AR Specialist
Resume:
Beverly R Carlson
*** ******* **. **** ******, IL 60466
708-***-**** (home) or 708-***-**** (cell)
************@***.***
Objective
To apply my strong knowledge of medical insurance follow-up (including denials and appeals) in either an office or hospital setting. I am interested in continuing to develop my skills and grow with the organization.
Qualifications
-- Over 18 years’ experience in medical insurance follow-up (denials, appeals, collections) for both hospitals and physicians
-- Excellent understanding of insurance contracts verbiage
-- Very strong customer service background
-- Creative problem solver
-- Successful record in sales, marketing and management.
Computer Skills
Strong computer skills / quick learner. Proficient in: IDX Citrix, Nebo, ECare, Meditech, NECS, Allegra, Facs, NSure, LexisNexis, Navinet, Emdeon and HPF. Also proficient in: PMT, five9,IEX and EDS. Also Microsoft Excel and Word (some PowerPoint).Very strong in EPIC billing queues and follow up queues, Centricity,Availity, Salesforce, UHC Link,OneSource and NGS/Connex.
RELEVANT EXPERIENCE
AR Specialist II 09/17/18 to 11/2/18 Position Termed
Conifer Health Solutions – 8151 W 183rd St,Tinley Park, IL
Followed-up and resolved outstanding managed care medical claims.
Submitted appeals, followed-up on appeals submitted
Documented and coded accounts per client specifications
Health Plan Advisor 04/17/17 – 05/14/18
Go Health – 225 W Superior Chicago, IL 60654 Position Termed
Explained Health Insurance to Medicare Beneficiaries
Completed enrollment if benefits fit beneficiaries needs
Updated clients systems on all calls
Health Plan Advisor 09/08/14 – 01/31/15 (temp during open enrollment) and 10/13/15-01/31/16 (temp position during open enrollment) Also from August 22,2016 to Feb 15,2017.
Go Health – 222 Merchandise Mart Plaza, Chicago, Il 06054 866/506/1260
Explained health insurance benefits to customers according to The Affordable Care Act.
Noted sales systems per client specifications. Used new system Salesforce for 2016-2017
Claims Collector 02/02/16-04/04/16 (Temp position)
Ingalls Memorial Hospital,Harvey,Il 60426
Follow-up on open medical claims for a resolution.
Contacted payers such as Medicaid and commercial insurance companies to determine the reason for denial and made corrections, resubmitted claim.
Followed-up on a lot of HMO/Commercial/Work Comp/Managed Care open balance accounts.
Verified eligibility on websites - BC/BS, Aetna, United Healthcare, Medicare, Medicaid, Availty.com, others.
Claims Collector 02/16/15 – 08/28/15 (Temp position)
Franciscan Alliance (through Aerotech ) – Schererville, IN
Follow-up on open medical claims for a resolution.
Contacted payers such as Medicaid and commercial insurance companies to determine the reason for denial and made corrections, resubmitted claim.
Submitted paper & electronic appeals to Indiana Medicaid, United Healthcare & VA
Biller/Collector 1997-02/28/14 (dept. closed due to downsizing)
MAC/TCS, Med Source, NCO Financial, EGS - Matteson, IL
Followed-up and resolved outstanding managed care medical claims.
Submitted 30 or more appeals per day, followed-up on appeals submitted.
Analyzed accounts for bad debt.
Collected on high dollar accounts.
Documented and coded accounts per client specifications.
Participated in training new employees.
Supported and addressed customer service issues.
Took and passed FDCPA for collections.
Ensured claims paid per rate contracted with client, if not called and sent appeal.
Followed-up on a lot of HMO/Commercial/Work Comp/Managed Care open balance accounts from AR report.
Verified eligibility on websites - BC/BS, Aetna, United Healthcare, Medicare, Medicaid, Availty.com, others.
Patient Care Specialist – Special Projects – Onsite Representative 1998-2001
University of Chicago Hospitals – Chicago, IL
Performed all admission and pre-admission verification, pre-certification and financial evaluation for in-patient hospitalization.
Verified all scheduling for both inpatient and outpatient services
Documented all information per client specifications to submit for billing
Performed thorough analysis of patient financial data
Determined and met requirements of third party payers to secure reimbursement for most all patient services
Submitted appeals/denial letters when denial was posted on accounts.
Established payment arrangements with patients when needed
Contact hospital finance department for patient cost (self- pay patients)
Verified all insurances upon admission via website or phone
Worked accounts from AR report.
Collector/Biller, Special Projects (Onsite Representative) 2001-2002
Ancilla Health Systems – Hobart, IN
Participated in the set-up of a billing and collections office
Verified, coded and billed open A/R balances on medical claims
Submitted appeal/denial letter when denial was posted.
Followed up on appeals/denials that were sent for payment.
Documented accounts per client specifications
Verified and billed Indiana Medicaid on NECS system
Set up payment arrangements per client specifications
Supported and addressed customer service issues promptly
Analyzed accounts for bad debt
EDUCATION
High School Diploma
ICD-9 Coding Certificate
Business Courses: Business for Entrepreneurs, Business Law 1, Business Sales
Insurance Licenses (current for Illinois, Michigan, Virginia, New Mexico and Texas)
Contact this candidate