIST 2012-2013 CCS Medical Plano, Texas Was responsible for claim resolution for patients in regards to governmental, commercial insurance companies and patient accounts. responsible for claim submission and Works ADR’s from Medicare obtaining all documentation required for re-submission/ obtains all documentation required for appeals. Med Assets review and release of claims daily. Coding for pharmacy, diabetes testing supplies, insulin pumps & supplies, ostomy, urological, incontinence and wound care supplies. Maintains compliance with regulatory and accrediting bodies; participation in the development and implementation of credentialing process and procedures. Collecting and maintaining an accurate provider database and analyzing verification information, including medical policies and fee schedules.

MANAGER OF BILLING AND REIMBURSEMENT DEPARTMENT 2010 to 2012 AMI Monitoring Inc. Richardson, Texas Oversee daily operations of the billing and reimbursement departments, Negotiate contracts with Insurance and TPA companies. Responsible for daily, weekly and end of month reports as well as performed HR duties, heavy customer service to assure our patients correct explanations of EOB’s and their insurance coverage guidelines, helped patients with obtaining financial assistance.

REIMBURSEMENT SPECIALIST 2005 to 2010 St. Jude Medical Plano, Texas Was responsible for clearing multiple cases in an efficient and timely manner. Auditing required clinical documents for completeness and accuracy for each respective carrier. Assisting Orthopedic and Pain Management facilities in all aspects of reimbursement. Thoroughly experienced in pre-authorization, pre-certification and pre-determinations activities. Received meritorious awards for having repeatedly demonstrated excellence in specialty denials and appeals, with all major insurance carriers as well as Medicare/Medicaid and Workers Comp. Medical coding based on state and federal guidelines, as well as policies and contracts. Work in a team environment to educate and support assigned Field Territory Managers and Clinical Specialist. (2005/2011 completed graduate courses for medical coding and reimbursement.)

REIMBURSEMENT SPECIALIST 1999 to 2005 Smith & Nephew Inc., Endoscopy Division Dallas, Texas Provided direct support for infield sales operations, physician offices, hospital facilities and insurance organizations. Provides utilization review standards and procedure criteria development, as well as, coding and reimbursement oversight. Expertise in prior authorization, pre- certification and pre-determinations as well as appeals for all major insurance carriers as well as Medicare/Medicaid and Workers Comp.

SENIOR MEDICAL ASSISTANT 1986 to 1999

NORTH DALLAS OB-GYN Dallas, Texas An experienced Medical Assistant whose duties included, team leader, coordination of nursing care needs, total patient assessment, education and counseling, injections, venipuncture, nonstress testing, surgical assist, and performing routine office OB-GYN sonograms. Well versed in surgery scheduling, appointment scheduling, filing insurance claims and performing routine lab work.

Privileges, Certifications, and Training

Ultrasound Training KMA/ Houston's Baylor Medical School 2005/2011 completed graduate courses for medical coding,,billing, and office management. BLS/CPR Instructor MA/EMT/P

Peggy Leavitt 214-***-**** Sharon Holm 972-***-**** Nichole Jones 469-***-****



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