Medical Management, billing/coding,collections,overpayments, authoriza
Resume:
Precious Scott
*** ****** ****** **********, ** *3323 757-***-**** *************@***.***
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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