Insurance Customer Service
Resume:
JAMES WOODS
Irving, TX ***60
Cell 469-***-****
E-mail - **********@*****.***
OBJECTIVE
Obtain a rewarding career in a vital, growing company utilizing my lengthy
experience in the business office environment.
PROFESSIONAL EXPERIENCE
All Star Orthopedics & Sports Medicine - 7/12 - Present
. Responsible for posting of receipts of insurance and patient payments
to two different billing systems
. Balanced daily receipts from 3 physician clinics, and prepared bank
deposits for those receipts
. Kept track of daily spreadsheet of receipts posted and deposited for
month-end balancing
. Posted payments from electronic remittance advices
. Verified correct CPT and ICD-9 usage on charges billed via EMR,
ensuring correct modifiers are used, and uploaded charges on a daily
basis for 8 orthopedic surgeons to electronic claims clearinghouse
. Billing systems used were Mysis and E-Clinical Works
Medical Edge Healthcare - 3/05 - 7/12
Charge Entry Team Lead - 11/07 - 7/12
. Responsible for managing daily workflow
. Produced work load requirements at month end to ensure maximum
productivity of department
. Assisted in determining overtime needs of staff, particularly at month
end
. Assisted in training of new employees
. Acted as point of contact for Clinic Practice Managers
. Assisted in resolution of billing issues, such as missing charges and
missing Superbills
Charge Entry Specialist - 3/05 - 11/07
. Proficient in IDX/Groupcast Billing System with Manage My Paper
Billing Interface
. Posted Physician charges from scanned superbills to patient accounts
. Responsible for posting appropriate modifiers to charges for proper
reimbursement from payors
. Verified correct linking of ICD-9 codes to CPT codes posted
. Maintained average quarterly production of 140% to 160% while
maintaining error rate less then 3%
. Responsible for posting lab charges from Quest Exception reports
. Produced reconciliation Reports and Audit Journals for each batch
posted
. Ensure copays posted balance with payments received at time of service
. Returned Superbills with missing information (i. e. diagnosis,
procedure, or referring physician)
Lonestar Health - 10/04 - 3/05
. Responsible for daily close and back up of Medical Manager computer
billing system
. Responsible for posting payments received from insurance companies and
patient's payments to patient accounts
. Ensure correct contractual adjustments taken when posting insurance
payments
. Flagging and copying Explanation of Benefits requiring follow-up due
to denials and rejections
. Route copies of EOB to account representative for follow up
. Complete daily bank deposits for two groups of Doctors
. Ensure that each batch posted balanced with every deposit made
. Generated computer reports depicting reconciliation of batches posted
with daily bank deposits
. File and track Medicare and Medicaid EOB for auditing purposes
JAMES WOODS Page 2
CPR Heartplace - 5/02-7/04
Charge Entry Specialist - 10/03 - 7/04
. Post Physicians charges to patient accounts
. Handled both clinic and hospital charges
. Enter patient demographics
. Ensure accuracy of CPT & ICD-9 codes
. Reconcile bank deposits to batch listings
. Produce daily TREGS for batches keyed
Payment Poster - 5/02 - 10/03
. Responsible for posting payments received from insurance companies and
patient's payments to patient accounts
. Enter physician and hospital charges onto patient accounts, ensuring
correct ICD-9 and CPT-4 coding
. Ensure correct contractual adjustments taken when posting insurance
payments
. Flagging and copying Explanation of Benefits requiring follow-up due
to denials and rejections
. Route copies of EOB to account representative for follow up
. Complete daily bank deposits for two groups of Doctors
. Ensure that each batch posted balanced with every deposit made
. Generated computer reports depicting reconciliation of batches posted
with daily bank deposits
. File and track Medicare and Medicaid EOB for auditing purposes
Practice Performance, Inc. - 11/01 - 4/02
Payment Poster
. Responsible for posting payments received from insurance companies and
patient's payments to patient accounts
. Ensure correct contractual adjustments taken when posting insurance
payments
. Flagging and copying Explanation of Benefits requiring follow-up due
to denials and rejections
. Route copies of EOB to account representative for follow up
. Complete daily bank deposits for two groups of Doctors
. Ensure that each batch posted balanced with every deposit made
. Generated computer reports depicting reconciliation of batches posted
with daily bank deposits
. File and track Medicare and Medicaid EOB for auditing purposes
Select Practice Management - 9/99-11/01
Payment Poster/Account Representative
. Posted insurance and patients payments to patient accounts
. Ensure correct contractual adjustments taken when posting insurance
payments
. Route copies of Explanation of Benefits to account representative for
follow-up due to denials and rejections
. Generated computer reports showing reconciliation of batches posted to
daily deposits
. Responsible for working daily aging report
. Responsible for self-pay and Prudential insurance accounts receivable
. Made and received daily phone calls to and from patients concerning
account balances
. Generated and mailed statements to patients
. Called insurance companies and check stats of unpaid claims
. Routed small balance and bad debt adjustments requests to supervisor
for approval
. Assisted in training of new account representatives and payment
posters when necessary
JAMES WOODS Page 3
Med Synergies - 11/97-7/99
Payment Poster
. Posted payments to patient accounts received from insurance companies
and patients
. Responsible for taking correct contractual adjustments when posting
payments
. Responsible for sending copies of Explanation of Benefits to account
representative for follow-up due to denials and rejections
. Responsible for posting of payments to multiple databases
. Handles daily download of Electronic Medicare payments and batching
these payments for posting generated computer reports for each batch
posted.
. Ensure daily reconciliation of batches posted to bank deposits
. Assisted in Customer Service Department when needed, answering patient
calls regarding accounts
. Assist in resolution of patients concerns regarding account balance
D/FW Anesthesia - 1/96-11/97
Payment Poster
. Posted payments to patient accounts received from patients and
insurance companies
. Copies Explanation of Benefits needed for follow-up and routed copies
of EOB to account representative
. Responsible for entering patient demographics and charges ensuring
physician concurrency
. Generated computer reports for each batch posted
. Assisted in preparation of "end of day" back up for two databases
EDUCATION
Corsicana High School, Corsicana, Texas
SKILLS
. Six Sigma Yellow Belt Certified
. Experience in Medical Manager
. Experience in Next GEN Medical Software
. Experience in PCN Health Network
. Experience in Millbrook Medical Software
. Working Knowledge of GPMS Medical Billing software
. Office 97
. Microsoft Word
. Microsoft Publisher
. Numeric and Alpha Data Entry 15000 KSPH
REFERENCES AVAILABLE UPON REQUEST
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