Customer Service Insurance

BETHANY JOY BURLEY

Atlanta, GA *****

Phone: #404-***-**** / E-mail: ********@*******.***

PROFESSIONAL SUMMARY:

A dynamic and highly effective customer service oriented professional with

thorough knowledge of the industry. Strengths are team building,

leadership, coaching and mentoring. More than 10 years of experience

combining strong analytical skills with business acumen to positively

contribute to the bottom-line of the organization. Maintains and

continuously improves proactive approaches in problem solving. Computer

skills include typing 65 wpm, Microsoft Excel, PowerPoint, Access, Internet

and Microsoft Office Applications.

EDUCATION:

CLARK ATLANTA UNIVERSITY

B.A. Business Administration

WORK HISTORY:

Frasier Healthcare February 2014-

Present

Healthcare Revenue Cycle Consultant

. Collect on all outstanding A/R as it pertains to appeals, billing, and

follow-up, as well as track and trend variance issues resulting from

the contract and/or its interpretation

Seton Medical Center (Austin, TX) May 2014-

present

Systems utilized were Citrix/Invision, SSI, Healthport, Healthware, E-

Smart, various payer websites

Trinity Hospital/CHS (Augusta, GA)

February 2014-May 2014

Systems utilized were HMS, Revenue Cycle Pro, SSI, HPF, various payer

websites

Dekalb Medical Center April

2013-February 2014

Variance Analyst

. Review claims that have been paid and still have an outstanding

balance to determine if they are underpaid, overpaid, or if it is a

contractual/adjudication issue

. Attain expert level understanding and knowledge of contractual

reimbursement requirements of insurance payers

. Track and trend variance issues with appropriate party for

presentation to leadership

. Lead meetings with Denials, Follow-Up, and Refund/Credit team for

resolution of payer issues

. Systems utilized were Allscripts, E-Premis, Sovera, and various payer

websites

Southern Regional Medical Center: 300 bed Acute Hospital 2011 -

Feb 2013

Denial Recovery and Prevention Analyst

. Review for Recovery Denial $ and Prevention of Denied UB04 claims.

. Review EOB, validate and ensure patient accounting system reflects

dispute disposition.

. Identify if Appealable, Un-appealable, or if it is a contractual

issue.

. Write first and second level appeal letters for all denied/underpaid

claims to ensure all efforts for recovery are exhausted.

. Attain expert level understanding and knowledge of

contractual/reimbursement requirements of Payers.

. Track and trend Dispute data with appropriate party for presentation

to leadership

. Lead meetings with Billers and the EOB analyst for resolution of payer

issues

. Root cause denials of UB04 claims to prevent future denials

. Systems utilized were McKesson Star, ePremis,Meditech, PCON,

MedAssets, HPF, and various payer websites

Conifer Health Solutions 2005 - 2011

Appeals Specialist

. Responsible for twelve acute hospitals in the Southeast Region;

Georgia, North Carolina, South

. Carolina, Missouri, and Tennessee.

. Communicate efficiently and effectively with insurance companies to

resolve payment discrepancies.

. Effectively write insurance appeals.

. Work closely with onsite Managed Care Team and Provider

. Representatives to resolve any contract related issues.

. Track and monitor accounts that may impact aging A/R.

. Communicate verbally and written to all levels of management on status

of accounts in dispute status.

. Systems utilized were MedAssets, ACE, HPF, E-Premis, and various payer

websites

Internal Revenue Service 2000 - 2011

Tax Examiner (part-time/seasonal)

. Review and Process tax returns and correspond for any missing

information needed in order to adequately process payment/refunds in a

timely manner.

NCO Financial Services 2002 - 2005

Paitent Account Representative

. Handle Inbound/Outbound calls.

. Collect on outstanding medical bills.

. Key needed documents for onsite staff at hospitals to reference.

. Receive or generate calls to and from responsible parties and third

party insurance.

. Obtain any new information and document prior activity on accounts to

determine appropriate action taken.

. Assisted with setting up payment plan, mail out financial assistance

applications, collect payments - credit card and/or electronic

payments.

. Assisted in training Patient Account Representatives.

Catherine Burley, MD 2001 - 2002

Assistant Office Manager

. Set-up appointments, answered telephones, prepared cash/credit card

deposits, also copied and filed charts.

. Verified insurance information and obtained referrals and

authorization for patients.

ACTIVITIES:

Treasurer, Toastmasters International/Conifer Communicators Co-Chair,

Care Committee/Atlanta National Insurance Center

Contact this candidate