Objective: To secure a position which will allow me to use my acquired skills and grow!

**/**/**-******* ********** Management Group (temporary position for Verity Medical Foundation HMO department) Duties: Provider Dispute Resolution adjudication (PDR’s), upon receipt of vendor PDR’s for payor sources such as UHC, Health Net, Anthem Blue Cross, Blue Shield, Scan Health Plan etc. due diligence is done to gather all claim adjudication documentation and contract verbiage to decipher said claim processing issues to reprocess (uphold denial if warranted) the claims for payment or forward them to either the UM director to review attached records for retro auth approval or forward them to the HIMS department for coding/ down coding review. Also generate acknowledgement, upheld, or approval letters and new EOB’s specific to each PDR resolution and provide all requested claim adjudication documentation to the payor sources respective appeals and grievance units within the time frame indicated on their request.

03/15/18-09/01/18 Simpson Chiropractic (temporary position) Duties: Billing and Collections on HCFA 1500 as well as prepare billing statements by finalizing cases to prepare attorneys to move forward with litigation on auto accident cases. Cash posting, appointment scheduling with use of Chiro Touch software system. Credentialing with third party insurance and Medicare contract maintenance.

03/11/14-05/15/18 Full Charge Skilled Nursing Facility Bookkeeper as Business Office Manager

Duties: Balance Census; Initial Billing; MSP and Secondary Billing and follow up Collections for all payor sources such as Medicare, Medi-cal, Managed Care, Hospice, Private and Share of Cost buckets as well as some Workers Comp, VA and Third Party cases. Utilization and No-pay (210) claims. Balance resident trust account, facility credentialing, financial counseling/verify resident demographics, Petty Cash, work correspondence; consolidated billing and invoice chitting for A/P. Communication with corporate offices, Physicians, Medical Groups etc., reporting of financials with use of excel sheets, meet deadlines; Month End Close, obtain authorization or retro-authorizations to ensure claim reimbursement when needed, appeals for auth, level of care or underpayments. Bank Deposits, Cash posting and adjustments. Attend department head meetings, recognize negative trends and come up with effective resolutions. Filing, faxing as well as offer leadership and positive encouragement to my assistant. Systems/business machines used: DDE, Ability, Availity, Matrix Care and Point Click Care software, MS Word, Excel, Email, Web based banking, Web based merchant site for credit card transactions, Medi-Cal provider site, multiple line office phone, fax machine, 10-key by touch. A/P and Payroll as well as PPD and licensed nurse and C.N.A. monthly scheduling.

09/4/13- 03/11/14: Adventist Health Patient Account Rep (contractor/Turning Point) Duties: Inpt./Outpt. Facility, Clinic and Pro-fee Commercial, Medi-cal Managed Care, Worker’s Comp (due diligence), Non Traditional Payors, and special project follow-up. Demand bills, use of SSI to bill and or scrub claims, submission of write off requests for account adjustments, resolve credit balances and prepare refund requests, account balance resolution, work other special projects/reports as requested, Appeals, review of contract matrix for expected reimbursement, customer service/calls to help patients with account issues, meet Aeos production quotas. Systems Used: SSI, AS400/MS400, Aeos, Power Chart, Spy Web(to access scanned documents), MS Office applications, i.e. Excel, Word, Outlook, internet explorer for various Payor Websites. Forms: UB04, CMS1500

04/13/12-12/12 Alameda County Medical Center Fairmont Patient Account Rep (temp./HRG) Duties: Inpt./Outpt. Facility and Pro-fee Medi-Cal follow-up rep from 04/13/12 through 04/20/12; Medi-Cal Managed Care follow-up rep from 04/20/12 through 05/23/12; Medicare Inpt. and Outpt. Facility and Pro-fee billing and f/u from 05/23/12 through 12/12. Demand bills, use of DSG to bill and or status claims, submission of write off requests, account adjustments, balance resolution, identified trends/error in regards to pro-fee billing to Medicare, special projects as requested, meet ATB deadlines. Systems Used:DDE, DSG, OAS/GOLD, Invision, MS Office applications, i.e. Excel, Word, Outlook.

10/10/11-04/10/12 Washington Hospital (Fremont CA) Patient Account Rep (temp./HRG) Duties: Inpt./Outpt. Facility and Pro-fee Pre-Billing for all payors, hard ball follow-up on Worker’s Comp cases, attorney communication/ account balance requests, employer communication resolved C4 and C3 issues, customer service, medical records requests, worked failed bill, failed claim and rejection reports daily, account adjustments, demand bills, insurance coverage verifications, appeals, EOR/EOB review, credit balance resolution, refund requests, special projects as requested. Systems Used: STAR, MS Office applications, Cirius,Internt Explorer/various payor sites, Internal Medical Records Software.

12/8/10-10/7/11 Alameda Hospital Patient Account Rep (temp./HRG) Duties: Pre-Billing; Appeals Specialist, Hard Ball F/U and collections, Worker’s Comp.;VA;TPL; Commercial,HMO,PPO,EPO plans etc.; Medicare, Medi-Cal and miscellaneous Medi-Cal Plans for both Inpt., and Outpt. Accounts. Credit balance resolution, refund requests, account adjustments, Special Projects, Self-Pay F/U and payment collections, Outgoing and Incoming calls to Insurance co., VA, Workers-Comp. and patients, Review of all EOB’s, RA’s, RAD’s, EOR’s for account resolution as well as review of patient payments. Use of web sites for numerous payors to status claims.Submission of PDR’s and Re-bills as needed, Knowledge of LTC/SNF billing. Systems Used: Medi-tech, Emdeon, SMS, Internet Explorer.

10/26/10-12/3/10 Montevista Hospital Patient Account Rep Duties: Cycle Billing hard cc: and electronic; Commercial/HMO; Medicare/Medicaid(use of Medicare DDE and Medicaid Cube for manual billing), Medi-cal billing and followup, customer service, credit balance resolution, patient and insurance refunds, account adjustment authorizations and contractual adj. resolution,appeals and re-bills,patient letters and other projects as needed. Systems used: SSI, HMS aka MS4. (Behavioral Health).

01/01/09-10/19/09 TechSkills “Student”(of Las Vegas NV Career School) Courses: Human Anatomy and Physiology; Pathophysiology; Advanced Physicians Coding; Advanced Facility Coding. Learned the specifics of Physician and Facility Coding, studied APC’s and Medical Terminology used ICD-9-CM; CPT; HCPC books according to the AMA as well as prepared for the ICD10. Curriculum focus was on accurate coding of procedures and services in a timely manner, knowing what coding would be necessary from the coder, Encoder or what would be indicated in the charge master.

04/19/08-11/24/08 CHW (Catholic Healthcare West) CBO Patient Account Rep Duties: Workers’ Comp and Commercial Inpatient High Dollar ($59k-$1M and up) PFS Follow-up Rep. Systems: MS4, Care Connect, Cirius, ESP+Desktop, SSI, IVANS DDE, Citrix ICA,CMS and CMG pricer, Ascent, MS-Office, Excel, Click On CCSM, Internet Explorer. Correspondence Resolution. Recoup Requests. Appeals (all levels) and Re-bills. Authorization and Retro Auth Requests (for inpt. bed/days and services). IPA and Medical Group issues. Certified Mailing and Receipt Log. Use of CPT, ICD-9, UB Editor and HCPCScoding manuals. Claim Status Calls national and internationally. Proposal Negotiations/Percentage Calculations. Credit Balance Resolutions. Write Off/Account adj. Records Requests from HIMS dept. Hard-Ball follow up using various work lists, MS Outlook Calendar, Emails, Account Notations and Tracer Files. Alpha Filing and File Purging. Faxing. EOR, EOB and EOMB Review. Review of Contracting Matrix for underpayments, Patient Calls and Letters. COB info. And ADR Requests. Some Outpt. Follow-up as needed. Communicate with Facility Attorney. UB92/UB04 and HCFA 1500/CMS 1500 experience. 10-key usage by touch.

4/15/06 thru 04/18/08 (I am Familiar with Nevada Insurance Plans)

Fremont Medical Center (of Las Vegas, NV ) Position: Follow-up Rep. (10/19/07-04/18/08)

Heavy Workers’ Comp. billing & f/u, Commercial, HMO, PPO, Indemnity, Self-Funded Insurance Billing, Medicare/Medicaid and Union Coverage Billing & f/u, Customer Service on the Phones (accepting private payments, helping patients with account resolution), Run A/R reports, interfacing systematic functions with Excel Spreadsheets, Credit Balance Resolution, Entering Return Mail/Correspondence Resolutions, Aggressive f/u with dead beat payors, Billing professional as well as hospital charges using CMS-1500 and UB04 (UB92 for older accounts), Special Projects as needed. 10-Key by touch. Systems Used: Mysis, Tiger, In house medical records scanning system.

Complete Neck & Back Care Position: Billing Office Manager (THIS POSITION WAS HELD IN LAS VEGAS NV 04/15/06-04/18/08) Medical Biller/ Collector Duties: Billing Office Staffing and Employee Relations as Team Lead/Billing Office Manager, Physician Credentialing, Medicare, Personal Injury, and Commercial, HMO/PPO, 3rd party, Med Pay,Workers Comp etc. billing (EDI/ electronic, resolve rejection reports) and F/U for chiropractic care. Initial and Follow-up on primary and secondary /tertiary billing hard copy and electronic, cash posting, account corrections & adjustments, Credit Balance Resolution, claim status checks, faxing, write offs, private billing to the patient, attorney/opposing attorney communication / Liens, proposals, reduction requests, prepare and send aged cases to collections agency and multi-line telephone reception duties, attend seminars, take meeting minutes, schedule Dr.’s Luncheons, created and distributed company newsletter via global email, Oversee system upgrade transition. Systems Used: CeoTrax and Medisoft (There were 4 billing rep. employees under me)

1/15/02 thru 3/07: Innovative Concepts Position: Home Health Care, Hospice and Unit Dose Billing (HCFA 1500), Filing, Faxing, Follow-up Calls with Insurance and Patients or Residents, Purchasing, Cash Posting, Front Office/ Receptionist duties.

08/03/04-2/15/05 temp. EMSO, Inc. Position: Temporary Employee Through Kenneth & Assoc. as a Collections Specialist Duties: Responsible for maintaining productive A/R for three or more outpatient ambulatory surgery facilities by performing W/O’s, F/U billing & Heavy Collections primary and secondary to HMO’s, PPO’s, Medicare Part B (National Heritage), and some Medi-Cal carriers as well as Patients, telecommunications with insurance companies, doctors and patients, Data Entry, Special Projects as requested, Patient and Insurance Refund Requests/ Credit Balance Resolution, Review and Mailing of Patient Statements, Collections Letters, Proposals for Claim Pricing Companies, Telephone Overflow Duty. Systems Used: MEGAWEST aka MEGAVIEW; SIS; ENCODER-PRO; MICROSOFT-EXCEL

7/6/00-4/1/04 Stanford Hospital & Clinics (hospital side)

Position: Patient Financial Services Accounting Rep (Government Dept.)

Duties: Inpatient/Outpt. Electronic and manual Medicare/Medi-cal Hospital Billing and Heavy Follow up, Customer Service, Interfacing with UGS Medicare Help Desk Reps; ADR Request; Secondary Billing; Credit Balance Resolution, Other Special Projects as needed. Systems Used: DDE/IVANS (Blue Cross); SMS; CAREMEDIC; DELIVEREX; IDX; ENCODER-PRO; MICROSOFT ACCESS; FILENET; MICROSOFT EXCEL (Also held P/T evening position at Alta Bates Hospital, Oakland Calif. as a Medical Biller during this time with the same duties as mentioned above thru HFS)

1/28/00-7/6/00 Fremont Hospital (temp. through Healthcare Financial Staffing)

Position:Medical Biller@ Fremont Hospital (Medicare Department)

Duties: Medicare Manual and E-Billing, RA’s, EOB’s, RAD’s, Collections & Follow-Up, File Purging, Account Reconciliation, Contractual Adjustments, Bad Debt Write Offs, Refund Requests, Claim Status Checks, Benefit Verifications, Cross Over Billing to Secondary, Private Billing (to the patient), Billing of HMO’s and other Commercial Insurances, Filing, Faxing, Mailing, Customer Service, Telecommunications. Systems: Passport; DOS. This was a free standing psychiatric facility.

8/3/99-1/27/00 Eden Medical Center of Castro Valley (temp through HFS)

Position: Medical Biller @ Eden Hospital (Medicare Department) Duties: Medicare pre-billing on UB92, Cross Overs to secondary Ins., Private Billing, File Purging, Contractual Adjustments and Write Offs, EOB’s and Follow-Up, ICD-9 Coding, E-billing, Data Entry, Customer Service, Filing, Systems: DOS, DDE

9/97-8/3/99 Vencor Pharmacy Position: Unit Dose Biller/Customer Service Rep. Duties: Billing for payment of medications, anesthesia (calculations) and infusion therapy for SNF patients. Systems used: QS1.

REFERENCES:

Brad Heap, Facility Administrator Invigorate Post-Acute of Los Gatos 408-***-****

Patti Romo HR director St Jude Care Center Manteca Ca 209-***-****

Joni McAllister, Billing Office Manager RCC Santa Rosa 707-***-****

Dr. Matthew Simpson, Owner Operator of Complete Neck & Back 702-***-**** / 702-***-****

Corrine Eagle, Chief Talent Director @ Turning Point 800-***-**** /925-***-****

Daniella Hernandez Skilled Nursing Business Office Assistant 559-***-****

Kate Cullen Complete Neck & Back Care, Biller/Collector Las Vegas, NV 704-***-****

Lisette Simon Stanford Hospital Medical Biller San Jose, CA 408-***-****

Celeste Collins Innovative Concepts, Director of OP. Las Vegas, NV 702-***-****

Fremont Medical Center, Las Vegas NV, HR 702-***-****

Catholic Health Care West CBO, HR 415-***-****

Stanford Hospital, HR 650-***-****

On Assignment, Formerly HFS HR 818-***-****

(On Assignment is able to verify an assignment as far back as 12/30/2002;

However I started on contract with them in 1999 at Eden Hospital, Castro Valley /see Resume)

Pharmerica formerly known as Vencor Pharmacy, HR 502-***-****

(Ask for Lia Nixon, let her know that I worked for Vencor Pharmacy

09/97-08/3/99 at 145 E. Dana Street Mt. View, CA 94041, this will establish

that I have been a biller/collector for at least 21 years).

Education

Obtained HFMA CRCR on 12/24/13 (certified revenue cycle representative)

04/2018 CDL Class A License for truck driving at American Institute of Trucking

01/13/2018 Certified Nursing Assistant Licensed earned from South Bay School of Nursing, San Jose CA

2017 AA certificate from University Of Phoenix in Health Care Business Administration

1/2009-10/19/09 Physician/Hospital Coding CPT/HCPC and ICD-9 student (Tech Skills, Las Vegas NV)

Currently CPR Certified (baby, child and adult) also CPI (child prevention/intervention) certified

2009 Parenting Class Courses (have received numerous parenting class completion certificates which can be used toward hours of continuing education, courses teach parent/foster parent and child relations) Through SAFY foster care of NV.

2002-2005 Parenting Class Courses (have received numerous parenting class completion certificates which can be used toward hours of continuing education, courses teach parent/foster parent and child relations) Through Kair in Home Social Services of Alameda County CA.

1/31/97 AAMA: Certified as a Medical Assistant

1995 Everest College formerly known as National Education Centers, Bryman Campus San Jose, CA ; Course of Study: Medical Assisting GPA 93.51

1992 Western Career College, Sacramento, CA; Course of Study: Medical Secretary

Acquired Skills: (Clinical) Venipuncture, EKG, Prescription Administration and Recording, Autoclaving, Injections, B/P & Vitals, Medical Terminology, First Aid and CPR, Familiar with Anatomy, Geriatric Care, Assisted Living Care, Appointment Scheduling manual and computerized.

(Medical Billing) Medical Terminology, ICD9/CPT/HCPC Coding, TARs, RAFs, PARs, RADs, RTDs, O’s & A’s (Culinary), RTP’s, Familiar with HCFA 1500/CMS1500 and UB92/UB04 billing forms, Some DME Billing, SNF Billing, Knowledge of credentialing, billing the Patient, HMO’s, Medicare, Medicaid/Medi-Cal, PPO’s, EPO’s, Worker’s Comp (State and AOE/ADR) and OHC billing i.e. TORT Liability, Auto Insurance Medical Payments, Balance Reduction Requests, Liens, Notarize Documents for the state of NV, for physicians and facilities, Hard ball Follow-Up. (Administrative) Payroll, 10-Key by touch, Typing 60wpm, Bookkeeping, Invoicing, Scheduling manual and computerized, Insurance Billing, MS Office, WP, MS Excel, Copying, Alpha and numeric Filing, Faxing, Mail Preparation, Shipping and Receiving, Inventory, Able to use the Internet for Research and Resources.

Other Doctor’s/Facilities or Areas that I have worked at primarily or either took it on as a second job at the time from 1989-2018:

All Care for Elders and Seniors September 2017 through Present: HHA / C.N.A. care giver: care giver for several private clients in their homes as well as care giver at Merrill Gardens Assisted Living Facility in Gilroy California providing assistance with ADL’s, changing of briefs, errands and light housekeeping as needed or requested.

In Home Supportive Services (San Jose California): Care Giver for various clients in their private homes June 2010 through 2013

The Water’s Edge Skilled Nursing Facility Duties: SNF Medical Billing, Medicare, Medicaid & Private in 1999 placed by contract/temp through HFS (On Assignment formerly Healthcare Financial Staffing)

Willow Bay Medical Group (Family Practice) Duties: Front Office, Back Office (CMA), Some Billing/HCFA 1500 in 1994

Dr. Dorothy Buckner (Dermatology)Duties: Front Office, Back Office (CMA), Some Billing/HCFA 1500 in 1995

Dr. Jerome D. Lackner (Family Practice) Duties: Front Office, Back Office (CMA) in 1996

I have also worked as a Personal Care Attendant/HHA/Care Giver Services off and on since 1989 through Present for In Home Supportive Services as well as various companies such as Visiting Angels, Comfort Keepers and private clients.

To Whom It May Concern:

I am a highly motivated, ambitious individual seeking a Fulltime position as a Medical Biller or Business Office Liason in a Skilled Nursing or other medical environment.

I specialize in Facility billing and meticulous Follow-Up and I am very capable of performing required duties of any Billing Office Position at an escalated level, having the ability to take on multiple tasks at once allows for me to meet productivity goals. My keen attention to detail and full comprehension of the revenue cycle and knowledge of coding grants me the ability to exceed most expectations.

Possessing a team player mind set and approachable attitude I am able to get various tasks done in a timely fashion, meet project deadlines as well as get along well with others. I am a fast learner open to cross training and sharing knowledge with co-workers.

Organization, punctuality, dedication, my strive for excellence and the fact that I show up daily ready to work, are a few of my greatest assets.

I also have an open mind, which allows my willingness to learn to bring forth a bright comradeship working atmosphere. My pool of acquired medical experience obtained while being a contractor for the majority of my career allows for me to be your ideal all around candidate.

If you feel that my qualifications fit your job description, please feel free to contact me anytime, at your earliest convenience.

Thank you kindly for your consideration.

Sincerely,

Jacqueline S. Burgess, Med Sec’y, MA, CRCR, CNA

CV Summary: 29 years of medical experience within that period 21 years of experience as a facility billier/collector using UB04 and CMS1500 medical claim forms. Understanding the revenue cycle from encounter to claim adjudication for payment, I am familiar with all aspects of billing and collections involving various Payors i.e. MEDI-MEDI / Government type and Commercial, Worker’s Compensation, TPA, MVA, HMO/PPO/EPO, Indemnity, self-funded, traditional and non-traditional. Customer assistance with private pay, relating to account resolution on behalf of the patient. Knowledge of ICD-9, ICD-10 CPT and HCPC coding and medical terminology; anatomy and physiology, I have experience with credentialing. I have a thorough understanding of hospital policies and procedures in relation to HIPAA, PHI, EDI and PPE, compliance issues. Able to use Payor websites for eligibility, claim status as well as other provider functions.

Managerial Experience and Integrity: 5+ years of previous experience as billing office manager where leading by example with moral judgment, character and honesty I have practiced service standards by being courteous to my co-workers, by smiling and making eye contact when speaking. While presenting a professional image I have listened to staff and responded to their needs promptly and reliably. I have anticipated the wants and needs of staff by asking how could I help and if there was anything that I could do to further assist with their needs. I have worked effectively communicating with staff and patients to identify and reverse negative situations. I respect the privacy and confidentiality of co-workers and employees. I strive to master the skills needed to do my best while positively representing the facility / hospital in the workplace and the community and adapt to continuous regulatory changes.

Candidate Consideration: I feel that I would be a wise choice for the available position because I have the required skill set and work ethic which will make me a valuable team player and I will perform to the best of my knowledge and ability growing in my career along with your organization helping to bring your company visions and mission to fruition I also have a flexible schedule and I am able to work any hours required 24/7.

Contact this candidate