Medical Customer Service
Resume:
WENDELL BALA
*** ****** ** **** **, ***** 714-***-****
**********@*****.***
QUALIFICATIONS
More than 6 years’ experience in healthcare billing management, coding, coverage and reimbursement. Experience has proven expertise in medical billing processes and claim submissions to Medicare, Medi-Cal/CCS and private insurers for durable medical equipment and medical devices. Familiarity with appropriate coding terminology and processes coverage and reimbursement.
Advanced understanding of state and federal billing regulations.
Provides support and executes plan related to reimbursement, health economics and costs that drives acceptance of durable medical equipment, DME products by key payers.
Follow guidelines for electronic billing systems of edited and non-edited claims; maintain controls to verify claims' receipt or rejection. Implement strategies to work all rejected claims and make corrections to systems to prevent future rejected claims.
Monitors and maximizes the company’s billing and collection efforts, develops and implements billing processes and staff facilitation to provide timely and accurate billings to all types of payers. Researches Payer/Contract issues raised by staff and management
Ability to plan and implement process improvements
Strong leadership and organizational skills
Professional Skills
Track regional reimbursement methodologies and trends to support strategic and tactical planning
Develop and implement reimbursement strategies and plans to support physician and facility, patients by identifying reimbursement issues, defining solutions and creating reimbursement successes. Monitors and maximizes the company’s billing and collection efforts, develops and implements billing processes and staff facilitation to provide timely and accurate billings to all types of payers. Researches Payer/Contract issues raised by staff and management
is maintained and company policies and procedures are followed
Identify and develop reimbursement education, training and resources for the sales organization and staff to ensure proper reimbursement of medical equipment.
Identify and develop relationships with physician, license care medical professional to support interactions with local and national payer organizations.
Accomplishments
Helped and led the team in achieving certain and multiple level of billing collections revenue
Received my Certification in 2010 for Medical Billing & Coding
EDUCATION
2010
MEDICAL BILLING & CODING, WESTECH COLLEGE
2005-2006
BUSINESS MANAGEMENT, MT.SAN ANTONIO COLLEGE
1988-1992
WILSON HIGH SCHOOL
SKILLS
PROFICIENT IN EPIC SYSTEMS
EXCEL WORDS
HDMS (HEALTH DATA MANAGEMENT SYSTEM
OFFICE ALLY
ONBASE
40-50 WPM
4 YEARS
7 YEARS
3 YEARS
3 YEARS
3 YEARS
6 YEARS
EMPLOYMENT HISTORY
May 2018 to August 2018
Medical Biller/Collector Newport Academy (Contracted from staffing agency)
May 2018 thru September 2018
§Conduct collection calls and/or correspondence in a fast-paced goal-oriented collections department.
§Manage claims collections and patient collections
§Provide customer service regarding collection issues
§Ability to differentiate difference between in and out of network
§Resolve insurance discrepancies and short payments
§Contact and inquire with insurance companies for collection
§Document in detail problem/action/ and follow up with insurance companies until claim paid
§Possess working knowledge of Explanation of Benefits (EOB’s)
§Responsible for monitoring and maintaining assigned accounts
§Accountable for reducing delinquency for assigned accounts
§
§Handles multiple patients account for Mental/Substance abuse claims
§Responsible for creating a daily spreadsheet for reports
§Analyze account from billing to collection to identify the accurate denial of the claim.
§Follow up on accounts and Appeals and collaborate with Medical Records department for request
Medical Biller-Emergency Group/Brault Employed through Staffing Agency Robert Half
Jan 2018 thru May 2018
§Follow up on accounts payments and report on trends that may cause delay on payment.
§Analyze accounts from billing to last collection in order to validate account balances and ensure compliance with contracts terms and conditions.
§Submit invoices to various insurance companies either electronically or paper.
§Submit secondary billing with supporting documentation.
Sr. Collector Representative/St. Joseph Heritage (Through staffing Agency)
March 2017 thru November 2017
§Works accounts receivable in assigned area to maximize reimbursement.
§Utilizes knowledge of PPO, HMO, Government, and DME billing guidelines.
§Contacts various payers and patients to collect on outstanding accounts. Tracks and enters all calls for documentation, trending and reporting. Identifies patterns of patient and insurance concerns.
§Handles multiple patient incoming calls and responds to each call in an efficient, effective, and professional manner. Also covers for customer service phones and front desk walk in patients.
§Updates registration and insurance data, analyze data, review records
§Edits accounts by working ATB’s daily.
§Reads and reviews EOB’s for appropriate response to situation.
Medical Biller/Payment Poster/ Medcore Revenue (Contracted through staffing agency)
October 2017 thru January 2017
§Review and examines entire current operative report for accurate and complete diagnostic and procedure information.
§Determines correct sequence of primary and secondary diagnoses according to uniform surgery and procedure data guidelines.
§Applies knowledge of ICD-10 CMS 1500, UB-4,HCFA forms.
§Physical coding questions. Identify and correct errors as needed. Performs follow-ups and appeals.
Medical Biller/QTC Management Lockheed Martin
November 2014 thru July 2016
§Reviewed claim files and analyzed patient medical diagnosis and reports.
§Interfaced with providers (medical professionals) on a regular basis
§Accountable for the timeliness, quality and thorough review of claims.
§Attained and exceeded established expectations.
§Performed other duties and responsibilities as assigned.
Medical Biller/Collector Long Beach Memorial Care (Contracted through staffing agency)
May 2014 thru September 2014
§Processed several queues via Epic, performed adjustments edits and writing off claims over a year old.
§Edited claims, evaluated and corrected claims that are missing information (Reports, SAR, TAR) and sent CIF appeals.
Knowledgeable with Epic, Emdeon, On-base Systems.
MCAL/CCS Collector Loma Linda Medical University
January 2012 thru May 2014
§Analyzed, audited, and resolved issues relating to Medicare and Medi-Cal accounts
§Obtained all information needed for claim submission and resolution through telephone and written inquiries with patients, other departments, and third-party payers
§Working knowledge of billing rules and regulations that govern the Medicare, Medi-Cal, Workers Compensation claims and CCS programs. Process and prepare all documents for appeals. Also process TAR & SAR.
Submit secondary billing with supporting documentation
Contact this candidate