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Administrative/ Public service

Location:
Philadelphia, Pennsylvania, United States
Posted:
May 17, 2018

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Richard Hammond

Summary

*+ years of customer/patient service experience. 3+ years of office, administration, medical billing, Enrollment & Processing, A/P, A/R and direct care within health care settings. Experienced with Medicare, Medicaid and commercial providers. Proficient with computer suites and extensive experience using banking systems

Skills:

CPT (4 years), Customer Service (10+ years), Excel (3 years), ICD (4 years), ICD-9 (4 years).

Financle operations (4years), Administrative duties (5 years), Customer Service (10 years).

ICD-9 (2 years), RECEPTIONIST (6 years), RETAIL SALES (6 years), A/P, A/R.

MS Office Applications (Word, Excel, PowerPoint), Caps, QNXT, HER, EMR, SQL.

Lock Box, Manual Processing, and Bank look up, CPT / ICD-9.

Professional Experience:

Aetna Better Health of Pennsylvania - Philadelphia, PA Mar 2017 to Dec 2017

Patient coordinator/Program Analyst Consultant –Medicaid

Responsibilities:

Coordinate & properly assess benefit rates in accordance with Gov, State and County percentage and enrollment guidelines. Supporting Sr. Analysts and other team members with eligibility and enrollment process. Billing and controlling the invoicing process to ensure timely and accurate invoicing.

Report, Analyze, and interpret complex abstract and financial data to assist management in evaluating and executing revenue maximization initiatives in compliance with the Health Services Cost Review for Medicaid Services.

Using Microsoft Excel to enter, manipulate balance and log payments being entered into batch, Using QNXT system to enter and finalize payment process.

Using Qnxt and Caps system to enroll eligible members and payment details into states Medicaid system.

Communicating/collaborating with appropriate internal and external departments/ Members to insure and expedite resolutions for issues and problems.

Center for Family Guidance - Marlton, NJ Jun 2016 to Jan 2017

Dept. of Corrections Medical Billing Processor

Responsibilities:

Responsible for processing medical bills/statements for state of New Jersey county jails with in NJ.

Correcting, Completing, and processing claims of all payer codes.

Generate reports from computer in accordance with established procedures.

Responsible for sending the electronic claims for Medicare, and other rendering providers on weekly basis.

Responsible for sending claims to all private insurance, third party hospital billing, on weekly or monthly basis as directed by the Billing Manager.

Handling all incoming and outgoing mail, phone calls, emails, fax, and operating all the office equipment, maintain billing file/records by batch in accordance with the established protocol and completing all other assignments as directed by the Billing supervisor.

Our Lady of Lourdes Medical Dec 2015 to Oct 2016

Medical Billing Coordinator A/R Rep

Responsibilities:

Follow-up on claims filed to Medicare, Medicaid, health insurance or commercial carriers for assigned practices. Ensuring that payments are collected promptly by working the accounts according to the specified procedures.

Input all charges for professional services provided in the office and or hospital for physician in the practice site.

Input demographics that relate to professional charges into the computer.

Input and maintenance of CPT and ICD-9 coding for all professional charges rendered by physician

Input of financial remarks into billing system including physician directives as to professional courtesy.

Communicate any escalated billing related issues with Office Manager/Billing Manager

Communicate Coverage Details to Patients, Assisting Patients with Understanding EOB per Insurance provider.

A/R Follow-up, Any other duties as assigned by the Billing Manager and/or CFO

Our Lady of Lourdes Medical Jul 2014 to Dec 2015

Patient Service Rep/Coordinator

Responsibilities:

Performing essential clerical/administration duties of practice maintaining a strong Patient and customer focus

Supporting the delivery and the highest quality of care while sharing a passion for patient and customer centered care to assist in exceeding patient satisfaction. Duties include warmly welcoming patients at time of check-in.

Maintaining a safe work place and organized work environment

Co-pay collections, initiate privacy practices, consent patient tracking

Triages patient's insurance and billing information, Triages patients inquires and telephone calls

Coordinates patient's appointments, Provided and explaining of EOB

Update patient's insurance and billing information

Support medical records related to scanning: managing record requests and preparing for patient schedule.

Handling Medication scripts, processing referrals, labs and additional testing being requested.

Mercedes Benz Corporation - Cherry Hill, NJ Jun 2012 to Jul 2014

Cashier & Sales Associate

Responsibilities:

Responsible for greeting customers, verifying legal & confidential documents processing payments & information from customers & repair orders to computer data base, placing phones calls to customers, excepting incoming calls & returning calls, v-mail messages, email messages & assisting customers with questing problems & inquires.

Innova Health & Rehab Dec 2010 to May 2013

Patient Service Representative I

Responsibilities:

Working directly with the elderly Population.

Responsible for greeting patients and families, collecting & entering demographic and insurance information, collecting payments associated with services rendered and reconciliation of daily services.

In addition, other duties necessary to facilitate efficient and timely services to patients and their families, such as scheduling appointments, answering phones, and obtaining appropriate insurance referrals and authorizations as needed per insurance guidelines.

Responsibilities also include working with medical records, following HIPPA guidelines. Communicating effectively and maintains a safe a d clean work environment.

Willow Glen Academy Aug 2008 to Dec 2010

Direct Care Associate

Responsibilities:

Working with developmentally disabled population in a group home setting, providing all aspects of care & all house hold activities for consumers as needed, working to engage consumers in as much of their own care as possible, advocating for them & guiding them through their daily routine to provide fulfillment & job skills for future use.

Documenting throughout shifts, administering medication, transporting consumers to & from doctors, dental, & hospital visits.

Assessing suicidal customers with one on one attention & ensuring safe environment at all times.



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