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Insurance Manager

Location:
Illinois City, IL
Posted:
December 26, 2018

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Resume:

Dominique Boyd

**** * ***** ***

Chicago, IL ****0

773-***-****

ac71x9@r.postjobfree.com

Education

Richard J Daley(Chicago, IL) - Associate in Science 05/2006

Loyola University (Chicago, IL)- 2 years Pre-Med 2014

Experience

Billing Coordinator 06/2018-current

Help At Home (Chicago, IL)

Bill Home Base Community Services(electrically and paper).

Learn and master contract billing requirements details.

Meet billing deadlines according Medicaid/State regulation.

Upload billing file to KYMMIS for reimbursement.

Monitor clearinghouse for rejections.

Follow A/R denials and supplement claims and resubmit corrections .

Review prior authorization to ensure proper servicing to clients.

Assist Cash Posting with remittance issues.

Train new employees on billing and handling A/R.

Assist Manager with interview processes.

Delegate task via spreadsheets to ensure A/R is under 180 days

Develop and maintain working relation with branch office and Case Managers.

Billing/Insurance Follow-Up (Lead) 08/2017-06/2018

Rev MD (Lombard, IL)

I Oversee 10+ Reps. in a department of 140 reps.

I perform weekly Audits to ensure Quality and Assurance

I delegate daily tasks via Excel Spreadsheet and report methods

I monitor clearinghouses such as: True-Bridge, Availity and internal billing system for rejections and/or RTP claims.

I perform charge entry, billing, editing and follow up in multiple systems to ensure proper reimbursement for all insurance carries.

I analysis ATB, Ad Hoc reports, EP summaries for system or billing trends.

I perform weekly training classes to ensure quality is maintained and company protocol is upheld.

I attend weekly Lead meetings to report all problems with resolution to upper management and to ensure company policies are being maintained.

I also perform Cash Posting from ERA(s) and 835(s) reports of Insurance, Client and Patient payments.

Financial Assessor/07/2016-03/2017

Advance Resources-Northwestern Medicine (Chicago, IL)

●I reviewed and updated Epic system with new insurance, claim edits, and EOBs, information

●I reviewed payers fee schedule ensure proper payment reimbursement was made.

●Submitted paper and electronic billing in a timely manner to payers such as: Medicaid and Medicare, BCBS, Cigna, ABH and MCO plans.

●I reviewed EMR for billing and appeal purposes

●Train new employees on Work-ques for No authorization or/and per-certification denials and locating trends.

●I reviewed payers’ web-portal or IVR to obtain claim or benefit information.

●I posted Medicare contractual adjustments in the Epic system

●I attended bi-weekly training meetings to keep updated on new procedures and trends.

Full Cycle Biller (November-2013-March 2016)

Magna Health System (Bedford Park, IL)

●I Billed full revenue cycle for Physicians, Facility and Anesthesia for all payers.

●I reviewed pre- coded Op-reports and enter CPT and ICD-9 codes for billing.

●I reviewed payers’ contracts and billed accordingly.

●I submitted I department claims electronically.

●I worked closely with office Physicians and Clinical Nurses, in reviewing medical records in order to obtain information relevant to patient issues or/and billing trends.

●I followed up on insurance A/R reports

●I verified patient’s eligibility and benefits prior to services.

●Generated EOM audits to ensure monthly goals were met.

Medical Collector/Biller (Aug.-2009 – November-2013)

Miramed Revenue Group (Lombard, IL)

●3rd party debt collector on past due medical balances for clients such as: Resurrection, Advocates, Northwestern Memorial Hospital and Faculty, Provena and Elmhurst

●Received 150-200 Inbound/Outbound calls from patients, insurance and attorney’s offices on delinquent accounts

●Pulled Credit Reports in effects to collect on outstanding patient accounts

●Reviewed EOBs for accurate adjustments and billing to patients

●I performed skip trace on patients to obtain new demographic information.

●I Assisted Kaiser Permanente Patients w/ account resolution

●Collected on hospital and physician billing ensuring payment plans were current.

●Updated Epic system with new insurance, patient information and all other related information necessary for re-billing

●Trained new employees on maneuver through epic and call handling.

Telephone Service Rep. (April-2006 – May-2009)

Teleperformance USA (Oakbrook, IL)

●Received inbound calls from Citibank customer inquiring about open credit card account

●Resolved financial problems for customer with outstanding balances

●persuaded customers from canceling their protection plan on their Citibank CC

●Received 100% monitoring on Quality and Assurance monthly

●Transferred all other questions or/and dispute to escalation department

Skills

I have worked the following billing systems: DataFlex, AuthentiCare, EVV, KYMMIS. Epic, McKesson, Med Mate, SIS, Cubs, DDE, Xifin, Evident and Cerner. Also Microsoft with all functions and Citrix.

I am proficiency with EMR, Avality, Navinet, Connex, HFS and NEBO and many others.

I have strong knowledge with UB, 1500, HCPCS, ICD 9/10 and CPT codes and Revenue codes

Knowledge with Ad Hoc, ATB, EOM consolidation reports and able to multitask.

Strong attention to details, excellent communication skills and able to type 35-40 wpm.

References

Danielle Berta- Human Resource Director(Rev MD)- 630-***-****

Demont Wahid- Consult for NM Professional- 678-***-****



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