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Insurance Manager

Location:
Garland, Texas, United States
Posted:
October 17, 2018

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Resume:

Shan Stokes

Garland, TX *****

ac7e0o@r.postjobfree.com

972-***-****

Work Experience

Business Office Manager

Ridgecrest Healthcare and Rehab - Forney, TX

January 2016 to February 2018

-Bill approx. 100-150 per month claims to Medicare and commercial insurance carriers

-Make deposits, post cash daily, receive private pay payments and post them to appropriate accounts

- A/R responsibilities including following up with insurance carriers and patients in regards to past due accounts and unpaid balances

- Complete the financial portion of the admission packet for incoming residents

- Prepare and submit statements on resident past due balances

- Responsible for balancing during month end using financial reports and reconciling reports against accounting dept. reports

-Prepare financial reports for month end and forward reports to executives in corporate office

-Attend weekly and monthly A/R calls with corporate office

-Post cash receipts and reconcile balances, statements, and A/R reports

-Responsible for entire revenue cycle of claims from billing, collections, and invoicing

-Maintain average of 99%-100%+ for collections of patient, Medicare and managed care accounts

-Financial counselor to families/residents for collection process of due balances

-Process credit card payments

-Helped develop SOPs for billing team

-Created productivity tracking sheets

-Trained employees on processes and company system

-Used Excel for reporting using pivot tables and V look-ups

-Reconciled accounts

-Managed employee time sheets in UltiPro

Team Lead Billing Rep

Forest Park Medical Center - Dallas, TX

July 2015 to December 2015

-Bill all claims electronically (approx. $2,000,000 per day)

-Analyze all pertinent information to ensure claim is received and processed

-Analyze and make decisions on billing procedures for billing department

-Reconcile claims imported from host and exported

-Compile late charge reports and submit corrected claims as needed

-Work with facilities on charge corrections

-Assist with special department projects

-Bill claims using SSI & MediTech

-Compile billing reports using Excel

-Train new employees

-Assist with potential employee interviews

-Helped develop reporting tools for the billing department using the billing software (SSI) & Meditech

-Helped develop policy & procedures for the billing & collection team Billing Analyst

LifeCare Management - Plano, TX

October 2013 to July 2015

-Bill all Medicare claims electronically ($2,000,000-$5,000,000/per day)

-Bill WC claims, auto claims, & LOAs (letters of agreement), electronically and by paper

-Verify patient's eligibility using Passport and other websites

-Contact Medicare to ensure claim is received and in process and to make any necessary corrections to ensure payment

-Make outbound calls to patients to verify insurance information

-Analyze all pertinent information to ensure claim is received and processed

-Analyze and make decisions on rather to pursue patient and/or insurance for payment or adjust balance

-Reconcile claims imported from host and exported

-Compile late charge reports and submit corrected claims as needed

-Work with facilities on charge corrections

-Assist with special department projects

-Review remittance advice forms to verify proper reimbursement and make adjustments as necessary Billing Specialist

Bethany Home Health - Dallas, TX

July 2012 to September 2013

-Responsible for the revenue cycle of all commercial claims and Medicaid using HealthTrust software and Kinnser

-Resolve unpaid claims (commercial insurance carriers & Medicaid) by making outgoing calls to insurance carriers

-Verify patient's insurance benefits with insurance carriers

-Take inbound calls from patients and insurance carriers

-Appeal claims to commercial carriers as well as Medicaid for additional payment (Appeal from

$30,000-$60,000 weekly)

-Assist manager with training new employees on system operations, appeals, billing, collections, etc.

-Run unbilled charges report, determine problems with unbilled charges/correct and bill claims via Zirmed

-Negotiate rates with outside payer sources other than insurance carriers (confirm and sign letters of agreement)

- Assist in credentialing department with getting providers set up with insurance carriers Patient Account Rep

Cancer Center Associates - Dallas, TX

April 2007 to July 2012

-Resolve unpaid claims (commercial insurance carriers & Medicaid) by making outgoing calls to insurance carriers

-Appeal claims to commercial carriers as well as Medicare & Medicaid for additional payment (Appeal from $30,000-$60,000 weekly)

-Assist in training employees on system operations, appeals, billing, collections, etc.

-Run unbilled charges report, determine problems with unbilled charges/correct and bill claims

-Reconcile patient's statements

Medical Claims Collection Representative

Digestive Health Associates - Dallas, TX

March 2001 to April 2007

-Analyze and resolve old age accounts for a total of eight physicians

-Make outgoing calls to insurance companies to verify patient eligibility (commercial insurance carriers, some Medicare & Medicaid)

-Follow up on claim payment with insurance companies by making outgoing calls to insurance carriers

(commercial insurance carriers, some Medicare & Medicaid)

-Adjust patient's accounts i.e. credit balances, incorrect provider discounts

-Appeal claims for additional payment from insurance carriers

-Manage demographics on patient accounts

Education

El Centro Junior College

University of North Texas



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