Insurance Medical
Resume:
LETHA JACKSON
************@*****.***
Experienced Healthcare Professional
• 18 years plus of healthcare revenue cycle experience specializing in provider reimbursement
• Experienced in Athena, EClinical,Navicure, Medisoft, IDX,Med Images, Practice Fusion, Allscripts, MHH
Healthquest, E Care, Microsoft Word, Medic, Excel, PCS,10-key by touch, HCHD Epic, Remit Data, Availity,
Claim Logic, Image Now
Education
• CPT and ICD-9 coding
• Medical Terminology Training
• Medical Assistant Training
Professional Experience
Edits / Denials Team Lead, McKesson November 2006-September 2013
• Manage a staff of 18 collectors with any issues on IDX, HCHD Epic, Claim Logic systems, insurance verification
and collecting on denials of EOB’s for Commercial insurance, Medicaid, and Medicare.
• Lead team meetings to address current issues.
• Run daily edit reports
• Correct edit reports
• Service contracts for University of Texas Physicians
• Resolve barriers inhibiting staff productivity
• Identify and verify trends and issues to increase A/R collections
• Review work files and workflow to determine employee effectiveness
• Council employees on disciplinary issues as needed
• Monitor employees time and attendance and maintain the current PTO schedule
• Perform monthly employee audits
Interim IT Support, McKesson January 2012 – April 2012
• Interim IT Support for an office of over 100 employees
• Assigned and maintained access to all websites for employees and clients
• Conducted employee and client training on web based applications
• Ensured office adhered to HIPAA standards
• Assembled and activated new and replacement computers
• Installed printer drivers and software for network and personal printers
Account Representative, McKesson August 2006 – November 2006
• Insurance follow-up with carriers
• Identify issues and denials and correct any claim discrepancies per payer guidelines
• Insurance Verification
• Up-date Patient demographics
• Filed claims to insurance companies, primary and secondary
• Filed appeals on denied claims
• Linked authorizations and referrals to the appointment visits
Office Manager,Chaslor General Medical February 2003 – August 2006
Manages the daily operation of the assigned clinic and all personnel in order to maintain an efficient
operation
Manage a staff of 15
Assists in selecting, interviewing, and hiring clinic personnel
Letha Jackson
Updates staff to new computer technology as it relates to clinic needs
Acts as liaison between personnel and medical staff
• Assists with preparation of annual budgets
• Orders office supplies and monitors inventory.
• Considers all possible ways to solve a customer’s problem before referring to others
Account Representative, Diagnostic Clinic of HoustonSeptember 2002 – January 2003
• Auditing accounts for maximum reimbursements per contracts
HMO’s
Commercial Payers
Medicare
Medicaid
• Interface with carriers for any discrepancies with payments or CPT-coding issues
• Posting payments to patient accounts
• Identify and appeal claim denials with carriers
• Charge entry
• Up-date patient demographics
Front Desk Coordinator, Dr. Odom, Gastroenterology & internal medicine 2000-2002
• Managed daily operations within the office
• Auditing accounts for proper follow-up
• Reviewing, analyzing and resolving credit balances
• Review correspondences from patients or payers
• Up-date patient registration
• Assist with patient calls
• Insurance verification
• Acquire and provide Pre-certification with insurance carriers
• Acquire and provide Prior authorizations to insurance carriers
Insurance Representative I, Baylor College of Medicine 1997-2000
Auditing Medicaid/Medicare/Commercial accounts
Posting of insurance and patient payments
A/R Follow-up on filed claims
Identify and appeal claim denials with carriers
Locate and evaluate audit trails
Prepare and monitor Financial status reports
Verify patient eligibility and benefits
Up-dating patient demographics,
Charge entry from various in-patient and out-patient clinics
Determined the appropriate ICD-9/CPT-4 codes for charges placed on patient accounts
Billed manual and electronic claims
Medical Biller/Auditor, Triad Medical Services 1992-1997
• A/R follow-up
Medicare
Medicaid
Commercial Insurance
• Identify and appeal claim denials with carriers
• Posting of insurance and patient payments
• Up-date demographics
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Letha Jackson
• Verify patient eligibility and benefits
REFERENCES AVAILABLE UPON REQUEST
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