Medical Billing Insurance
Resume:
Quezita Smith
Baltimore, MD *1201
**************@*****.***
To obtain a position where I can utilize my skills as a Professional Medical Billing or Coding Specialist.
Work Experience:
Registration Liaison/St Agnes Hospital / Baltimore, MD /June 2015 to Present
• Greets patients and visitors, responds to questions/concerns and directs them to appropriate location. Provides on-going communication with clinical staff regarding patient status.
• Collects and enters all necessary demographic, clinical, billing and insurance information from patients or responsible parties. Explains processes and forms to patients prior to securing signatures and ensures that all documents are properly signed and witnessed as required.
•Adheres to the departmental policy for Verification of Patient Demographic and Insurance Information, including EVS (Eligibility Verification System) and/or EMDEON. Utilizes the Meditech or ED MSM Tracking System and Process Orders, according to established procedures.
Patient Account Specialist 1 /Medstar Health/ Baltimore,Maryland/ May 2017 to Present
• Responsible for ensuring that 3808s matches accurately against the outgoing claim in the Med Assets or care medics Clearinghouse
• Resolve claims edits for claims that were for Maryland, DC and VA claims as well as Kidney Disease, Behavioral Health and Out of State Medicaid.
• Request NOE for claims that are over 1-year date of services
• Process daily billing to include review and correction of daily edits to ensure that payments are met in a timely manner and that benchmarks are met
Revenue Cycle Coordinator/Johns Hopkins Health System /Baltimore, MD/ April 2016
to Mar 2017
• Working accounts by high dollar, and aging report for accounts 21 days and greater
• Submitting appeals and claims reconsiderations for accounts that have denied for all administrative denials.
• Working the receivable of multiple facilities and will comprise of the receivable of multiple third-party payers, as well as, supporting management in the overall execution of Revenue Cycle collection duties. Worked all insurance under the UHC umbrella.
Reimbursement Lead Associate/Osiris Therapeutics Inc/Columbia, MD June 2015 to February 2017
•Initiates and coordinates the insurance verification and prior authorization processes for physicians, hospitals, and ambulatory surgery centers for all company products.
• Performs a detailed insurance verification for all product and applicable procedures.
• Obtains product and procedure reimbursement rates and special billing rules.
• Relays coordination of benefits between primary, secondary, and tertiary insurers.
• Answers technical reimbursement questions for providers, billing and coding staff, and sales representatives.
Team Leader Billing/J.R Healthcare - Baltimore, MD/ March 2012 to June 2015
• Research and follow-up on claim denials and request for additional information utilizing denial management reports and correspondence
• Review unpaid accounts to determine status and appropriate action required from work list that was generated from Medics Elite and Avenues EMR system.
EDUCATION:
Forest Park Senior High School/June 1998/ College Prep/ High School Diploma
Test College of Baltimore/May 2010/ Medical Billing and Coding/Certificate
SKILLS:
• Knowledge of Medical Terminology and ICD-10, HCPCS & CPT CODES
• Knowledge of Medicaid guidelines and procedures including 3808's
• Detailed working knowledge and demonstrated proficiency in multiple payer's application billing and or/collection processes. Proficient use working with Epic, GE Centricity, Care medics and Med Assets
• Working knowledge of UB04 and/or 1500, and Explanation of Benefits
• Excellent communication, analytical, interpersonal and organizational skills
• Proficient use of hospital registration and/or billing systems and personal computers as well as Microsoft excel, word applications and EMR systems
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