Medical Insurance

LORISA JACKSON

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

Long Beach, Ca 90808

562-***-**** ********@*****.***

Summary of Skills

• Over 12 years of experience in the Revenue Cycle services in Hospital and Physician Billing and Collecting

• Experience in billing for codes for surgery and internal medicine

• Extensive knowledge of HMO, PPO, Medicare, Medi-Cal, Blue Cross, Blue Shield, Aetna, Cigna

• Knowledge and experience working with CPT codes, ICD-10, Modifiers & medical terminology

• Well versed in working rebills, denials, Inpatient and outpatient claims

• Software: EPIC, Meditech, XClaims. Power Chart M186, IDX/PCS, Microsoft Excel, PowerPoint

Professional Experience

Uptimum Medical Group

May 2017 – Current

Biller/Collector Specialist

• Verify all claims insurance information, checked each bill for corrections of charges before billing.

• Responsible for reviewing the status of claims on hold for authorization or eligibility

• Follow up with insurances to rebill or provide information directly via phone

• Identifies and resolves 50 billing claims daily

• Rebill for HMO, Medical, Medicare, and PPO to secure payments

• Assists 3 doctors with billing and collections on high dollar claims

• Strong understanding of CPT, IDC-10 codes, Modifiers, medical terminology and reimbursement

• Review denial reports daily to ensure prompt follow up on denied services and requested appeals

• Review accounts to determine contractual adjustments, reimbursements, credit balances, charge entry, and payment posting

• Responds timely and accurately to all incoming correspondence and inquiries from payers, patients and third parties

• Implement notes into IDX for every account with action taken and resolved NThrive January

2015 – October 2017

Medicare and Commercial Biller/Collector

• Responsible for reviewing, correcting, and completing UB04 forms and sending all necessary information and/or documents to government payers

• Verified Medicare, Medi-Cal, Aetna, Blue Cross, Blue Shield insurance information, checked each bill for correction of charges daily

• Identified and resolved 60 billing claims daily

• Responsible for reviewing, correcting and completing UB04 forms and sending all necessary information and/or documents to government payers

• Reviewed and billed secondary/ third party liability insurances by collecting proper explanations of benefits and rebilling to the proper insurance companies

• Responsible for daily billing of Medicare/MSP claims/Skilled Nursing Facilities and Commercial insurance claims

• Followed up on claims eligibility, unworked weekly worklist, and T status Medicare accounts following the CMS billing guidelines

• Reviewed the completes billing reports such as DNFB, late charges, overlapping, adjustment, credit balances report, patient information, and insurance information before billing and rebilling

• Understanding of CPT, ICD-9, ICD-10, HCPCS codes and Modifiers/knowledge of medical terminology and reimbursement issues

Memorial Care April

2013 – January 2015

Medicare and Commercial Biller/Collector

• Responsible for reviewing, correcting, and completing UB04 forms and send all necessary information and/or documents to government and commercial payers

• Verified Blue Cross, Blue Shield, Aetna, Cigna, Medicare, Medical insurance information and checked on each bill for correction of charges daily

• Identified and resolved 70 claims daily

• Reviewed and billed secondary/third-party insurances by collecting the proper explanation of benefits and sending correct information to insurance companies on UB04 and HCFA 1500 claim forms

• Reviewed the complete billing report such as Do not final bill, late charges, overlapping, adjustments, and credit balances report

• Monitored the Advanced Beneficiary Notice (ABN) for outpatient procedures

• Reviewed charges, patient information and insurance information before billing and rebilling claims

• Identified and reviewed denial reports daily to ensure prompt follow up on denied services and submitted appeals using templates

• Understanding of CPT, ICD-9, ICD-10, HCPCS codes and Modifiers/ Expert knowledge of medical terminology

West Anaheim Medical Center July

2006 – April 2013

Medi-Cal and Commercial Biller/Collector

• Responsible for Inpatient/Outpatient billing and code modifiers with the knowledge of UB04, HCFA 1500, CPT, HCPC, ICD9 coding

• Reviewed charges patient information, and insurance information before billing and rebilling

• Processed Medicare, Medi-Cal, CCS and Commercial insurance claims and maintained knowledge of rules and guidelines

• Billed and collected for the OBGYN department for specific tests

• Resubmitted denied claims and followed up to ensure they were paid in a timely manner

• Physician billing for the Skilled nursing facility and entered codes

• Verified eligibility online claim status and reviewed EOB’s

• Followed up on outstanding claims in A/R, underpayments and denials claims list

• Reviewed contractual adjustments, reimbursements, credit balances, charge entry, payment posting, charge injury and payment posting

• Maintained monthly aging reports

Education

High School Diploma, Long Beach City College, 1992 Certifications

Medical Coding, Medical Terminology and Medical Billing

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