St Nicks Alliance Homecare, Brooklyn, NY July 2017-.
Accounts Receivable Analyst
Review weekly claim denials, EOB’s, bill claims on a weekly basis
Accounts and Aging reports for MCO/MLTC programs to ensure timely billing and follow up
Create excel spreadsheets for unpaid and denied claims for review by MCO
Collect delinquent accounts by monitoring payments
Eligibility check for CDPAP/HRA (Medicaid) members
Prepare claims for billing
Responsible for preparing and sending new or corrected claims on paper forms UB04- HCFA1500 on a weekly basis
Submit electronic claims to MCO/MLTC companies
Review contracts and liaise with MLTC companies to retrieve any outstanding payments
Centers Plan for Healthy Living MLTC, Staten Island, NY June 2016 - July 2017
Provider Claims Resolution Analyst
Processes claims for payments for both Medicare and MLTC claims
Resolve claim denials with Providers via phone
Upload, process Claim reconsiderations
Work alongside Provider Relations with claims that needs their contract updated
Knowledge of Medicare Products (FIDA and D-SNP)
Train new hires into the company’s method of processing claims
Inputting claims from the UB-04 and HCFA 1500 for processing
White Glove Homecare Agency, Brooklyn, NY February 2016 – June 2016
Accounts Receivable Resolution Specialist
Enter check payments and post payments when received
Resolve claim denials
Process unapplied cash and Recoupments via Excel spreadsheet
Resubmit corrected claims via online and at times using the HCFA forms (1500)
Apple Home Care/Meditrans Ambulette, Brooklyn, NY April 2014 – February 2016
Bill on a weekly basis for Medicaid, Aetna/WellCare, MLTC
Process payments for various health insurance into Deerfield/Routing Box
Process Excel spreadsheets and PDF’s for claims processing and payment
Weekly adjustments of procedure codes and modifiers for Medicaid billing
Verify non-emergency transportation authorization for clients
Lutheran Medical Center (now NYU) Brooklyn, NY October 2015 – March 2015
Human Resource Assistant (voluntary).
Substantiates applicants' skills by administering and scoring tests.
Welcomes new employees to the organization by conducting orientation.
Submits employee data reports by assembling, preparing, and analyzing data.
Maintains employee information by entering and updating employment and status-change data.
Provides secretarial support by entering, formatting, and printing information; organizing work; answering the telephone; relaying messages; maintaining equipment and supplies.
Maintains employee confidence and protects operations by keeping human resource information confidential.
Maintains quality service by following organization standards.
Contributes to team effort by accomplishing related results as needed.
Berkeley College, New York City, NY Jan 2010 – May 2016
B.B.A., for Health Service Management
SKILLS: MCO- (Manage Care Optimizer), Case Trakker, Deerfield/Routing box, Microsoft Word, Excel, Outlook, Power Point, Knowledge of Human Resources, Adobe, ICD-9 and 10 Coding and HCPCS Coding, HHA Exchange
Volunteered at Lutheran Hospital (NYU) from November 2013-April 2014
**LICENSED CERTIFIED NURSING ASSISTANT 2010**