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Collector, Billing, Contract Specialist, Claims Auditor, Coding

Chicago, Illinois, United States
March 18, 2019

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Janeice Hall

**** *. ********

Chicago, IL *****


Objective: Seeking a position I can do from home, and I’m willing to outsource as an Independent Contractor in any of the RCM services, with limited to no need for supervision. I have a home office, my own computer, high speed internet and phone service. I love finding extra ways to get, earn, and or keep finances at an all time high. My definition of teamwork is everyone on the same page, I don’t do competition, I believe any good idea should be shared, and everyone is unique, and the bottom line should always be the main focus. Proficient:

UB-04, CMS-1500, 837 Format, ICD-9-CM, ICD-10-CM, HCPCS, CPT-4, CDM, EOB, RA, UCR, APC, PPS, RVS, RBRVS, UCR, RVU, DRG, IPPS, OPPS, Modifier Usage, Rev Cds, Bill Types, Point Of Service Codes, Anatomy, Medical Terminology, Typing 60 wpm, 198 rpm-Ten-Key. Software:

EPIC, DDE Ivan, Ability, SSI, Newman, Meditech, Advantex, Medical Manager, Ecare, HMS, Lastword, Sirius, Citrix, CDM Parathon, Xactimed. IDX, MS Word, Access, Excel; RightCare, Sedero, Cook County, Optum, Replicon, Aldera, CodeitRight, CDM, EOB, RA, UCR, APC, PPS, RVS, RBRVS, UCR, RVU, DRG, IPPS, OPPS. Qualities/Attributes:

Exceptional Problem Solving Ability, Critical Thinker, Highly Analytic, Detailed, Organized, Multitasking, Strong Work Ethics, Excellent Interpersonal Skills & Team Player. Extensive Knowledge In Denial Management: NCCI National Correct Coding Initiative, (LOC ) Level Of Care, (RAC) Medicare Recovery Audit Service, (MUE) Medically Unlikely Edits, BCBS, Medicare, Medicaid, All Commercial Insurances, Auto, TPL, Work Comp Payers. PROFESSIONAL EXPERIENCE:

Northwestern Medical Faculty Foundation

Patient Financial Assessor


BCBS Claims Administrator:

Resolved All Payer Issues, Lower A/R Days, Increase Revenue

Claim Types: In/Out Hospital, Urgent Care, E/R, Observation, Office, ASC Services Proficient EPIC Operator, Exceptional In Resolving Multiple Denials, and Billing Issues. Regularly Applied The CMS Billing, Coding and Reimbursements Guidelines Against Multiple Payers Who Follow There Guidelines - Examples: CCI, NCCI, LCD, MUE & Add-on Code, Multiple Service Guides, Along With The Individual Payers Medical Policies, And Corporate Compliance Guides. Abstracted Accurate Medical Records, To Support The Medical Necessity & Experimental Service Allowances. My Coding Proficiency Enabled Me To Multitask - via Coding Software, Payer Website, Medical Terminology, Anatomy, Physiology via Reference Books & Other Available Web-sites To Obtain The Necessary Information To Process Both Written/Verbal Communication With Payers. Valence Healthcare Chicago, IL

Contract: Medicaid Claims Adjudicator


Claim Types and Services Processed:

Skilled Nursing Facility, Behavioral Health, Rehabilitation, Home Health, Dental, Physical Therapy, Occupational Therapy, Speech Therapy, Hearing Aide, Lab, Radiologist, Anesthesia, Hospice, Non Emergency, and Emergency Transport Services. Observation, ER visits, Urgent Care, Inpatient Hospital, Outpatient Clinics, and Provider Office Visits.

Independent Claims Adjudicating Duties:

Analyzed the details of each claim to determine if it should be paid or denied. Responsible for the accurate and timely processing of claims. Also, responsible for adjustments to previously processed claims. Prioritized data from system-generated reports and client claims processing details in order to identify and resolve errors prior to final adjudication. Processed recovery of overpaid claims through refund request. Processed claims for erroneous items or codes and missing or questionable items and ensured that the said discrepancies are handled immediately. Interpreted and processes routine and complex claims per Medicaid industry standards. Keyed claims into internal database systems using updated processing procedures. Applied Correct Coding Initiatives, Mutually Exclusive Edits, and Medical Necessity guidelines, to determine coverage, complete eligibility verification, and resolve payment discrepancies. Processed (OCIs) Online Client Inquiries for assistance on acquiring payment of claims wrongfully or erroneously denied per eligibility, authorizations, benefits, pricing, and or processor feedback necessary to determine a correct course of action. Reviewed claim or referral submission to determine, appropriate guidelines, procedures, diagnosis, or coding requirements, Member identification processed, payments applied per COB policy and procedure guideline. Recurring claims processed in accordance to receipt date, Duplicate claims investigated prior to final adjudication process. I consistently maintained quality standards, and productivity based on transactions/units per hour

(20). Utilized Share Point for multiple functions such as, communicating with other inter-departmental staff in regards to dubious claims and authorizations or system issues as suitable. Also to alert claims management to claims aging issues as well as provider billing problems.

Key Results and Accomplishments:

1. Exceeded daily productivity of 20 claims per hour, by 25-35 claims per hour. 2. Simplified the application process for working OCI claims, and increased productivity, 4,000 open and pending cases worked to close within 2-5 days of procedure implementation. 3. Training was expected to last 3-4 months, assigned live claims by 2nd month of employment. 4. Assisted in the adjudication of more than 90,000 claims within project 30/day deadline. Accretive Healthcare Chicago, IL

Contract: Medicare Collections Specialist

11-01-2014 - 1-22-2016

Processed collections in a fast paced goal oriented collections department.

Responsible for monitoring and maintaining assigned accounts.

Investigated account balances for correct adjustments.

Accountable for reducing delinquency for assigned accounts.

Obtained information necessary to accelerate the collection process.

Prioritize and manage multiple responsibilities.

Follow up effectively with accounts on a timely basis.

Establish effective and cooperative working relationships with clients, and carriers.

Provided excellent & considerate internal and external participation in team planning meetings.

Meet defined department goals and activity metrics.

Oversee all write offs and assist to balance all nonpayment.

Maintain track of payments according to collection policy.

Perform research on all accounts and document all explanations of collections process.

Ensure compliance to all federal and local regulations for collection process.

Processed Medicare claims overlapping Hospice Episode, Home Health Episode, and SNF accurately for payments responsibility.

JDA Revenue Cycle Management Napervile, IL

Contract: Hospital & Physician Contract Specialist Dec 10, 2012- Feb 2, 2014

Contracts: Builds, loads and maintains current fee schedules in the database system including, Commercial Insurance- Medicare, Medicaid, Workers Compensation; as well as other Surgery, Lab/Path, Radiology fee schedules as they relate to payment. Verify contracts have been loaded correctly, analyze and translate contracts to ensure proper setup and linkage of providers in database system. Links correct financial responsibility tables to proper benefit option exception set. Updates financial responsibility tables based on Health plan contracts and amendments. Assisted in developing policies and procedures surrounding the building, loading and maintenance of fee schedules.

Reporting: To other hospital constituencies regarding CDM, billing and charge capture; follow-up to ensure desired outcomes are reached; Participates in Terms and Conditions staff meetings, implementations, and inter-departmental meetings as required. Provide maintenance and analysis of fee schedules and financial responsibility tables in the database system and perform all duties related to database maintenance. Design and conduct regular audits of the data entered into the database system to ensure integrity of the data. Developed weekly, monthly and quarterly reports to provide overview of fee schedule activity and auditing in the database system.

Revenue Cycle Management: Analyzes payment and charge discrepancies to determine issue, area of responsibility and assists in the development of an appropriate corrective action plan. Support performance improvement, development, documentation, testing, training and upgrades to ensure streamlined billing and collection activities at all facilities. Maintains library of Regulatory guidelines surrounding the development and updating of Fee Schedules as well as all Medicare, Medical and RBRVS changes in policies, NCCI edits and Local Medical Review Policies. Develops a library and tracking of numbering systems of fee sets and extended fee sets.

Consulting: Work directly with Billing Group personnel and Division AR staff to address and resolve contracted claims receiving incorrect revenue adjustments. Responsible for updating and maintaining Current Procedural Terminology

(CPT) Billing Coding and service maps for reimbursement of claims for payers that require special coding that deviates from standard CMS practices. Worked closely with Billing Groups to identify and resolve denials as a result of incorrect billing /CPT codes. Review and identify claims with suspicious activity e.g.; zero adjustments.

Accomplishments: Completed employee training estimated to take one year, in four months. Assisted in a massive project to resolve discrepancies or errors in contracted claims receiving incorrect revenue adjustments. Verify contracts have been loaded correctly, identify missing contracts and load them, organize, prioritize and resolved hundreds of client case complaints.

Six Corners Same Day Surgery Center, Chicago, IL

Held (3) Position: Collections/Billing, Orthopedic Surgery/Office Coding Specialist, Medical Office Administrate Assistant.

Mar 7, 2011- September 12, 2012

Coded physician ASC, EM, and Physical Therapy Services

Ran reports for missing charges, procedures, and coding errors

Manual cross-referencing schedules/charge sheets missing charges

Created excel spread sheet/itemized statements from surgery invoicing

Proficient in modifier usage, error editing, bundled codes, and inclusive codes

Compliant billing processed per carrier guidelines/procedure

Negotiated discounts at the 85%-90% percentile

Established reimbursement for a non-contracted provider at its highest level

Submitted electronic claims and scrubbed claims to ensure first submissions

Submitted patient monthly statements

Established return mail reports/researched correct address

Established 100% quarterly comp data report

Insurance eligibility/benefits verified electronically & carrier calls placed

Obtained all prior authorizations, retro authorizations

Collected co pays & deductibles; establish patient payment arrangements

Conducted new patient intake; signed forms copied/scanned

Attorney billings/medical records audited physician settlement

Knowledgeable in lien law; and letters of protection

A/R collections processed on all denied, low pay, no-pay claims

Supervised and Managed all office administrative duties and staff

Trained and cross-trained office personnel; created training materials

Posted payments for both insurance and patient; prior postings corrected

Conducted employee interviews; created testing for interviews

All correspondences processed/scanned/stored/organized database Health Information Services, Willowbrook, IL

Contracted: Radiology Collections Specialist

Apr 28, 2010-Jun 17 2010

Worked independently on project to resolve low paid no pay, denied, and aged accounts.

Processed accurate billing, corrected claims, late fees,

Appealed denials, processed claims request for medical records.

Established correct COB/on denied claims

Obtained student status, to obtain insurance payment.

Billable Cancer/Donor programs, located for radiology services billed.

Analyses reports for loss charges, submitted corrections per coding errors.

Worked account posting errors, validated all write-offs.

Processed numerous Timely file denials, by submitting details to carrier

Obtained Self-Pay Patient/Medicaid, Medicare eligibility.

Assigned patient accounts to collection, contacted patient for collections, and made payment arrangements.

Aged Account hard-copy explanation of benefits organized worked for payment daily. Fresno Regional Medical Center

Medical Account Collector

Mar 2007 Dec-2009

Collections: Hospital ER/Trauma, Lab/Path, Radiology, Ambulatory Surgery, Observation, In Patient, Out Patient, Mammograms, Heart Center, Cancer Center, Dialysis Center, Urgent Care, IVF, Donor, Burn Unit, Physical, Speech, Occupational Therapy, Outpatient Clinic Services, Hospital Based Physicians Services.

Insurances: All Commercial Insurances, Workers Comp, Medicaid, Medicare, No Fault, At Fault Auto, Private Injury Attorney, Champus, Tricare, VA, Prisons, Jails, Bankruptcy, All Third Party Providers, Self Pay.

Duties: researched refunds, discounts and allowance adjustments, and verified payment accuracy, appealed denied claims, submitted corrected claims, late fees, coding errors, assign accounts to bad debt as applicable, established financial hardships, placed patient collections calls, established payment arrangements, set up patient EFT, took credit card payments over phone, worked patient bad debt reports, and A/R aged reports, contract detail accurately interpret, contract language, definitions, terms and conditions. I, and limitations and exclusions, multiple ratios, case rate, per diem and percentage discounts applicable to reimbursement, limits and specifics for exceptions, and exclusions not otherwise notated.

Fresno Regional Medical Center

Patient Account Biller

May 2003 - Mar 2007

Screened accounts in computer system for accurate billing information.

Corrected claims billed, late charges, and secondary billings submitted.

Reviewed billing, completed physician billings, and third party billings per regulations of the payer.

Processed hard-copy claims and transmitted electronic claims.

Made debit/credit adjustments; maintained record of how claims billed and date sent with dollar amounts. Fresno Regional Medical Center

Admitting Verification Specialist

Jun 2000 - May 2003

Conducted all New Patient intakes.

Accurate financial and demographic data obtained.

Screened uninsured patient financial data, Medical eligible patients/referred to on-site medical worker prior-application screening.

Recorded physician orders both verbal and or written.

Processed service packets, orders, medical record chart, and all forms/signatures

Verified insurance eligibility/benefits and obtained all authorizations per services. Volunteer:


Fresno Community Hospital:

Employee Health Dept, Clerical Aide

ER/Department, Administrative Clerk

DME & Supply Service, Office Aide


Joseph Business School

Certificate of Completion, 01/10/2016

Fresno City College, Fresno, CA

Certificates of Achievement, June 2000

CA Medical Administrative Assistant, June 2000

Certificate of Completion, June 2000

CC Medical Clerical, Office Professional

CC Integrated Computer Technology

Application Specialist

CC Certified Medical Billing/Coding Professional Awards Received:

Outstanding Business Student GPA 3.9

Certificate of Accomplishment Admitting Department

Community Health system Volunteer 209.5 HR

Active Accreditation In Process

Course Provider: AAPC

Course Name: Medical Coding Auditor

Start Date: 02/14/19 Expected Completion Date: 008/14/19 References:

Vivian Malorie, Medicare Supervisor


Six Corner Same Day Surgery Center

Ken Riesterer


Jda Ehealth Systems

Terri Johnsen

Valence Health


Faith O’Neill Program Manager


Northwestern Medical Faculty Foundation

Sabina A Strzeminska Manager


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