Crystal Sullivan

Cell # 312-***-****

Email address: ac9fvu@r.postjobfree.com

PROFESSIONAL SUMMARY:

My name is Crystal and I am highly proficient with data entry and in medical terminology I have experience in billing pre- authorizations---utilizations, referral, appeals and diagnostic imaging’s, Ultrasounds, MRI, and Cat Scans. I am also knowledgeable in Medical Credentialing-and accounts receivables and medical collections. And is able to understand and analyze insurance benefits (eobs). I have also worked in various medical fields and is able to multi-task. I am very detail oriented and is a quick learner and I am very resourceful in problem solving. And able to take and follow through with delegated tasks and accountability with little supervision. I am also knowledgeable of medical E.M.R and E.H.R s. Soarian. Cerner. Passport I also have several medical web portals. Aetna Better Health, WellCare, Anthem, Aetna Medicaid MCO Healthcare- Kentucky Medicaid Traditional and Medicare Part B- Humana CareSource-Availity- just to name a few. Coventry Cares and EDM CERNER’S system. Uninstall and Reinstall and repair Microsoft Office Suites and Healthcare FACETS (TriZetto Claims processing system)

PROFESSIONAL EXPERIENCE

Medical Consultant- Remote 10/2018 – 12/2018

Hospital Claims Auditing/Coding/Accounts Receivables

• Demonstrated extensive knowledge and understanding of the proper accounting treatment for accounts

receivables. And noted all manage care and government accounts

•Supported Management by distributing timely and accurate Accounts Receivable information

•Audited claims/medical records to make sure ICD-9/10 /HCPS codes are accurate for physician’s billing purposes with Soarian Cerner EHR. on a daily basis, and noted what cpt or icd codes was paid based on providers contractual rate-agreement for Medicaid-Medicare -Manage care insurances

•Reviewed insurance claims and explanation of benefits/ RA’s for possible under payment on a daily basis

•Contacted appropriate payers for additional payments when needed

•Verified patient eligibility through several different web portals on a daily basis, and through Soarian -EDM system on a daily basis to read claims submissions that was not located on insurance web portals.

•Reviewed accounts with payment contacts for compliance or delinquency and applied payments on a daily basis, noted accounts through Soarian Cerner and on excel spreadsheet the root cause and claim status and, and patients receivable group numbers. Troubleshooted medical software when needed

•Contacts government or commercial healthcare insurance companies to follow up on outstanding accounts receivable.

Fast Track Urgent Care Center West Chase FL 09/2016 –12/ 2017

Medical Referral Coordinator

Contacted patient on a daily basis and review patient medical records to determine specialty, and electronically emailed on a daily basis. Entered patients’ demographics on a daily basis

Ensured complete and accurate registration, including patient demographic and current insurance information, and called patient to inform about balance due on accounts, and facilitated requests for information from outside providers form multiple clinical specialties on a daily basis

Assembled information concerning patient's clinical background and referral needs. Obtained initial authorizations via insurance web portals or by contacting manage care companies by phone.

Per referral guidelines, provide appropriate clinical information to obtain authorizations -ICD 9-10codes and diagnosis codes for imaging appointments weekly.

Contacted and review organizations and insurance company’s policy and procedures to ensure prior approval for authorizations and denials requirements were met.

Presented necessary medical information from patient medical records such as history, diagnosis and prognosis from HCFA 1500 on daily basis with EMR

Provided specific medical information to financial services to maximize reimbursement for collection purposes

Established and maintain relationships with identified service providers

Released medical records upon Attorney’s request that provided a subpoenaed for the patients that received medical attention from the Dr’s at Fast Track Urgent Care Center on a weekly basis (ROI daily to over 17 medical specialties and Workers Comp and Auto accidents patients

Ensure that referrals (Stat-Urgent) and authorizations were obtained within a few hours with progress notes and medical codes were accurate for medical necessity that was provided and signed off by clinical staff. Identify and utilize cultural and community resources.

Assisted in credentialing Medical Doctors, ARNP(s) and PA ‘s on a monthly basis

Pediatrix Medical Group /St. Joseph Women’s Hospital. Tampa, FL 02/2015-11/2015

Hospital Medical Biller/Auditor

Gathered and verifying current demographic information from speaking with parents or hospital to register babies on a daily basis. Verified on a daily basis reviewing patient’s information with the hospital EHR system

Obtained correct insurance information from mothers to assist in filing for Medicaid for their new born. (short form applications)

Supplied authorization numbers as requested by the insurance companies for claims to be paid accurately. Reviewed medical census by providers to obtain through hospital EHR for correct ICD 9-10 Diagnosis codes for correct physician’s billable amount to be paid per contractual rate

Utilized the correct verification forms for requesting insurance and referring physician codes after reviewing the claims on a daily basis. Follow up on appeal process.

Provided credentialing assistance to non-par providers to participating providers.

Managed request for information from outside providers on a daily basis to troubleshoot medical software.

Registered One thousand and one hundred and ninety-three new born babies in Dr. Connect EHR in one month

Reinstall and Uninstall Software.

Generated medical reports for providers on weekly basis. Reviewed patients’ information through hospital EHR/Power Chart to make sure the MD’s used the correct code

Contacts government or commercial healthcare insurance companies to follow up on outstanding accounts receivable.

Bana’s Independent Transfer---Part-Time

Accounts Receivable’s/ Office Administrator 11/2013- Present

Do ageing reports on a weekly basis

Posts customer payments by recording cash, checks, and credit card transaction

Contact vendors via phone or email or by phone for collections and negotiating purposes.

Moffitt Cancer Center Tampa, FL 01/2014- 12/ 2014

Financial Clearance Specialist III

Assisted RN’s with coding high profile chemo therapy drugs/ patients in obtaining authorizations. Referrals- ICD 9-10 Coding, and insurance verification process. Notated patient’s files in EHR and updated patient’s demographics and reviewed HFCA 1500 for the claims to be paid accurately. Released medical records via email/fax to several (17) medical clinics upon Dr” s request for patients scheduled for multiple clinics.

Ensured delivery of exceptional customer service to patients, families and all internal clinical staff.

Reviewed patient’s EHR. records/ clinical notes on a daily basis to determine the medical procedures and diagnosis of the patient was accurate for the RN’s and Physicians on a daily basis.

Processed medical orders for seventeen clinics. GI, HEM, OB-GYN.ect. Completed the appeals process for RN’s on the high chemo therapy patients on a daily basis

Coded for seventeen medical specialties / clinics on a daily basis with Moffitt EHR system for out/patients on a daily basis

Pyramid Healthcare Solutions Clearwater, FL 6/ 2011 – 2/2013-

Insurance Verification/Accounts Receivable - Consultant

Contacted insurance companies to verify client’s eligibility for Medicaid and Medicare and commercial insurance.

Processed payments from insurance companies and prepares a daily deposit when requested.

Performed various pre-collection actions including contacting patients and insurance companies by phone, correcting and resubmitting claims to third party payers.

Initiated follow-ups and reports status of delinquent accounts from third party insurance carriers.

Ability to interpret EOBs (explanation of benefits), perform actions based on EOB and process responses from insurance companies after reading the medical records for accuracy purposes for coding

Lamperts Home Therapy Largo, FL 11/ 2009 – 12/2010

Patients Accounts/Medical Billing -Consultant

Answered questions from patients, clinical staff and insurance companies

Processed responses to patients, payers, physicians and other providers of services as identified by the client

Collected and processed payments from patients, payers and other providers of services as identified by clients

Obtained and provided medical records EMR when requested by payers for medical denials purpose and updated patient demographic information accurately. Prepared and mailed invoices to patients.

Reviewed medical claims and ICD 9 coding for billing purposes

Contacted insurance companies to obtain authorizations/referrals for scheduled appointments for multiple specialties

US Oncology Central Billing Office Clearwater, FL 01/2008-12/2008

Patient Accounts Rep/Cash Application

Performed audits on patient account to ensure accuracy and timely payment and resubmitted insurance claims

Followed up on 3rd party insurance billing to ensure timely receipt of payments

Reviewed EOBs to ensure proper reimbursement of claims

Demonstrated the ability to deal with patients and insurance companies in a professional manner

Verified insurance, the effective date and coverage, type of plan and payable benefits.

Checked to see if the patient has any pre-existing clauses to accounts,

Informed patients regarding drug replacement and assistance programs for prescription drugs through Medicaid and advised of supportive programs eligibility if necessary.

Maintained records for accounts receivable billing and participated in patient write off submissions

ROI on a daily basis for Oncology appointments per request by clinicians

Principle Counseling and Consulting Out Patient Mental Health Charlotte, NC 02/2005 – 12/2007

Clinical Office Administrator/Out Patient Facility

Billing of co-pays, deductibles, and third-party insurance companies.

Prepared patients account for outside collections, audit accounts for accuracy and troubleshoot as necessary

Responsible for monitoring patient accounts and account receivables, and coding claims for outpatient mental health services. troubleshooted soft when it was necessary

Initiated hard collection towards third party insurance carriers and processed claims and posted payments to patients’ accounts daily

Reviewed denied claims and ICD 9 and CPT codes for accuracy and resubmitted the claims on a timely basis, identifying deceased patients and estate to confirm dollars amounts for collection

Followed up with patients regarding delinquent accounts to make payment arrangements, determines financial clearance for each patient and refers patients for financial counseling as necessary

Provided credentialing assistance to non-par providers to participating providers and searched data base CAQH for provider’s information. Did follow-up through company data base to make sure providers state licenses was not expired. Reviewed medical records for clinical staff for correct ICD-9 and CPT diagnosis for billing purposes

SUMMARY OF SKILLS:

Ten Key Calculator

Microsoft Office Suite

ICD-9 /10 -CPT Coding & CMS-1500/HCFA’S

Medical Terminology

Milliman & InterQual

Soarian Clinical Software EHR

AppsBar Clinical Medical Records Software

Med iSOFT Electronic Medical Billing Software

E-Clinical Works Electronic Billing

Medical Manager Electronic Medical Billing Software

Tiger /Misy Company Billing Software

ZirMed Electronic Medical Billing Software

DME Medical Billing/EMC/HMO’S/HCPC Coding

Medicare Billing/NaviNet

CPR+Electronic Billing Data Base

Stratacare/Strataware & Claims Platform Software

Homecare Home Base Electronic Software -EHR

Excellent Interpersonal skills

Dr. Connect /Power Chart EHR Software

TheraManager Electronic Medical Billing/Records Software

Web Xtender, FL Depart. Of Health/ NPI Website

Paymentech Credit Card Machine

Soarian Cerner EHR Software-People Soft

Medical EDM – Electronic Document Management

EDUCATION:

2019 – Certificate Part-C- Organization determinations, Appeals & Grievance Medicaid and Medicare (CMS

2019 – Certificate Part-D Coverage Determinations, Appeals & Grievances Medicaid and Medicare (CMS)

2019 – Medicare Part -C & D General Compliance Training- Medicaid and Medicare (CMS)

2019 - Combating Medicare Part- C- and D Fraud, Waste, and Abuse Medicaid and Medicare (CMS

2009 - Option Care Billing Claim Preparation Pharmacy and Infusion Services - St Petersburg, FL

2009 - Certificate Medicaid Provider - Florida Medical - Largo, FL

2004 - Diploma C.N.A - Leary Technical Education Center - Tampa, FL

2002 – Medical Office/ Certificate ICD -9/10 & CPT Coder - DESI - Jacksonville, FL

2019 - CPR Certified - Temple Terrace Fire Department - Tampa, FL

2014 - Certified HHA - Tampa Bay CNA Institution - Tampa, FL

2014 - Certified Hospice Care – Tampa Bay CNA Institution - Tampa, FL

2014 – Certified Personal Healthcare Tech - Tampa Bay CAN Institution – Tampa, FL

GED

Associates Degree - Paralegal- Florida Metropolitan University – Clearwater, FL

Certified Business Software Applications- Pinellas Technical College- Clearwater, FL-

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