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Medical Management, billing/coding,collections,overpayments, authoriza

Location:
Chesapeake, VA
Posted:
September 26, 2018

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Resume:

Precious Scott

*** ****** ****** **********, ** *3323 757-***-**** ac66ra@r.postjobfree.com

Experienced medical administrative professional that can lead motivate and educate. Positive proficient individual with the ability to implement policies and procedures. Proven success in diverse environments, including compliance regulatory and effective marketing strategies.

Education

Bryant & Stratton College Graduated March 2006

Medical Billing/Coding Certificate

Bachelor of Science in Healthcare Administration Graduated August 2017

Medical Careers Institute, School of Health Sciences of ECPI University

Certifications

Certificate: Medical Billing/Coding March 2005

Certificate: Lean Six Sigma, Green Belt July 2016

Experience

Externship Site 1: PAC Home Association June 2017-July 2017

Length: Five Weeks

Reviewed resumes, pre-screened candidates, conducted interviews, and advised mandatory back ground checks on all new hires.

Shadowed the owner of a private adult care home for seniors.

Attended meetings with the family, durable medical equipment suppliers, physicians and nurses.

Learned about the different types of long-term care insurance policies, cost, reimbursement, and benefits verses Medicare and Medicaid.

Created the company’s application for employment and employee time sheet

Externship Site 2: Freda H. Gordon July 2017-August 2017

Hospice and Palliative Care of Tidewater

Length: Five Weeks

Assisted human resources with filing, verification of required employee training and setting up new hire packets for nurses

Assisted the medical office manager with filing, faxing, scanning, and uploading documents electronically into the patient’s medical records.

Set up new patient packets for registration

Attended weekly care meeting with the nurses, chaplain, and activities director

Externship Site 3: Westminster Canterbury May 2018- July 2018

On the Chesapeake Bay

Length: Ten Weeks

The administrator was the preceptor, who gave the opportunity to work with the Director of nursing, Infection Control, Dinning supervisor, Admissions Director, Nutritionist, Recreational Therapy department, Billing Department, Quality, Human Resources and the Assisted Living department.

Reviewed resumes, pre-screened new hires, and assisted with the interviews

Assisted with the marketing plan to include identifying the target market and the development of a brochure.

Inspected the facility rooms for new patients and survey preparation

Used and learned about the importance of using Virtual Reality Gargles for reduction of pain and decrease in anxiety

Learned about the importance of an effective disaster recovery process

Attended budget meeting with accountants

Attended the onboarding of a new physician

Created agenda for a meeting

Created mock survey form to use for short stay residents

Interviewed short stay residents

Attended Quality Assurance and Performance Improvement meetings

Attended patient care planning meetings and resident council meetings

Worked with the dinning supervisor who inspected the kitchen, discussed state regulations, citation preventions, quality of food, preparation of food, adaptive eating utensils, and sanitation.

Met with Accounts Receivables Specialist to discuss, bill submission, payment, expenses and budget allowance.

Completed Alzheimer’s computerized training for employees through Relias.

Assisted with floor programing for the cognitively impaired population

Reviewed Navihealth Referral system, requirements for admission, and refusals

CTR Group August 2018 - Current

Staffing Agency

Investigated insurance denials

Appealed claims with appropriate documents

Contacted insurance companies via phone or internet to receive claim status

Processed refunds for insurance and patient overpayments

Resolved patient billing complaints and explain benefits

Set up financial arrangements with patients to ensure payment

Conduent October 2017 - April 2018

Reimbursement Specialist

Register patients into a prescription assistance program

Ensure that the patients complete the manufactures’ consent

Screen patents to verify eligibility

Receive prescription insurance information from eRx Network website

Set up cases for declined transactions, authorizations, and merge accounts

Mail out prescription assistance cards to patients

Track packages through UPS website to ensure receipt.

Transfer patient and pharmacy calls to the required departments

Review FDA approve usage for prescription and safety with the patient

Report side effects of the prescription to the manufacturer

Cherokee Nation Businesses, Portsmouth, VA September 2014 – June 2017

Administrative Clerk

Determine Tricare eligibility in the Defense Enrollment Eligibility Reporting System

Register beneficiaries in the system

Verify and update demographic information

Update other health insurance information

Make PCM assignments for military treatment facility prime enrollees

Book medical appointments at military treatment Facilities

Set up referrals to specialty clinics

Print discrepancy reports and filing

Medical Management Services October 2010 – February 2014

Patient Account Representative, Chesapeake, VA

Investigated insurance denials

Appealed claims with appropriate documents

Contacted insurance companies via phone or internet to receive claim status

Negotiated payments for out of network insurance companies

Requested and prepared write-off and charge corrections documents

Processed refunds for insurance and patient overpayments

Resolved patient billing complaints and explain benefits

Set up financial arrangements with patients to ensure payment

Set up and approved charity request for indigent patients

Centura College April 2010 – October 2010

Instructor- Courses below, Norfolk, VA

Medical Terminology

Hospital Billing

Medical Insurance

Computers in The Medical Office

Keyboarding

Advanced Pain Management February 2008 – April 2010

Virginia Oncology Associates February 2007 – October 2007

Patient Account Representative, Norfolk, VA

Investigated insurance denials

Appealed claims with appropriate documents

Contacted insurance companies via phone or internet to receive claim status

Negotiated payments for out of network insurance companies

Requested and prepared write-off and charge corrections documents

Processed refunds for insurance and patient overpayments

Resolved patient billing complaints and explain benefits

Set up financial arrangements with patient to insure payment

Set up and approved charity request for indigent patients

Mirrus Systems June 2005 – February 2007

Client Account Specialist, Virginia Beach, VA

Investigate unpaid insurance claims greater than 90 days

Hospital, physician, and third party billing

Adecco Staffing February 2003 – June 2005

Administrative Clerk at Portsmouth Naval Hospital, Portsmouth, VA

Determine Tricare eligibility in the Defense Enrollment Eligibility Reporting System.

Register beneficiaries in the system.

Verify and update demographic information

Enter other health insurance.

Make PCM assignments for military treatment facility prime enrollees

Schedule medical appointments at military treatment Facilities



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