Insurance Customer Service

JAMES WOODS

**** ***** **** *****

Irving, TX ***60

972-***-****

Cell 469-***-****

E-mail - acc2b8@r.postjobfree.com

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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