Insurance Medical Billing

Kimberly Thomas

A/R Coordinator/Medicaid Coordinator/Entitlement Specialist/Medical Billing &

Collections

Bronx, NY

**************@******.*** - 347-***-****

WORK EXPERIENCE

MEDICAID COORDINATOR ASSISTANT/FACILITY FINANCIAL COORDINATOR

New Franklin Center for Rehabilitation - Flushing, NY - March 2012 to March 2014

Nursing Flushing, New York

MEDICAID COORDINATOR ASSISTANT/FACILITY FINANCIAL COORDINATOR

• Screened patients for qualification of Medicaid gathering all documents needed for the application process.

• Assisted/screened patients for the NHTD (Nursing Home Transition & Diversion) Medicaid waiver program.

• Aided disabled patients in applying for SSD/SSI benefits insuring that medical records received and patients

attended interviews either in person or by phone.

• Reviewed financial documents i.e. bank statements, IRA's and Annuity statements received from potential

& current Medicaid applicants.

• Submitted NEW Medicaid, Conversions and Re-certifications applications to the proper jurisdictions of HRA

in a timely manner via the Easyng/Bluemark/EDITS system or via mail.

• Followed-up with various HRA- Medicaid Office agencies to check status of Medicaid applications submitted

and noted the status of each case.

• Responded to denials/deferrals for request for further information appeared at fair hearings and court which

involved guardianship when necessary.

• Interacted with several law firms concerning guardianship application/patient representation for Medicaid

application.

• Contacted Computer Sciences when necessary concerning billing issues from the finance department.

• Handled the address changes for NAMI to be collected for various pension companies, Social Security, and

other income received into the facility for LTC patients.

• Verified insurance, obtained authorizations, advised family, healthcare proxy, or guardian of co-pays/

deductibles/co-insurance or due the facility.

• Followed-up, billed and collected private payments, NAMI's, and insurance co-pays due to the facility.

• Enrolled patients into various Medicare Part D prescription plans.

MEDICAL BILLING/ADMINSTRATIVE ASSISTANT

NYU Medical/Rusk Associates - New York, NY - December 2008 to March 2012

New York, New York

MEDICAL BILLING/ADMINSTRATIVE ASSISTANT

• Administrative Assistant to the Department Administrator for The Department of Rehabilitation Medicine.

• Processed and posted daily cash, donations, gifts and credit receipts in Quick Books into the correct ledger

and prepared/made bank deposits.

• Prepared and followed-up on purchase orders, change orders, check requests and petty cash vouchers.

• Handled the processing of reimbursements for tuition, fees/dues, travel, hotel, malpractice insurance, and

other reimbursable items for physicians, interns, chairman and administrator.

• Performed monthly vendor statement reconciliations, overseeing orders of supplies and equipment, plus all

related functions keeping Department Administrator/Controller apprised of all problems.

• Screened/scheduled patient appointments, schedule referrals of special testing or doctor's visits.

• Billed Medicaid/Medicare/Third Party carrier insurance by inputting billing information into database and

initiated electronic transmissions thru Ivan's & Practice Point Manager System weekly.

• Administrative support for physician credentialing, recruitment, contract management processes and

physician services.

• Responsible for credentialing/re-credentialing prospective/existing providers for multiple locations in the

NY/NJ/CT Tri-State area.

• Handled the renewal of all licenses' including NY/NJ/CT medical/dental, DEA and malpractice insurance.

• Tracked expiration dates of staff's professional licensure and notified of upcoming expiration to prevent

suspension.

• Maintain detailed tracking schedule on status of clinical staff privileges and payor provider numbers.

• Actively followed up with medical staff offices to expedite clinical privileges.

ACCOUNTS RECEIVABLE COORDINATOR

Schervier Nursing Care Center - Bronx, NY - September 2007 to September 2008

Bronx, New York

ACCOUNTS RECEIVABLE COORDINATOR

• Handled all the billing of Commercial, HMO, Worker's Compensation and No-Fault, and medical claims/

private bills for 350 bed skilled nursing facility and the Home Health Care division.

• Followed-up with insurance companies for claim status, appeals, insurance verification, and payment

disputes.

• Negotiated rates with various insurance companies not contracted with the nursing facility.

• Implemented the development of electronic medical billing of commercial insurance billing practices and

policies.

• Trained new hires, temporary staff, and current staff employees on insurance verification of patient and

pending patients.

• Interacted with various hospitals and admissions department on the acceptance of new patients/readmits

to the home.

• Assistant to the Medicaid Entitlement Coordinator reviewing documents needed to apply for Medicaid for

long-term patients, approving applications, and handling and processing security deposits.

• Managed patients private funds account to ensure that monies was used for the necessary care of the patients

and that money was reimbursed to patients power of attorneys, family member and Medicaid.

• Processed check requests received from various funeral homes/vendors from residents personal funds

account.

PATIENT FINANCIAL ACCOUNT REPRESENTATIVE

GBMC- Greater Baltimore Medical Center - Baltimore, MD - October 2003 to August 2007

Baltimore, Maryland

PATIENT FINANCIAL ACCOUNT REPRESENTATIVE

• Responsible for the accurate and timely billing/follow-up of Medicare, Medicaid, HMO and commercial

outpatient insurance claims to ensure A/R goals are met.

• Handled all written/online medical appeals for accounts within in an assigned work file.

• Worked directly with Nurse Auditors to ensure the appropriate denials are appealed.

• Identified and communicated with the supervisor/manager all issues, problems, and negative trends affecting

hospitals commercial/managed care revenue cycle.

• Knowledge of third party, federal and state regulations, insurance coverage, rejection codes, and billing

requirements related to hospital billing follow-up.

• Reviewed patient accounts and posted/adjusted payments received.

• Interacted with various hospitals departments verifying authorizations and referrals on file.

SENIOR ACCOUNT SPECIALIST

DYMOND Management Company - Bronx, NY - January 1996 to September 2003

Bronx, New York

SENIOR ACCOUNT SPECIALIST

• Trained new hires, assigned staff, and reviewed work performances and conducted employee orientation.

• Developed/maintained relationships with 250+ physician's/provider's/practice managers in an assigned

database.

• Processed Medicare, Medicaid, and 3rd party insurance, dialysis, x-ray, physician, anesthesia, and surgery

medical claims.

• Liaison with insurance carriers, employers, lawyers, collections agencies, and Workers Compensation Board.

• Verified insurance, claim status, payments issued, and denials with various insurance companies and

employers.

• Responsible for posting lockbox and credit card payments, issued refunds to patients/insurance when

necessary.

• Prepared account analysis in order to identify/reconcile accounts to pursue collections.

• Created aging reports, invoices, revised invoices, handled all aspects of accounts receivable.

• Invoiced clients for services rendered based upon contracted fee schedule, time, and out-of-pocket

expenses.

• Researched overpayment, underpayment, refunds, write-offs and contract issues according to department

policies.

• Reconciled posted payments and electronic remittance files; audited claims, credit balances and batch proofs

on monthly.

• Contacted bank rep when lockbox batch items (i.e.: check, EOB's, etc) were missing or attached to wrong

documents.

• Prepared IDX batch proof reports to match deposits received.

• Preformed adjustments, corrected contractual allowances, and reversed claims from collections.

PATIENT ACCOUNT REPRESENTATIVE

John Hopkins Hospital - Baltimore, MD - June 1989 to December 1995

Baltimore, Maryland

PATIENT ACCOUNT REPRESENTATIVE

• Performed assessments of patients with exceptional financial needs, screening/enrolling them into various

insurance plans, government programs (Medicaid, Medicare) or different hospital/surrounding area charities.

• Verified insurance and COB information during registration/admitting process.

• Organized the aftercare of discharged patients in compliance with the plan of care issued by the physician.

• Processed inpatient/outpatient Medicaid/Medicare, commercial, and HMO insurance claims.

• Filed appeals on behalf of the physicians, and interacted with various insurance carriers.

• Assisted with accounts payable/receivable, processing and posting payments.

• Researched/resolved customer complaints, billing inquiries, handled collections.

EDUCATION

Bachelor in Health

DeVry College of New York. New York - New York, NY

Bachelors in Health Services Administration

Strayer University - Baltimore, MD

Certificate in Insurance Billing

Queens College - Jamaica, NY

Nursing Home Eligibility Division Medicaid Training Courses/Seminars

HRA (Human Resources Administration) - New York, NY

SKILLS

SigmaCare, Epaces, OmiiPro, David Klein, McKesson, IDX (PCS/BAR) systems, SMS Rumba, SMS

Document Imaging, MediTech, Medicare Online (Florida Shares System), Medicare Easy Print, MyAbility

(NEW Ivans System), Ivans System (Medicare, Blue Zone, Medicaid), BlueCross (Online System), MYSIS,

Ideal Medical Billing System, ACS, PCN, AS400, MediSoft, Medical Manager, ClaimPro, FoxPro, Oracle, MS

Word, Outlook, Excel, Access, Quick Books and PowerPoint.

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