Valerie A. Sims

*** ****** ** *** ** #*** DACULA GA 30019 Email: ac6lkj@r.postjobfree.com

404-***-****

Professional Summary:

A responsible healthcare specialist, with a solid background in medical, and a proven track record of efficiency and accuracy in handling and completing assignments upon request. Experienced in reconciling accounts in high-pressure environments involving keen attention to details. Academic qualifications, including extensive course work in medical billing and coding procedures. Committed to HIPPA confidentiality policies and procedures.

Key Skills

Medical Billing, Medical Coding, Charge Entry, Payment posting, Insurance Verification, Claims processing, Patient Accounts, Customer Relations, Medical Terminology, MS Word, Excel, PowerPoint, Epic, 3 M encoder, Availity, GAMMIS, Claims IQ, Med-host, Centricity.

Professional Experience:

Various Temp Agencies

Robert Half/United Health group Peachtree Dunwoody Georgia Jan 2018- July 2018

Medical Billing/Insurance Follow-up Specialist-

Contact insurance companies to determine claim status for denied claims as well as rebilling and appeals status.

Verify patient’s eligibility for coverage and benefits thru Passport, GAMMIS, DDE, Availity and other various softwares.

First Financial Asset Mgmnt Peachtree Corners, Georgia July 2017- December 2017

Commercial Insurance Specialist-

Initiate outbound calls to patients to complete accident interviews via telephone

Investigate and confirm any medical coverage related to auto, general liability, and/or worker compensation insurance available to the patient, updating the patient file in the system

Contact Auto/Work Comp insurance carriers and attorneys via telephone to identify available accident insurance coverage for the patient

Verify patient’s eligibility for coverage and obtain billing contact information for the insurance adjuster and/or attorney

Send hospital bill to no-fault, third party and workers’ compensation insurances via fax, mail and e-mail

Hollis Cobb Associate Duluth, Georgia Sept 2016- April 2017

Medicare/Medicaid Insurance Resolution Specialist-

Follow upon outstanding balance with insurance carriers for claim status for resolution of payment, and applying adjustments on patient’s account.

Verify the timely filing of medical claims with insurance carriers to ensure that the claims are filed timely.

Verifying and updating insurance information with coverage and eligibility thru Passport, GAMMIS and DDE. Working accounts on current and previous EOB denials for Medicare and Medicaid, and for reimbursement, Follow-up on denials. Billing and rebilling Ub-04 hospital claims filing.

Grady Health system Atlanta, Georgia January 2009-Sept2016

Medical Coding Assistant-/Charge Entry/Coder- Health Info Management

Patient Access-Emergency Medicine

Coordinate charts for coding purposes by date order. Assist coders with documentation as needed for coding specific accounts. Querying the physician.

Review revenue cycle by identifying medical charts for information on coding relating problems. Abstract CPT-4, procedure codes. Posting charges for coding and billing. Processing claims for filing and rebilling. Applying adjustments when necessary.

Verifying and updating insurance information with coverage and filing purposes. Working accounts on current and previous EOB denials for Medicare and Medicaid, and major insurance companies for reimbursement. Billing and rebilling claims on 1500 and Ub-04 claims.

Worked with Various Temp Agencies

Avery Partners-Roswell Jan-May 2016

Medical Billing Specialist- Validate and update insurance information for coverage and filing claims.

Prestige Staffing-Atlanta Georgia July-2007-Feb 2008

Atlanta Women’s Health-Front Desk Administrative- Front office, and data entry, insurance verification, checking in/out patients. Faxing, scanning and printing.

Mahone Group- Marietta Georgia June 2006-March 2007

GE Capital – Medical Billing Specialist- Medical claims processing, verifying insurance follow up on denied claim with all commercial insurances including Medicare and Medicaid.

Emory Clinic Decatur, Georgia January 2001-May 2006

Review Team Leader/Medical Billing Specialist/Front Office/Patient Access Specialist

Validate patient’s insurance eligibility coverage for proper claims processing.

Performed “follow up” with insurance carriers on unpaid claims or denied, as well as appeals with insurance companies for reimbursement on denied claims.

Handled accounts that needed to be re-bill for additional payments by resolving coding discrepancies. Collect co-pays and deductibles. Inbound/Outbound calls.

Proficient in interpreting EOB denials, billing, research work error report, follow-up, cash posting, verification of insurance, collect co-pays, obtain pre-certs and authorizations and appeals.

Knowledgeable of HCC coding diagnoses and procedures that reflects chronic conditions found within scopes of Medicare.

Education

Associate Degree in Health Information Technology-pending CPC & RHIT

References upon request

Contact this candidate