Jacquelyn Pritchard

PO Box ***** Houston, TX ****1 602-***-**** ac6tdd@r.postjobfree.com

Objective

To obtain employment that will utilize and enhance my current skill set within the healthcare industry. I have extensive experience in the medical billing field, exceptional analytical skills, problem solving and organizational skills. Also working knowledge of ICD-10, electronic claim processing, appeals and insurance reimbursement. I would like to be part of a growing company that encourages both education and occupational advancement.

Skills & Abilities

Knowledge of Clinical Research Operations Computer Proficiency Excel, Outlook

Computerized Database Subject Recruitment Medical Coding; ICD-9, CPT

Medical Business Operations Financial Management

Data Abstraction & Reconciliation Accounting & Auditing

Medical Documentation Review

Experience

INTERVENTIONAL ASSOCIATES 11/27/17

Create and send out claims to insurance carriers, process/post denials and insurance payments. Audit aging accounts submit appeals and resolve outstanding claims. Generate and audit claims that are submitted daily. Reconcile and audit claims, Identify trend in reimbursements and denials. Review and audit account for collections. Post payment daily and send statements to patients.

HOUSTON HOSPICE 10/16-06/17

Audit patients daily for initial insurance verifications and level of care change authorizations from insurance companies and report. Audit, track, correct and report physician visits log entries, make corrections when needed.

Back up for insurance verification and authorizations, reverify active and current insurance coverage for all active patients. Coordinate physicians managed care and patient billing, claim processing and collections.

Ensure all month end and death & discharge bills are created and transmitted to commercial insurance payors for physician charges.

Respond to all patient and insurance company written and telephonic inquires in a timely manner. Coordinate with PCMs and Medicaid Specialist to record, track, and submit documents related to Medicaid SIA billing process.

Submit accounts for write-offs on uncollectible and resolve commercial accounts with credits balances.

HEART & VASCULAR CENTER OF ARIZONA 07/15-08/16

Communicates with insurance company seeking proper compensation on medical claims, includes phone communication, appeals and other correspondence.

Reconciles process payments to ensure accuracy, address and resolve account credit balances and work with coders and billers for accuracy of claims.

Monitors AR to identify billing errors, coding errors, timely rebilling and prepares accounts to be sent for collections.

Follow up on past due accounts with payers/patients, utilizing appeals processing as appropriate, maintain current information on correct and lawful practices for insurance companies and supports leadership with daily, monthly reporting.

8-16-13 TO 5-9-15

OFFICE TEAM/CENTENE CORPORATION/BRIDGEWAY HEALTH SOLUTIONS; TEMPE AZ

Document all activities for reporting and resolution through the customer relationship management application (CRM) and Respond appropriately to provider issues and concerns and provide trending feedback to improve the customer experience.

Answer inquiries from providers regarding claim, eligibility, covered benefits, authorization status issues, Process customer correspondence and provide the appropriate level of timely follow up and Educate provider on health plan initiatives during interactions with providers via telephone.

Provide first call resolution through issue documentation and resolution with appropriate internal resource, follow-up and ensure closure with the contact who initiated the inquiry and helped provider regarding website registration, navigation and customer related inquires.

Maintain performance and quality standards based on established call experience guidelines and Manage service related follow up items and outstanding tasks in accordance with established turnaround times.

Research and identify any processing inaccuracies in claim payments and route to the appropriate site operations’ team for claim adjustment and Identify any trends related to incoming or outgoing calls that may provide policy or process improvements to support excellent customer service, quality improvement and call reduction.

02-12 TO 11-12 BILLER

NATIONWIDE VISION CENTER; MESA AZ

Billing invoices to Blue Cross Blue Shield and Superior Vision Plan on CMS 1500 claim forms, post payments

Maintain a current AR, follow up on denials and incorrect payment. And prepare adjustments and refunds

for insurance companies and issue authorizations for services.

11-05 TO 10-11 SENIOR BILLING ANALYSIS

AFFILIATED UROLOGISTS, LTD; PHOENIX AZ

Coding surgery charges, consults and keeping surgery log. Billing claims on CMS 1500 forms to all the major

Insurance companies, posting insurance and patients payments, request refunds for patients and

Insurance companies. Produce customized end of month reports for providers, handle banking operations,

patient phone calls and worked daily correspondence from patients and insurance companies.

05-05 TO 10-05 INSTRUCTOR

EAST VALLEY INSTITUTE OF TECHNOLOGY(EVIT); MESA AZ

Medical Billing and Coding Instructor.

10-99 TO 3-05 SPECIALTY CODER

MEDICAL PROFESSIONAL ASSOCIATE (MEDPRO); PHOENIX AZ

Coding for Ob/Gyn billing daily charges and surgeries.

Prepare and review CMS Claims 1500 and UB-04 forms.

05-97 TO 10-99 MEDICAL BILLING SUPERVISOR

OB/GYN CONSULTANTS; PHOENIX AZ

Coding and billing office charges, billing claims on CMS 1500 forms to all the major insurance companies, post

insurance and patient’s payments and requested refunds for patients and insurance companies. Produce

customized end of month reports for providers, and handle bank deposits and handle patient’s problems and

questions. Checked patients in and out of the office, schedule follow up visits, other office procedure, supervising

the front staff of 5 to 6 employees and handle all HR questions and problems for the office.

Education

SAM HOUSTON HIGH DIPLOMA 1975

GATEWAY COMMUNITY CERIFICATION OF COMPLETION IN HEALTHCARE MANAGEMENT AND CLINICAL RESEARCH 2005

UNIVERSITY OF PHOENIX

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