Medical Billing Professional

Denise Marie C. Hooks

*** ********* **. #**** ******, TX. 77301

314-***-**** (Cell)

**********@*****.***

Professional The Outsource Group, St. Louis, MO – 2/2013 - present

Experience Insurance Follow Up Client Rep

• Handle incoming and outgoing patient and facility calls

• Request pertinent information from patients and insurance payers for account resolution

• Review outstanding accounts for errors and submit to facilities for corrections

• Process adjustment and self-pay requests

• Review cash posting and adjustments by clients

• File appeals to various insurance payers

• Process Georgia Medicaid accounts

• Update patient demographics and insurance information

• Review Explanation of Benefits for denials, payments and underpayments

• Client liaison responsible for peer training on client software

Denestra Medical Solutions, LLC, St. Louis, MO – 3/2008 – present

Owner

• Full Office Management

• Release bills pending to various insurance payers

• Re-file denied claims for lack of information

• Contact various insurance carriers for reimbursement

• File appeals on claims that denied incorrectly for payment

• Handle patient calls relative to their accounts & monitor productivity

• Post payments and adjustments to all open accounts receivables

• Run reports and track trends on denials and underpayments and overpayments

• Monitor reimbursement strategies, keeping up-to-date on federal guidelines for health reimbursement

funds as well as managing billing for reimbursement funds

• Responsible for analyzing health reimbursement expenses and making reports based on this

information which may affect future policies and procedures

• Motivate team to reach company set goals

• Assist with appeals when needed

• Update staff on any findings and/or changes

McMallum Place – St. Louis, MO (10/2009 – 3/2010)

Patient Financial Rep

• Released bills pending to various insurance payers

• Re-filed denied claims for lack of information

• Contacted various insurance carriers for reimbursement

• Filed appeals on claims that denied incorrectly for payment

• Handled patient calls pertaining to their accounts

• Posted payments to open accounts receivables

• Performed adjustments to credit balances

Centerre Healthcare – St. Louis, MO (06/2008 – 8/2009)

Patient Financial Rep

• Released bills pending to various insurance payers

• Re-filed denied claims for lack of information

• Contacted various insurance carriers for reimbursement

• Filed appeals on claims that denied incorrectly for payment

• Handled patient calls pertaining to their accounts

• Posted payments to open accounts receivables

• Performed adjustments to credit balances

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Purkinje Software Firm - St. Louis, MO

Billing Medical Specialist (1/2006-2/2007)

Medical Billing Supervisor (2/2007-4/2008)

• Contacted commercial and Government payers regarding payment on medical claims.

• Staff trainer for the India staff

• Monitored productivity levels and disbursed daily work to staff

• Reviewed patient accounts and billing statements with patients & processed payments

• Perform adjustments, cash posting and collections

• Re-filed medical claims for payment to insurance and third party payers for payments

• Performed cash posting, charge entry, handles correspondence. Created training manual for new

business accounts

• Responsible for working both current and aged account inventory

• Worked closely with management to implement monthly goals and achievements to excel in reaching

productivity. Provided feedback to management on behalf of the staff

• Trainer and promoter of projects to boost morale in the department by organizing team lunches

Medical West Respiratory – St. Louis, MO (8/2005 –1/2006)

Accounts Receivables/ Medicaid & Commercial Biller & Collector

• Submitted claims electronically to Commercial and Government agencies for payments or denials

• Performed cash posting for self-pays, Medicare, Medicaid and Commercial carriers

• Refiled claims that deny due to insufficient information

• Responsible for working both current and aged account inventory

• Processed adjustments and appeals

United Seating and Mobility - St. Louis, MO (11/2004 – 5/2005)

Accounts Receivables

Medical Documentation Specialist

• Submitted claims electronically to Commercial and Government agencies for payments or denials.

• Performed cash posting for self-pays & adjustments for Medicare, Medicaid and Commercial carriers

• Refiled claims that deny due to insufficient information

• Responsible for working both current and aged account inventory

• Implemented a process for creating the LMN and CMN which allowed a smoother process for

authorization approval

West Port Benefits – St. Louis, MO ( 3/2003-3/2004)

Customer Service Representative

• Received inbound and outbound calls from patients and providers

• Reviewed contacts to ensure the medical claims paid accordingly

• Performed patient education on benefits and claims

Magellan Health Systems – St Louis MO (11/2000-5/2002)

Claims Adjustor

• Paid claims based on contracts set forth by the clients

• Uploaded authorizations into our data base

• Applied authorizations to claims that fall within the authorization date span

• Electronic Billing & Cash Posting Functions

Areas of Expertise

• Accounts receivables & Collections

• Revenue Cycle Management

• Customer Service & Client Account Management

• Medicare and Medicaid Expertise

• St. Louis College of Health Careers, St. Louis, Missouri

Education/ Training – Certificate of Completion

• Florissant Valley Community College, St. Louis Missouri

– Some courses

• Various Leadership Workshops & Seminars

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References • Furnished Upon Request

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