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Medical Administrative Assistant

Location:
Capitol Heights, Maryland, United States
Posted:
February 04, 2019

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Resume:

**** ******* **** *** ***, SUITLAND, MD *****

PHONE 202-***-**** * E-MAIL ac8d05@r.postjobfree.com

DE ETTA Y. JOHNSON

PROFESSIONAL EXPERIENCE and TRAINING

Fort Belvoir Community Hospital

Resource Management Department

Medical Affirmative Collection, Third Party Collection, and Treasury Department

Oscar Hartley571-***-****

Medical Service Accounts Technician (MSA) 08/2013-04/2018

Served as a Claims Examiner and subject matter expert assigned to Resource Management,, Treasury, Third Party Collection Program (TPC), and Medical Affirmative Claim Program Office (MAC).

Evaluate, review, investigate, verify and process (MAC), auto, on-the job injury and workers compensation claims for medical care furnished to service members and their families caused by the negligence of third parties.

Proficient in the use of various software programs to include Microsoft Word, Excel, Outlook, pay.gov, ABACUS, Composite Health Care System (CHCS), AHLTA, and JAGCNET and HIPPAA compliance.

Communicated with third parties, to include attorneys,members, insurance companies, and Medical Treatment Facilities (MFT), as necessary to ascertain pertinent information and documentation in the procession of claims;

Evaluated emergency room records,clinical data sheets, ancillary information, and other supporting documents relative to the potential recovery of liability claims.

Provided training and guidance to other claims examiners to aid them in the processing of claims and troubleshooting novel issues;

Independently conducted legal research as needed, to ensure the correct processing of MAC claims

Request medical records from Medical Treatment Facilities (MTF) throughout the United States and overseas.

Created MAC tracking spreadsheet of all medical billing ordered for the MTF.

Ensure the maintenance of an accurate database Affirmative Claim Medical Process (ACMP).

Reviewed patient records to ensure that the records or medical service provided therein is related to the accident which is being billed for reimbursement.

Verified the accurate billing rates per appropriate fiscal year are populated on the billing documentation;

Perform all phases of patient accounting functions to included insurance verification, billing, follow-up, and collections of account receivables to meet monthly budget and collection projections.

Implements appropriate account processing based on established policies and procedures for billing, rebilling, write-off (i.e., small balances, late charges, etc,);

Utilizes patient accounting knowledge and day-to-day operational experience to constructively participating in various inter-intra-departmental meeting as required;

Maintains appropriate account level reviews to ensure timely account processing, executes aggressive, accurate and timely follow-up on accounts according to established procedures.

Create financial records of transactions including accounts receivable management, unpaid, overpayment or refunds for medical claims;

Perform daily audits and reconciles account balances; make necessary corrections to billing documents;

Review accounts receivable reports to analyze claim rejection trends. Review Explanation of Benefits (EOB) for appropriateness to the claims, Return bills lacking required information to responsible personnel for follow-up corrections;

Identify system errors; Determine the entries required to bring the account into balances.

Ensure that records of billed claims have adequate audit trails. Identify accounts from aged receivable reports requiring additional actions and reviews status of delinquent Monitor billing and collection procedures for compliance with agency policies and procedures.

Ensures all private insurer guidelines are met to maximize reimbursements to the hospital.

Identify way to decrease turnaround time and increase collections.

Advise the Supervisor of unusual trends for non-payment by insurance companies and provide input for analytical and evaluative methods to improve reimbursement;

Provides expertise in technical and administrative areas or record management, quality assurance and advisor for various committees, functions and professional meetings.

Provided training das needed.

Provided excellent customer care.

Fort Belvoir Community Hospital

Medical Management Department

Betty Thomas 571-***-****

Administrative Assistant

02/2011-08/2013

Served as the Medical Receptionist /Healthcare System Assistant for Medical Management/Referral Management and Case Worker.

Experienced medical receptionist skills included receiving and processing 40-60 calls/day while ensuring that all messages are delivered to the appropriate party within a 2-5 minute window; urgent messages are processed and delivered immediately to the appropriate party.

Assisted and analyzed all Patient Referral activities, including the referral appointment process, resolution of problems, tracking of referral metrics Composite Health Care System (CHCS).

Worked closely with the Referral Managers and internal/external parties to achieve organizational goals, most importantly a closed loop process for patient referrals.

Provided guidance and assistance to an average of 10-30 Medicare clients via telephone communication and/or face-to-face encounter/day to provide vendor information and coordination of services for specific population.

Routinely demonstrated the ability to understand functions and processes related to healthcare management, including knowledge of medical terminology and procedures, insurance plans and patient referral procedures, medical record practices, theory, terminology and codes.

Create, file and maintain all correspondence, timecards, and personnel training folders.

Walter Reed Army Medical Center

Washington, DC 20065

Felicia Davis 202-***-****

Patient Appointing Agent 08/2008-02/2011

Coordinated and schedules patient appointments with Military Treatment Facility (MTF) clinics and or specialties, includes appointments at other MTF’s.

Ensured all treatment request by physicians have been schedule and /or rescheduled as indicated.

Monitors the schedules of the various clinics to avoid conflicts in different clinical schedules;

Coordinated and input appointment schedules for providers into ensures appointments are timely and in accordance with provider request.

Proceeded T-con to provider as requested.

Skills: Knowledge of Microsoft Words, Excel, Outlook, ABACUS, pay.gov, and HIPPAA

REFERENCE AVAILABLE UPON REQUEST



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