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Medical Billing/Insurance

Location:
Houston, Texas, United States
Salary:
$15
Posted:
April 12, 2019

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Resume:

Beryl Denise Powell

850-***-****

ac82rq@r.postjobfree.com

SUMMARY

Healthcare Professional

Administrator/Management/Educator

A diverse professional with an extensive background in Health Care Administration, accounting, and education. Excellent candidate with solving and implementing healthcare goals, policies, and visions of the organization. Reliable leader with knowledge in building strong partnership, and the ability to multitask projects while thriving in deadline-driven environments. EDUCATION

U.S. Career Institute, Medical Coding & Billing,

University of Phoenix

Master’s in Healthcare Management/Education,

Bachelor of Arts; Healthcare Administration,

Lincoln Medical Institute, Certified Medical Assistant SKILLS &TRAINING

● MEDICAID (15+ years), MEDICAL BILLING (10+ years), MEDICARE (15 years), BILLING

(12+ years), HEDIS (8 years) Medical Records (12+ years) Certified Coder/ medical billing

(2016), Nextgen System, Excel Word, Power Point Presentations, Access, Microsoft communicate Outlook, Master Databases, and Medifast products. Medical Assistant Certification 2003, X-ray Technician Certification March 2004.

● Knowledge of ICD-9 ICD-10 CPT codes, and Revenue Codes. Medicaid Management Information Systems (MMIS).

● Skilled in HEDIS measures, Six Sigma training, Marketing and Sales of Medical supplies and services, CMS1500, UB92 Billing, Revenue cycle, Charge capture, HIPAA, Medicare/ CMS, NCQA-National Committee for Quality Assurance.

● Health program/project development and management experience. Train students, and customer service

PROFESSIONAL EXPERIENCE

Office Administrator

Taylor Logistics 01/2017-07/2018

● Review and ensure all transportation paperwork such as the DVIR (Daily Vehicle Inspection Report) driver logs, trip reports, and invoices are completed.

● Record driver concerns, direct main issues to transportation manager.

● Approve driver hours and review carrier agreement contracts for signatures.

● Scan all driver receipts, organize and file. Assist Operations manager with special projects including audits, inspections and compliance. Bridgeway Center Incorporation Fort Walton Beach, FL 4/2014 - 10/2017 Authorization Specialist/Biller/Medical Record/HEDIS

● Responsible for HEDIS surveys, peer review, Medical records, and assist providers for audits. Performed coordination and preparation of medical records collection. Communicated with providers and process medical records via to hospitals and other providers by fax, phone, and mail electronically. Obtain medical records information from providers and upload information in database.

● Document and report all phone calls and enter new Medicaid client information on excel spreadsheet and email staff about new client information. Credentialing /re-credentialing for providers.

● Maintain providers NPI numbers and complete updates as needed for new providers.

● Maintain copies of licenses, malpractice coverage, certifications, etc. Track expiration dates of provider’s licenses and certifications.

● Collect and process significant amounts of verification accreditation information, maintain and update accurate databases for both practitioners and facilities.

● Obtaining all authorizations for third party payers at BCI.

● Communicate and coordinate with front office desk staff, insurance carriers, and providers in completing Authorizations.

● Complete outpatient treatment reports, Medication Management clinical forms for all insurance groups, letter of referrals for Tricare/Humana and inform providers once completed for signatures.

● Follow-up with staff and/providers once forms are completed.

● Post payments on clients account. File appeals, denials, when claims are denied.

● Make verbal appeals on denied claims.

● Process claims on Availity web portal, check claim submission for timely filing.

● Collect on high dollar accounts and completed aging reports for accounts past 120 days.

● Responsible for reviewing claims in the claims error log in Psych consult provider.

● Review any errors and correct as needed.

● Responsible for maintaining referrals for providers and insurance companies seeking to assist their clients in the transition to Medicaid, and MMA program.

● Databases include pertinent education, training, experience, and licensure content.

● Prepare records for regular auditing, as well as maintain close communication with all appropriate practitioners to ensure that records are up-to-date and consistent.

● Demonstrate knowledge of credentialing regulatory and accreditation requirements (NCQA, CMS, Medicaid, etc.).

● Review the CAQH system and download applications or supplemental documents as appropriate. Pediatrix/Mednax Medical Group Atlanta, GA 09/2007 - 09/2012 HEDIS/Medical records Specialist/Front office coordinator

● Prepared medical records for HEDIS audit, attorneys, patients, and insurance companies.

● Greet and check in patients for a busy OB/GYN and Maternal Fetal Specialist front office, maintain billing flow, process, and schedule appointments, and verify patient’s insurance.

● Contact various sources including insurance professionals, patients, and other parties to verify relevant data. Secure documentation from medical providers, insurance companies, and patients, and accurately update pending liability claims with new information obtained from documents.

● Obtain medical bills and medical records from EMR system scanned and mailed to insurance companies for processing.

● Assist providers and staff to find ways to encourage member clinical participation in wellness and education.

● Assist in resolving deficiencies impacting plan compliance to meet state and federal standards. Review and scan medical records to be process in patient’s electronic chart, Update Medicaid, Peach state, and WellCare patient eligibility on Medicaid portal. Performed coordination and preparation of medical records collection. Process medical records via to hospitals and other providers by fax, phone, and mail electronically.

● Oversee the coding, charge capture, and charge entry process to assure that medical billing is current and accurate.

● Daily posting of patient’s account, financial reports; collect on 50 to 80 patient’s accounts daily, collect balance for accounts that are 90-120 past due. Train employees and students in front office department for obstetrics/gynecology and maternal fetal specialist office. Maintain insurance and self-pay collection flow from $10,000 to $20,000 a month for the practice.

● Maintain a working relationship with external contacts such as pharmaceutical representatives, managed care representatives, as needed.

Blackstone Resources Tucker, GA 08/2007 - 09/2007

Medicaid Analyst/Biller

● Assist with the delivery of healthcare payer process improvement and payer system implementation projects.

● Knowledge of payer business challenges & translated them into requirements and solutions. Prepared, document, and resolve issues on a timely basis, and understanding of payer operations.

● Assist with knowledge of health plan skills in re-engineering claims, benefits, and enrollment eligibility processes, in conjunction with a new implementation (systems such as NASCO etc.).

● Knowledge in understanding of workflow design methodologies and tools; understanding impact of payer many business practices excel-based modeling, reporting, and analyzing of Medicaid and Medicare.

Care Medic System Alpharetta, GA 09/2006 - 05/2007 Reimbursement Specialist

● Responsible for analyzing previous account documentation in Web mats, HIS system. Implement goals for Managed Care Specialist.

● Maintain an external working connection with Managed Care Representatives. Correct errors as determined in system validation.

● Provide comprehensive data processing, transformation of data and information among healthcare professionals, hospitals, and other appropriate stakeholders.

● Responsible for reviewing and correcting UB-04, UB92, HCFA 1500 claims, and Explanation of Benefits. Prepared and mailed 100-200 claims to insurance companies.

● Collect on accounts 90-120 past due and reports for high dollar accounts. Set project goals 50-75 accounts per day. Prepare and correct aging reports. Train new staff for A/R position. First Foundation Medical Suwanee, GA 04/2004-09/2006 Front Office/Nurse Supervisor/Medical Records

● Performed coordination and preparation of medical records collection. Process/sent medical records via to hospitals and other providers by fax, phone, and mail electronically. Supervised five employees, and train over 100 students from various medical technology schools in Georgia.

● Worked with vendors ensure execution of products and services. Scheduled patients for surgery; called in medications, collection on high dollar accounts and aging reports, insurance follow-up, referrals, authorization for medication, and insurance.

● Organize meetings with pharmaceutical representatives to market products with internal medicine facility. Assist patient preparation for examination. Obtain medical records information from providers and upload information in database. Coordinate, and facilitate educational programs and educational tools for staff. Reviewed and process medical reports for patient’s chart. Ensure that appropriate billing guidelines and standards are met based on payor and/or state. Make written or verbal appeals to payers on denied claims.

● Obtain claim status and gathering supporting documentation to submit appeals. Secure documentation from providers, insurance companies, and patients, and accurately update pending liability cases with new information obtained from the documents. Obtain bills and medical records from medical providers and send them to insurance companies for processing. Colombia HCA Norcross, GA 10/2001-11/2003

Account Representative

● Obtained Medical billing, authorizations, referral, and analyzed commercial (TPL), Managed Care, and Medicare and Medicaid Insurance transactions. Follow up on accounts, 90-120 days past due and high dollar accounts.

● Post payments and issued guidance to resolve potential or existing problems. Serve as a liaison between customers and technical staff in implementation, development, and business contacts. Worked with the company

● Medicaid team to provide information relevant to the billing process for the Georgia Medicaid electronic health record initiative program.

● Contact various sources including insurance professionals, patients, and other parties to verify relevant data. Coordinate with payors to ensure appropriate filing guidelines are met for reimbursement. Requested appropriate information, both verbally, and written, from appropriate parties to ensure proper claim dispositions.

● Maintain and update payors on denied claims. Ensure that appropriate billing guidelines and standards are met based on payor and/or state.

● Obtain claim status and gathering supporting documentation to submit appeals. Secure documentation from medical providers, insurance companies, police departments, and patients, and accurately update pending liability cases with new information obtained from the documents. Obtain bills and medical records from medical providers and send to the insurance carriers for processing.

Tenet Healthcare Atlanta, GA 09/1998 - 08/2000

Account Representative

● Worked with Managed Care, Commercial (TPL) Medicare and Medicaid accounts. Processed EOB’s, referrals, and post payments transactions.

● Resolve accounts as quickly and accurately as possible, obtaining maximum reimbursement on high dollar accounts.

● Review and research accident claims to investigate possible leads. Billing for no-fault and third-party liability carriers when appropriate. Requested documentation from insurance representatives when no no-fault insurance exists.

● Review and research insurance claims to determine possible payment sources.

● Contact various sources including insurance professionals, patients, and other parties to verify relevant data. Coordinate with payors to ensure appropriate filing guidelines are met for reimbursement. Maintain and update payors on denied claims. Ensure that appropriate billing guidelines and standards are met based on payer and/or state.

● Obtain claim status and gathering supporting documentation to submit appeals. Secure documentation from medical providers, insurance companies, patients, and accurately update pending liability cases with new information obtained from the documents. Obtain bills and medical records from medical providers and send them to insurance companies for processing.



Contact this candidate