Insurance Office
Resume:
PROFESSIONAL EXPERIENCE
Provident Medical Practice Management LLP July 2013-Present
AR Specialist; OB/GYN, Pediatric, Gastro, Cardio, Urgent Care, Ortho
Running weekly A/R reports to aggressively work on claims over 60 days old
Posting office, hospital, surgery charges as well as insurance and patients
Set up payment plans in regarding high balance
Managing refund from overpayments on accounts
Generating patient statements on a weekly basis and covering different areas when needed
Review request for medical records and manage the collections of delinquent accounts
Review information submitted for accuracy and compliance and make adjustments
Resolve any unbillable claims and research to solve unbillable claims
Entering charges & submitting claims electronically in a timely manner, posting payments,
preparing statements and working accounts
Working on denial & calling insurance companies for status, insurance follow up on appeal &
denials, review claims and EOB's
Collection on up paid accounts, appeals, insurance verification, daily deposits, etc.
Answering billing or other insurance question from patients
Accurately and efficiently process all billing and collections paperwork
Ensure claims are accurately entered and submitting claims through EDI system
San Antonio Digestive Disease Consultants July 2012–July 2013
Insurance Benefit Coordinator/ Billing/ Collection
Oversaw registration, patient insurance, billing and collections, and data processing to ensure accurate patient billing and efficient account collection
Provided monthly status reports
Obtained eligibility benefits, prior authorization or precertification for surgeries, diagnostic testing and procedures
Documented and obtained information on patient's account set up payments for coins
Relayed information to office/hospital
Participated in professional development efforts to ensure currency in healthcare practices and trends
Served as a liaison between clinical staff, facilities, and patients regarding coordination of care
Reviewed current status of patient accounts to identify and resolve billing and processing problems in a timely manner and worked with billing staff to accomplish this task
Worked a system for the collection of delinquent accounts ensuring third party payers are contacted
Followed and recommended credit and collection policies
Makes recommendations for improvement
Maintained contact with medical records and other departments to obtain and analyze additional patient information to document and process billings
Other duties as assigned, such as charge entry, surgery billing, referrals assistance
Oversaw claim processing and payments to third party providers
Answers associated correspondence
Monitored charges and verified correct payment of claims and capitation deductions
Sends denial letters on claims and follows up on requests for information
Audited and reviewed claim payments reports for accuracy and compliance
Researches and resolves claim and capitation problems
Prepares claim reports for administration and finance on utilization and claim payment
Identified exceptional claims for review
Initiated payment recovery for stop loss reinsurance, worker's compensation, and overpaid claims
Orthopedic Solution LLP, Laurel/Columbia, MD Aug. 2009–May 2010
Billing/Collections Specialist
Ensured charge entries, claim submission and denials are worked on a daily basis
Implemented new office policies to improve patient flow and payment collection
Kept track of the yearly fee schedules from the different insurance companies and adjusting our office fee as necessary
Contacted insurance companies to obtain authorization for Durable Medical Equipment and MRI testing
Verified patient benefits prior to their appointments
Ran weekly A/R reports to aggressively work on claims and accounts over 60 days old
Posted office and hospital charges as well as insurance and patient payments
Setup patient's on payment plans regarding their high balance
Managed patient refunds from overpayments on accounts
Continuous communication and follow up with insurance companies regarding the status of appeals and denial resolution
Meeting with the physicians and practice administrator once a month to discuss the financial reports and practice revenue along with any other office issues
Properly trained billing staff on new policies and procedures from the different insurance carriers
Answered billing or other insurance question from patients
Generated patient statements on a weekly basis and covering different areas when needed
Maintained strict confidentiality and adhere to all HIPAA guidelines/regulations
Updated procedures and ICD9 libraries
Maintained ongoing knowledge of HFCA 1500, UB9 billing forms and filing requirements
Capital Digestive Care LLP, Silver Spring, MD Aug. 2002–July 2009
Payment Recovery Specialist
Contacted insurance companies to obtain authorization for DME and MRI testing
Verified patient benefits prior to their appointments
Ran weekly A/R reports to aggressively work on claims and accounts over 60 days old
Posted office and hospital charges as well as insurance and patient payments
Setup patient's on payment plans regarding their high balance
Managed patient refunds from overpayments on accounts
Continuous communication and follow up with insurance companies regarding the status of appeals and denial resolution
Met with the physicians and practice administrator once a month to discuss the Properly training front desk and billing office staff on new policies and procedures from the different insurance carriers
Answer billing or other insurance question from patients
Generated patient statements on a weekly basis and covering different areas when needed
Maintained strict confidentiality and adhere to all HIPAA guidelines/regulations
Update procedures and ICD9 libraries
Audited and reviewed claim payments reports for accuracy and compliance
Researches and resolves claim and capitation problems
Prepares claim reports for administration and finance on utilization and claim payment turnaround time
Identified exceptional claims for review
Initiated payment recovery for stop loss reinsurance, worker's compensation, and overpaid claims
Maintain ongoing knowledge of HFCA 1500, UB9
EDUCATION University of Phoenix-Bachelor Business Administration
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