Medical Insurance

***** **** **** ***** ******, TX *****(***/***-***9( ******@*****.***

Kamatrice R. Hayes

Objective

To obtain a position where I can advance, apply my knowledge, and

amplify the accomplished goals within the healthcare industry.

Experience

12/17/2012-Present Universal American

Houston, TX

COB/MSP ANALYST- COORDINATION OF BENEFITS/MEDICARE SECONDARY PAYOR

Identify and confirm the insurer that should have been the primary

payer

Assist management with daily COB/MSP operations to ensure performance

metrics and key deliverables are met

Validating other coverage leads and updating member records as it

pertains to Medicare primacy for other insurance reporting Section 111

reporting

Update procedural documentation to align with new COB/MSP processing

requirements per Center for Medicare and Medicaid Services

Assist in supporting COB/MSP audit initiatives and take responsibility

to remediate any notified deficiencies.

Complies with all guidelines established by the Centers for Medicare

and Medicaid (CMS) guidelines set forth by other regulatory agencies

and departments.

Verification of Insurance Commercial/Non Commercial carriers reported

to CMS

9/2007 - Texas Health Resources Arlington, TX

09/28/2012

Patient Account Representative Lead/ Managed Care Denial

Medical Collections hospital acute care and short stay inpatient /

outpatient claims

25 Acute Care Hospital Facilities and Physician Collections for

Managed Care Claims

Research clinical denials/underpayments from payers due to but not

limited to pre-authorizations, medical necessity, PCP referrals and

level of care issues

Process written or verbal appeals as necessary within the appropriate

timeframe per the contract

Communicate and/work with other departments to resolve the denial

accounts, Utilization Management, and medical records

Review accounts for legal assistance

Track and trend recurring problems

Document the patient account in the system thoroughly

Maintain productivity numbers in compliance with department standards

Review the EOB and the payment breakdown per the carrier and facility

contract agreement

Collection of payments, denials, and pending claims review to Managed

Care Carriers

Insurance follow-up on claims, denials, zero payment, lay pay penalty

07/2006-12/2006 General Motors Co. Arlington, TX

Production Worker\ Assembler

Assemble Truck and Motor Vehicle Parts

Place parts to the truck frame work

Sort out the parts ordered per the customer invoice

03/2005-06/2006 Coppell Adult Medicine Coppell, TX

Medical Biller/Insurance Specialist, Receptionist

160 Hours of participation in on- site clinical training

Submit electronic claims to Payor, Medicare, and Medcaid

Post payments received from Managed Care Carriers, Medicare, and

Medicaid

Insurance verification and Authorization for services

Answer Telephones, Schedule Patient Appointments

Schedule patient referrals to Physicians office, healthcare services

Clinical appeals to carrier denials of charges, late pay, medical

necessity

Code Medical charts physician charges

Insurance follow up and denials review

6/2003-04/2005 Texas Health Resources Arlington, TX

Health Analyst\ Patient Care Tech

Sort Medical Records for Electronic Filing

QA and Core Inspection Medical Records scanned into system

Inpatient care 2-14 patients, take vital signs, assist the nurse and

physician in procedures

Assist the patient in care (baths, walking, and feeding)

Education

2013-Current University of Phoenix Houston, TX

Bachelors of Science Healthcare

Administration with concentration

Management

2005/2004 High Tech Institute

Irving, TX

Medical Billing and Coding Diploma

1991/1995 Everman Senior

High School Everman, TX

References

References are available on request.

Skills

Macess

Facets

Electronic Correspondence Referral System ( ECRS)

Valencia -Gorman

Marx ( CMS Enrollment )

Supervisor Skills ( Restaurant Management - 6 years)

Analyze Carrier Payments

Correspondence With Insurance Companies

Microsoft Word, Outlook, Windows

Canopy

Siemens

Data Entry

Invision

CSC Papers

Meditech

MegaWest System

Knowledge of EOBs, CPT & ICD-9 codes, ICD-10 codes,CMS 1500, UB04,

HCPCS, DRG, and authorization/referrals

Research denied claims, pending claims, payments, and contracts.

Contact Carriers for dispute of unpaid claims, denials, zero pays.

Training and Development

Lean Six Sigma - Yellow Belt 2013

Contact this candidate