Richard L Jones
Highly skilled, knowledgeable, and proficient Hospital Medical Financial Eligibility Counselor / Medical Claims Biller, brings extensive, specialized experience working in medical billing, collections, patient accounts management, and customer care capacities throughout hospital and independent medical billing environments. Key qualifications:
Fulfillment Center Associate (Amazon Fulfillment Center, Fresno, Ca.)6/13/18-1/1/19
-My responsibility was to complete customers’ orders on a professional /timely basis, using the best state of the art technical advancements from Amazon.
Hospital Financial Medical Eligibility Counselor (Navigant - Cymetrix,@Tulare Regional Medical, Tulare, Ca. 2011-2017).
I was responsible for screening patients on site for eligibility assistance programs either at bedside or in the ER, while working in conjunction on a daily basis with the Case Management Dept., doctors, nurses, and staff to ensure the highest quality of financial / program assistance offered.
Review the hospital census on a daily basis, to identify self-pay patients, whether from the United States or outside non-citizens from countries across the world.
Review patients that are in house or designated as self-pay for state, county and / or Federal assistance programs including starting / completing application processes.
Responsible for tracking of program assistance offered / accepted of past and present hospital patients, while keeping track of successful vs non-successful outcomes.
Maintained a positive working relationship with the hospital staff of “all” levels and departments.
Medical Billing (Tulare District Hospital, 9-06-2006 thru 7/11/2011)
* Recognized for a proven ability to efficiently process medical claims for major and private insurance carriers including HMO/PPO, Blue Cross/Blue Shield, and Medicaid/Medicare.
* Highly skilled with a demonstrated knowledge of medical terminology, ICD-9/CPT codes, No Fault, and Worker’s Compensation claims.
* Keenly recognized, investigated and resolved discrepancies leveraging extensive experience going through appropriate channels to facilitate medical claims review and appeal processes.
* Process in excess of 60 healthcare claims per day for ABC Administrators, a third-party administrator of health benefits, in areas of surgical, dental, mental health, and physical therapy cases.
* Respond to inquiries from providers on a broad scope of coverage issues pertaining to eligibility, coordination/explanation of benefits, and payment schedules
* Carefully research and review individual/group claims exercising a strong working knowledge of major medical plans and leading healthcare networks
* Proficiently utilize the RIMS program and collaborate with Claim Review Department to expedite the resolve of claim discrepancies and insufficient information.
* Acted as Professional Relations Representative for between the main office and three regional locations to ensure the timely and accurate processing of insurance claims.
* Trained and supervised personnel on accident insurance claim processing and approval procedures.
Tulare Community Health Clinic, Tulare, Ca (April 2003-September 2006)
* Implemented an efficient follow-up system to expedite the recovery of 30-day outstanding payments from non-responsive insurance carriers.
* Reconciled outstanding balances and incidents of returned claim checks from Medicaid/Medicare.
* Gained a reputation for accuracy and timely responses to requests, most frequently requested associate by physician’s offices to locate and process charts.
Hanford Community Medical, Hanford, CA (July 2002- April 2003)
* Processed computerized medical and dental billing for 1,200 patients under private, No Fault, and Worker’s Compensation insurance plans.
* Followed up with insurance carriers and patients to expedite the recovery of payment obligations.
College of the Sequoias, Visalia, CA
Associate of Arts Degree, Business Marketing, graduated 1/1978
Cerner, AS 400,MS Word, Excel and PowerPoint; Patient Management System (PMS)
Nancy Korovillas(former Supervisor/patient Director @Tulare Regional Medical Center)#559-***-****
Gilbert Mora(former Supervisor-Tulare Regional Medical Center), #559-***-****
Susan Sigler(Revenue Cycle, Regional Director – Navigant/Cymetrix)#559-***-****
Sandra Silva, #559-***-****