Customer Service Insurance
Resume:
ROSE M. SARIKAYA
Frisco, Texas 75033
E-mail: ********@*****.***
SUNY- Alfred College of Technology Associate in Applied Science, AOS
Alfred, NY
May 1996
EMPLOYMENT HISTORY:
Insight Global
Frisco, TX
Temporary - Accounts Receivable Representative
July 1, 2013
to June 1, 2014
Conifer Health Solutions - Ambulance billing
Rural Metro Corporation - Responsibilities consists of contacting insurance
companies regarding outstanding claims. Appeal claims with all necessary
information (medical records, itemized statements, EOB's) requested by the
insurance companies to process claims. Identifying and documenting
insurance denial trends and issues as they arise.
Maintain a system to ensure timely follow-up is completed for each
outstanding claim.
Working closely with all outside agencies contracted with the patient,
assisting them with account resolution.
Performs accounts receivable reimbursement analysis and denial management
activities for assigned payors using monthly aged account and A/R reports.
Maintain status reports consisting of outstanding accounts assigned.
Documenting report according to patient accounting department policies and
procedures.
Pediatrix Medical Group, Inc
Richardson, TX
Collections Administrator II - Cardiology
May 2012 to
December 2012
Responsibilities includes - Telephone contact with commercial and
government payors for resolution to claims not paid or claims not paid
according to plan benefits. Submit written appeal for denied claims
according to contract along with medical records, and all requested
documents. Identify billing and collection practices that are inconsistent
with contractual agreements and government regulations.
Follow-up on unpaid/unresolved account balances, including claims rejected
electronically, EOB denial and working A/R aging reports as directed.
Reviews and researches insurance correspondence and make necessary
corrections to ensure claims payment.
Assists with credit balance resolution, review EOB's for proper
reimbursement.
Prepare adjustment and write-off request as necessary.
Resolve electronic claim rejections and complete re-bill request as
necessary to facilitate timely filing and proper claims payment.
Researching problems with out of network collections and appeal denied
claims with necessary documentation.
Med3000, Inc
Plano, TX
1 Accounts Receivable Specialist - Primary Care
January 2009 to May 2012
Health Texas Provider Network - Follow-up and review patient accounts for
discrepancies, conducts direct telephone communication with third party
payors according to policy and procedures until there is no balance or the
account is turn over for collection. Submit written appeal for denied
claims according to contract along with medical records, and all requested
documents. Provide verbal and written instructions to the practice
representatives on issues involving daily claim processes.
Follow-up on unpaid/unresolved account balances, regular contacts with
government and commercial payors for resolution to claims.
Perform claim appeals as require, resolves and documents patient issues and
communicates more complex issues to department manager.
Resolve electronic claim rejections, review EOB in an efficient and timely
manner and act on appropriate denials.
GE Healthcare
Plano, TX
Accounts Receivable Representative
January
2008 to January 2009
Health Texas Provider Network - Duties consist of follow-up on commercial
and governmental payors. Reviewing insurance payments to verify that the
insurance companies are paying according to the fee schedules, process
insurance tracers, and requests patient and insurance company refunds.
Submit written appeal on denied claims along with medical records,
providing all requested documentation.
Follow-up with insurance payors regarding balance due.
Posts payments and adjustments in accordance with EOB and patient checks.
Worked with supervisor on special projects to obtain reimbursement from
insurance companies.
Business Professional Staffing
Dallas,
TX
Temporary - Administrative Assistant
March
2006 to January 2008
Dallas Independent School District - Responsibilities consists of utilizing
Microsoft Office. Using Oracle Application to assist with invoicing,
requisitions, purchase orders and payroll. Compose correspondence; memos,
graphs, tables and reports for Athletic Directors, and answering extremely
busy telephones.
Interface with vendors/officials regarding payments of their services
rendered for athletic events.
Work in a fast-paced and demanding environment, managing multiple
priorities simultaneously. Provide excellent customer service; support
Management of vendor and athletic official.
1199 National Benefit and Pension Funds/SEIU
New York, NY
System Coordinator -Telnet
September 1998 to January
2004
Create automated solutions for repetitive processes, updating of files
using application software, and provide assistance to staff with
hardware/software operational issues.
Update the member's hours worked into Telnet Application to ensure
continuation of medical benefits.
Provide system maintenance including bimonthly reboots to increase
efficiency, monthly full system dumps, nightly file saves, and
configuration of new CPU's with network software.
Coordinate scheduling, testing and training of all Telnet enhancements and
data conversions.
Manage multiple projects with IS Management regarding System Clean-up and
Special projects.
Process incoming and outgoing eligibility bank reconciliation tapes.
Generate batch scheduled and specially requested reports for all
departments.
SKILLS:
Everest College
Dallas, TX
Medical Insurance Billing & Coding
February 2006
to September 2006
Knowledge of ICD-9, CPT, Evaluation/Management, HCPCS, and Revenue codes.
Experience in payment posting, billing and insurance reimbursement
procedures, including comprehension of EOB.
Claims processing - CMS 1500/UB-92 forms, Medicare/Medicaid and HIPPA rules
and regulations.
Knowledgeable in AS400, Onbase, Nextgen, Vision, Plus Medic, Allscripts and
Microsoft Office, XP Professional, Typing, Customer Service.
Medicare, Medicaid, and commercial payors.
Good organizational, verbal and writing skills, problem-solving, and
attention to detail.
Contact this candidate