Medical billing/insurance
Resume:
Lakishia Partridge
Bridgeview, Il, 60455
********.*********@*****.***
EXPERIENCE
Medical claims specialist ll, Multiplan 5/16-present
Foster and maintain provider relationship to facilitate current and future negotiations by
Performing claim research and analysis to provide support for desired savings;
Generating agreement by communicating with provider by written and verbal communication throughout the negotiation process; and
Partnering with internal and external clients, including Account Managers, Customer Relations, Provider Services, and direct client contacts as applicable.
Meet and maintain established departmental performance metrics.
Initiate provider telephone calls with respect to proposals, respond to providers following receipt of proposal, and follow up with phone calls to providers as necessary to finalize claims with savings.
Address counter-offers received and present proposal for resolution while adhering to client guidelines and department goals.
May partner with medical review team or team lead on escalated claims for medical review and/or approval on a case by case basis.
May identify and seek opportunities to
establish ongoing global and/or concurrent agreements with providers and
achieve savings with previously challenging/unsuccessful providers.
Collaborate, coordinate, and communicate across disciplines and departments.
Ensure compliance with HIPAA protocol.
Demonstrate commitment to Company core values.
The position responsibilities outlined above are in no way to be construed as all encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned as necessary.
Collection Specialist, Iks health 3/16-5/16
Receive inbound calls from patients and work to resolution any concerns or issues they may have with their bill
Task accounts to appropriate department that need specialized handling and follows up within 24-48 hours that requested action has been completed
Calls and communicates with patients to collect outstanding balances or past-due payments
Pursues past due payment arrangements
Sets up acceptable payment agreements
Analyzes accounts focusing on a multitude of criteria (denials, underpayments, etc.)
Must adhere to collection, production, and quality standards as determined by management.
Obtain status of outstanding claims and making necessary changes to bring resolution to each account.
Maintains accurate and complete records concerning collection activity on all accounts by documenting all account activity in appropriate systems
Supplies supervisor/manager with current account status for collections
Registration Specialist, Loyola hospital. 10/15-2/16
Reviews patient registrations, obtains benefit verification and necessary authorizations (referrals, precerts) prior to patient arrival for all ambulatory visits, procedures, injections and radiology services, Contacts self pay patients to make payment arrangements or discuss charity options. Collects patient payments for pre-arranged visits. Answers high volume of incoming phone calls from patients, physicians, insurance companies and clinic staff to confirm/facilitate the authorization. Performs insurance registration at an expert level and creates hospital account records to insure accurate billing to increase cash flow and revenue collection for the Health System. Communicates authorization issues regularly to clinic staff (clinical and clerical). Creates appropriate referrals to attach to pending visits. Documents all efforts in each account for all to see. Creates HARs for appointments after obtaining benefit information and authorizations. Perform insurance verification/precertification for all scheduled ambulatory visits including, but not limited to, office visits, radiology visits, high cost drug infusions. Contacts patients or patient guardians regarding insurance status issues or verification of insurance prior to patient arrival. Liaison to Ambulatory Management regarding staff performance through documented rounds "on the job" training for service representatives and targeted communication of staff mistakes in registration. Provide support for the department by participating in special projects and assignments as needed.
Benefits Specialist, Pillars--6/14-2/15
Checks new client eligibility and obtains detailed information regarding benefit coverage.
Initiates authorization inquiries to the Managed Medicaid insurance companies and helps resolve any authorization and coverage issues with clinical staff that may arise during the pre certification process.
Assists with maintaining and monitoring of the agency database for coverage and fee matrix for the new clientele.
Calls or conducts online checks to various payers to check eligibility and benefits for new clientele.
Obtains pre certification for the assigned therapist and/or psychiatrist for treatment, which includes processing authorization requests for all Payers (ex. Medicaid, Managed Medicaid, Medicare and Commercial payers) to ensure future reimbursement.
Follows up and ensures timeliness on pre certification requests.
Provides notification of the authorization to the assigned clinical staff.
Obtains detailed mental health benefit information (client co-pay, deductible, authorized number of visits, approved type of services) prior to initial client treatment.
Enters authorizations (both verbal and mailed) into agency database.
Assists with RIN applications through E-RIN web portal.
Rechecks any problems with client coverage or benefits that may arise with insurance claim issues. Contacts clients to confirm address and/or phone number(s).
Assists with general office tasks as needed.
Provides back-up coverage for Reception as needed.
Assists new clinical staff in learning the authorization process.
Completes required training requirements
EDUCATION
Everest College, Medical Insurance Billing/Coding Diploma, 2009
Northwestern College, Health Information Technology- Associates, Present
EXTERN
Accretive Health, Coding - 7/13-1/14
SKILLS
Call center
Medical/Legal/Insurance terminology
Billing and collections
Microsoft Access/Excel/Word
Typing/Keyboarding, internet proficiency
HIPPA rules and regulations
Knowledge of Medicare, Medicaid and Commercial insurances
Knowledge in New Managed Medicaid Programs. (MMAI, ICP, FHP, CCE, ACE etc)
ICD-9/CPT
Knowledge of Medisoft/Claimgear Epic, Cadence and RIS
knowledge of Nebo (Ecare), NGS Connect, Availity, Provider Connect, and individual insurance websites
Knowledge of physician billing, ENT billing, mental health billing, and pharmacy billing
Salary expectation $16/hr
Contact this candidate