Medical Billing

RANDY BRADFORD

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

HOUSTON, TEXAS 77066

281-***-**** (Mobile)

281-***-**** (Home)

********@*******.***

Objective

To secure a position that will use my education and work experience thus providing a

path for career advancement based on performance.

Education

Licensed Insurance Agent by the Texas

Department of Insurance & NAIC for Texas

Houston, Texas

General Lines Life, Accident, & Health

2012

Houston Community College

Houston, Texas

Health Information Management

2000 to 2002

Houston Read Commission Houston

Texas

Certificate of High School Equivalency

1995 to 1995

American Security Officers Academy

Houston Texas

Certificate of Achievement Graduate

1994 to 1994

Summary of Qualifications

Medical Terminology/Medical Billing & Collections Certified Insurance and Coding

Specialist

Well trained with several medical claims clearinghouses ZirMed, S.S.I., as well as

Availity

Proficient in ICD-9 and CPT diagnostic and procedural codes

Insurance verification/follow-ups with 3rd Party Collections Experience

Extensive follow-up on denied claims, Customer and patient service oriented

Additional experience:

*Mechanically incline with mail distributions, assembly line procedures and computer

manufacturing operations.

*EOB processor

*Remittance Advice explanations from Commercial Insurance and Medicare.

Employment History

Nexus Health Systems Houston, TX

Medical System Coordinator March, 2012 - Present

My duties as a Medical System Coordinator of patient accounts are but not limited to the

maintenance and collections of the organization's accounts receivable. It is my

responsibility to follow up on claim status; assure claims are billed timely, electronically

via the clearing house system, SSI. My duties also include maintaining time management

of A/R reports to assure claims are paid correctly and aging appropriately. Nexus Health

Systems is a three entity organization; Nexus Specialty Hospital; Touchstone

Neurorecovery Center & Health Bridge Children's Hospital. These organized entities work

together to provide excellent long term care facilities in the arena of patients with complex

medical, rehabilitative, as well as neurological injuries from infants to senior geriatric

patients. After patients are released from the hospital, Nexus provides long term

neurological & rehabilitative care the patient will desperately need to reunite and function

in society independently. For aged accounts 60 days or older, I am responsible for

evaluating and determining what needs to be done to bring account status to resolutions. It

includes actively working denials & all correspondence daily; reviewing SSI's claims

rejection report to spot billing errors that may need to be addressed immediately; and to re

bill to payers for prompt payments. Per the denials management, if warranted, commences

verbal reconsideration request and draft appropriate written appeals per the contractual

guidelines. At all times, ensure the payers are adhering to the Medicaid & Medicare

guidelines, rules, & contractual obligations. Medical System used for revenue cycle and

billing is Vision which is currently undergoing a conversion to have updates to latest

MediTech medical system. Well trained with several claims clearing houses i.e. ZirMed,

S.S.I., as well as Availity.

United Surgical Partners International Houston, TX

Senior Claims/Collections Specialist Oct., 2010 – March, 2012

I am responsible for the follow up and collections on professional claims (CMS 1500) as

well as UB04 institutional claims. My duties include but are not limited to the maintenance

of all accounts receivables alpha A thru Z. Including to maintain aged accounts, insurance

follow up, medical billing and collections, coder reviews and appeals for the Memorial

Hermann Surgical Center Accounts Receivables for all Commercial Carrier, including

Medicare, Medicaid and Workers compensation accounts. I am responsible for completely

working a minimal of 50 accounts per day. USPI is a joint venture with Memorial Hermann

Ambulatory surgery centers, which we are responsible for all billing and coding processes.

Medical systems are Advantx (Meditech) and Citrix is the main frame server system we use

to access the gateway to each center’s records to work the accounts. All billing procedures

and collection activity is done per the guidelines of the Joint Commission and Ambulatory

Healthcare Accreditation Program. Electronic Claims System clearing house used is

ZirMed. ZirMed is an excellent claims management and revenue tool. Innovations that

simplify healthcare reimbursement and prevent timely filing issues of hard copy claims.

Foundation Surgical Hospital Bellaire, TX

Appeals Specialist- Workers Compensation - [second shift] June 2009 – Sept

2010

I am responsible for the complete appeals process according to the guidelines of the Texas

Department Of Insurance DWC rules. My duties include but not limited to extensive

insurance follow up, weekly review and research of aged ATB A/R by payer code and

financial class. I assure all UB’s have been billed correctly and insurance carriers have

received for processing with the 95 days timely filing deadline mandated by T.D.I. I am

solely responsible for workers compensation alpha A Z of accounts totaling a 20 million

dollars or more accounts receivables. I am required to maintain a daily goal of 50

completely worked accounts and 250 plus weekly. I am responsible for the UB Billing

process through CITRIX /HEALTHLAND which the facility has completely a conversion

over to HMS (Healthcare Management Solutions). Prior to billing packages being mailed,

it is my responsibility to assure boxes 1 81 are filled out properly. I am responsible for the

review of all daily correspondence and E. O. B. to assure and enforce the rules carriers are

processing workers compensation claims per the guidelines of the contracts they are

accessing.

U.T.M.D. Anderson Cancer Center Houston, TX

Revenue Collection Specialist May 2003 – May

2010

My duties and responsibilities were to maintain the A/R for every patient account between

the dollar amounts of $3,000.00 $1,000,000.00. The duties included but not limited to

Insurance follow, medical billing for Primary and Secondary payors to assure prompt

payment of the contractual negotiated amounts. To closely monitor electronic billing

process and to review the N.E.I.C. (Electronic Claims System) report daily for rejection of

UB92 and if rejection found immediately have claim dropped to paper billing. Respond to

all correspondence from payors requesting additional information and the follow up of

every denial received. This research includes retrieving medical records to proved medical

necessity and the submittal of all appeals if needed. It is also my responsibility to monitor

all accounts to assure they are being paid correctly according to the contractual obligation

of every network the payor’s are accessing. I was solely responsible for adjustments and the

movement of monies appropriately whether it is confirmed patient responsibility,

contractual adjustments, down to large balance adjustments due to past filing deadline due

to provider liability and I must investigate, and retrieve all documentation to support such

adjustments. It is mandatory that I maintained 50 accounts worked completely to meet my

employer’s daily production standards.

References Available Upon Request

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