Medical Insurance

April Due

*** ****** ****, *** ***, Brooklyn, NY 11239

(H) 347-***-**** (C) 408-***-**** - ********@*****.***

EXPERIENCE

*/**** -**/**** ********* Surgery Center dba Manhattan Surgery Center, Ny,

Ny

Business Office Manager

. Managed business office staff schedule

. Ordered office supplies as needed for clinical and business office

staff

. Admitted and registered patients for their surgeries, collecting

accurate information and collecting in-network responsibilities at

Time of Service.

. Coordinated surgical scheduling with physician offices and clinical

coordinator as needed

. Handled aging A/R collections from major insurances and patients

. Handled patient billing and preparation of insurance claims

. Verified patient insurances prior to scheduled surgery assuring they

have the same insurance and responsibility

. Managed and maintained sliding fee scales with patients

. Maintain up-to-date billing information from OIG

11/2009 - 7/2014 - Beth Israel Medical Center, Head and Neck Institute,

NY, NY

Biller/Credentialer/Executive Assistant

. Provided administrative support to Director of Talent Acquisition

. Managed calendar of Director

. Kept Director on schedule, making sure each meeting wrapped up in a

timely manner

. Designed and updated PowerPoint presentations

. Handled expenses and reimbursement for Director

. Generated correspondence, letters, and memos

. Scheduled applicants for interviews and escorted them to and from

their interviews when appropriate

. Screened and directed phone calls

. Arranged meetings, including catering and all technical needs (video

conferencing, projection, audio)

. Verify Patient Insurance and obtained prior approvals and referrals

when needed.

. Obtain medical transcriptions from physicians and

collecting/processing patients' co-payments and payments at close of

day.

. Manage a medical front desk in areas of manual and computerized

scheduling, billing, and medical/insurance records management,

including major carriers and Medicaid.

. Maintain open lines of communication between patients, physician,

staff, and laboratory personnel.

. Maintained up-to-date computer-based patient information

. Handle prior authorizations for CT, MRI, PET/CT, Ultrasound,

Octreotide scan, etc.

. At the doctor's request, ordered slides to be reviewed by pathologist.

. Cover for staff (Administrative Assistants, Secretaries and Managers)

as needed.

. Prep patient charts for the following day appointments.

. Efficiently process medical claims for major and private insurance

carriers including HMO/PPO, Blue Cross/Blue Shield, Medicaid/Medicare.

. Recognize, investigate and resolve discrepancies leveraging extensive

experience going through appropriate channels to facilitate medical

claims review and appeal processes.

. Reconcile outstanding balances and incidents of returned claim checks

from Medicaid/Medicare.

. Collect and maintain files in relation to credentialing of network

providers, including application, contracts, current physician

licenses, DEA licenses, malpractice insurance, board certifications

and other pertinent forms.

. Prepped charts for review before surgical procedures.

. Obtained medical clearances prior to surgeries.

05/2009 - 08/2009 - Advanced OrthoMedical Supplies, Long Island City, NY

Financial Investigator/Administrative Assistant - Temporary Position

. Assisted with billing, prior authorization, medical commercial

insurance, Medicare Ins., Medicaid Ins. No Fault insurances and

Workmen's' Compensation insurance for Durable Medical Equipment.

Handled Prosthetic insurance cases.

. Knowledge of billing process for Medicare, Medicaid, BC/BS,

Commercial, No Fault, Worker's Comp Insurance.

. Maintained and updated patient information.

. Maintained open lines of communication between patient and Prosthetic

Practitioner.

07/2008 - 10/2008 - Complete Orthopedic Services, Flushing, NY

Financial Investigator/Administrative Assistant - Temporary Position

. Assisted with billing, prior authorization, medical commercial

insurance, Medicare Ins., Medicaid Ins. No Fault insurances and

Workmen's' Compensation insurance for Durable Medical Equipment.

. Knowledge of billing procedures for Medicare Ins., Medicaid Ins, Blue

Cross/Blue Shield, Commercial, No Fault, Workman's Compensation

Insurance.

. Handled Prosthetic insurance cases.

. Maintained and updated patient information.

. Responsible for resolving patient or insurance company refunds.

. Responsible for secondary billing for out -patient DME claims.

. Maintained open lines of communication between patient and Prosthetic

Practitioner.

. Followed- up on pending claims or denials computer or phone.

12/2005 - 7/2008 - Lifestyle Lift, Westbury, NY

Office Manager/Surgical Technician/Administrative Assistant

. Analyzed process control concerns & recommended corrective action

plans to ensure adequate and timely resolution of related issues.

. Business compliance support included supporting areas such as banking,

accounting/finance, business ledger and human resources.

. Maintain open lines of communication between patients, physician,

staff, and laboratory personnel.

. Manual and computerized scheduling, billing, pre-authorizations and

medical/insurance records management.

. Manage patient inquiries regarding payment issues.

. Responsible for secondary billing on all in-patient and out-patient

ambulatory surgery claims.

. Process overpayments, handling correspondence with insurance

companies.

. Manage and supervise new associates with administrative and surgical

procedures.

. Business compliance task include ensuring corporate code of ethics

policies are being followed. To ensure this is done, quarterly

training is required for all employees. Employees are required to

read and sign documents that I created and to ensure that these

practices are being followed. On a monthly basis, employees are

required to watch code of ethics videos published by the company.

. Maintained and updated client information on the company database.

. Worked side by side in invasive facial plastic surgery which included

blepharoplasty, platysmaplasty, liposuction, suture removal, pre/post-

operative care and instrument maintenance.

. Troubleshoot and resolved physician, patient or staff issues in a

timely fashion.

SKILLS

. Microsoft Office

. Quickbooks

. Medflex Software

. IDX/ IDXtend Software

. Eagle Mainframe

. ICD9 coding and HCPCS Billable coding

. Medical Insurance billing processes

. Eclinical Works

. ADVANTX

. Cyramed

. Zirmed

. WebchartMD

. Knowledge of Haitian Creole

. Knowledge of Spanish

EDUCATION

Queens College CUNY, Flushing, NY

Bachelor's Degree in Sociology May 2010

Access Career Center, Kew Gardens, NY

Certified Patient Care Technician Certification/ Nurse Technician

Contact this candidate