Insurance Medical
Resume:
SHELBY WELLS
Apt ***
Fairburn, G.A. 30213
(Phone) 718-***-****
EXPERIENCE:
Staten Island University Hospital
Staten Island NY, 10305
Patient Account Representative,
Medicaid/Medicare 3rd Party 6/11 – 7/2014
• Obtain authorizations/referrals from private insurance carriers and Medicaid/Medicaid HMO’s.
• Follow up of accounts over 60 days and more, software used. Series 2000 HIS
• Collection of Co-payments/ deductibles and self- pay.
• Prepare super bill associated with all procedures and consultations.
• Responsible for coding of diagnosis and procedures, completing insurance and other related forms.
• Electronically bill/ correct, delete, print, claims, primary and secondary, through ePremis.
• Medicare verification confirmed through the use of Ability Network.
• Medicaid verification and confirmation of authorization with the use of EmedNY through Epaces.
• Contact patients regarding insurance information up dates, and demographic information/updates
Columbia Dental School 09/2008 - 03/2011
For Oral & Maxillofacial Surgery
NY, NY 10032
Billing and Collections Coordinator
• My responsibilities were to handle all the financial aspects of this position of Billing Coordinator for 3 Oral
Surgeons, 2 Pediatric Dentists, 1 Dentist and 2 Oral Pathologists.
• Posting of lockbox payments, self- pay payments, credit card, checks / cash and setup payment arrangements
for self-pay accounts, as well as process statements.
• Responsible for the coding and billing of all O.R. surgeries and pediatric procedures.
• Electronic billing, paper claims and appeals filed via fax or USPS
• Monitored claims every 30 days for payment or appeal, using AR reports
• Electronic claims were monitored daily through e-commerce, and by the use of EOB follow-up.
• Corrected and appealed claims were filed in a timely manner.
• Worked with a collection agency for our long past due accounts, as well as with patients to help resolve their
issues of payment, or any other problems they may have regarding their accounts.
• Approved the settlement amount for payment of non -participating carriers and my patients.
• Credentialing/re-credentialing of our physicians.
• Attended all credentialing meetings regarding the credentialing and re-credentialing process for faculty Practice.
• Charge entry and processed refunds to patients and insurance.
• Setup up electronic fund transfer account for our third party payers.
• HIPPA Compliant and attended compliance meetings to keep on top of new compliance guidelines.
• Updated and corrected patient demographics which included insurance information when needed
• Attended third party meetings to learn and discuss any problems that I may be experiencing with that payer.
• Attended meetings with shared practice (OPS Meetings) to discuss new software or problems experienced with
IDX software.
• Help co-workers when needed if I am available.
• Assisted with the interview and decision making of new hires.
Seaview Medical Anesthesia Group, P.C. 06/2007 - 02/2008
Staten Island Hospital, South
Medical Secretary, Pain Management
• Opening and closing of the office, preparation of examination room for patients, meeting and greeting patients,
scheduling of appointments, answering calls and taking messages over the phone.
• Obtaining authorizations/referrals from private insurance carriers, and Medicaid HMO’s, Workers
Compensation and No Fault insurance carriers/or representatives responsible for the claimant.
• Set up appointments for medical procedures and the reservation of the operation room for such procedures.
• Collection of Co-payments/ deductibles and self- pay.
• Prepare super bill associated with all procedures and consultations and prepare all from dictation.
• Prepare and filed the patient’s charts, also responsible for coding of diagnosis and procedures, completing
insurance and other related forms and maintenance of the reception area.
NYU Medical Center, School of Medicine, New York, NY 10/2004 - 05/2006
Senior Patient Acct. /Rep, Faculty Practice Radiology Department
• Third Party Payer Expediter, of Aetna, other Commercial Insurance and Self-pay.
• Daily follow - up of account’s over 120 days, or less by use of A/R on Excel spreadsheet.
• Collections and billing of corrected claims, electronically or by paper.
• Telephone contact with patients and Medical Insurance Carriers.
• Software’s used to complete these tasks each day are, IDX Group Cast, IDX Flow Cast WEB, TPX Eagle which
connects us to other Facilities, CCI Tools 11.0 - for correct coding, IDX RAD to obtain patients Medical
Reports.
• Image Now Client 5.41 - used to collect EOB, and patient information received from our other sites.
• Access to all commercial Insurance web sites including the NHIC UPIN Registry and NYMIT to connect to
Care Core National, LL, E-commerce to check commercial claims rejections to be corrected and appealed in a
timely manner.
• Edit patient demographics and insurance information; make all necessary adjustments to accounts.
Ocean Breeze Home Care, Staten Island, NY 11/2002 - 06/2003
Medical Biller, Collections; Durable Medical Equipment
• Third Party Payer Expediter, Commercial and Self pay, working from A/R reports.
• Responsible for follow up of commercial and self- pay accounts.
• Obtain Authorizations, pre-certifications for equipment; verify all insurance information
• Close patient contact, daily use of the Internet to access commercial insurance information.
• Account up dated and maintained by use of Dezine software.
Revenue Maximization Group, Garden City, NY 03/2002 - 11/2002
Collections, Hospital & Private Billing; In-patient & Outpatient
• Third Party Payer Expediter, Commercial, Medicare/Medicaid & Self Pay Collections.
• Responsible for follow up of claims over 120 days, and appeals when reimbursement was incorrect.
THE VETERANS ADMINISTRATION, Long Beach, CA 2001 - 2002
Volunteer - Medical Billing
EDUCATION:
The Healthcare Network
CPC Prep Course for Physician Coding – Completed - 05/2014
Teaneck, NJ
Stratford Career Institute, Washington, D.C. 10/2003
Psychology/Social Work Program
National Institute of Technology, Long Beach, C.A. – 10/2001
Medical Insurance Billing, Collections
Coding ICD-9-CM, CPT, HCPCS
Medi-Soft Software 6.1Diploma,
Crown Business Institute, Queens, N. Y. 9/1980
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