Medical Billing
Resume:
TARA D. WILEY
*** *********** ***** *************, ******* 30046 *******@*****.*** 484. 219-5354
OBJECTIVE
Detailed oriented quality focused professional seeking a challenging rewarding position within a dynamic organization
to utilize my current knowledge of Revenue Cycle and Medical Billing which offers advancement opportunity.
TECHNICAL SKILLS
EPIC SSI EC2000 MICROSOFT PRODUCTS
MEDITECH EPREMIS RUMBA UB-EDITOR PRO
OAS GOLD FISS DDE EMDEON ICD-9/HCPCS/CPT
SEIMENS SMS SEIMENS AS400 CERNER MEDICAL TERMINOLOGY
PROFESSIONAL EXPERIENCE
Xtend Healthcare Revenue Cycle Solutions, LLC
Medicare Biller Travel Analyst June 2012- Present
Ensures timely follow-up on all outstanding Medicare claims and denials every 14 days.
Reviews accuracy and timeliness of Medicare claims prior to submission for reimbursement.
Researches Medicare claim rejections on the FISS DDE system for correction and claim resubmission.
Ensures MSP claims are accurate and submitted to Medicare timely.
Travels to client sites to perform onsite billing functions when delegated by AVP.
Responsible for submission of paper and electronic Secondary bills with appropriate correspondence.
Researches missing/unapplied payments and adjustments for account resolution.
Analyzes outstanding claims trending issues and expedites to management in a timely manner for resolution.
Proactively communicates with Fiscal Intermediary for prompt account resolution on outstanding Medicare claims.
Ensures all account actions performed are documented in all appropriate systems accurately and efficiently.
Experienced with CMS 1500 and UB-04 claim forms billing.
Expedites invalid claims to appropriate department for integrity review.
Assists team members with problematic accounts for resolution and reimbursement.
Applies knowledge of ICD-9, CPT/HCPCS and Medical Terminology to ensure claims are compliant.
Adheres to mandatory quarterly HIPPA Compliance training.
Successfully adapts to various client specific hospital and billing systems.
Grady Health System
Patient Financial Services Vendor Management Coordinator 2008 to July 2012
Reviewed Vendor Financial and Operational reports for improvement opportunities.
Performed daily placement reconciliations with Vendors to resolve placement variances.
Performed Vendor Quality Audits to ensure accounts were handled in the appropriate manner for resolution.
Proactively anticipated and prevented potential Vendor issues; interacted with Vendors to resolve existing issues.
Utilized Epic, Siemens, RAS and ATB to generate A/R reports to monitor Self Pay and Bad Debt activity.
Monitored High Dollar A/R to ensure satisfactory follow-up was performed by Vendors.
Tracked Vendor contracts for renewals, changes and terminations.
Reviewed Vendor Adjustment requests to validate the integrity of each adjustment and ensure approvals were
keyed into the Patient Account Management System.
Responsible for the oversight of Vendor On-Site Client Liaisons.
Attended Vendor meetings to ensure compliance of the Health System Policies and Procedures.
Reviewed, negotiated and approved settlement offers from attorneys and patients.
Compiled updated Training materials; provided on-site training sessions to off-site Vendor staff to ensure
comprehension of GHS policies and procedures while performing account maintenance.
Monitored Vendor collections and performed follow-up on declined collections.
Proactively interacted with Epic IT Build team to report and resolve system issues.
Demonstrated knowledge and experience with Microsoft Office products.
Resolved missing/misapplied payments, credit balances, un-posted contractual allowances and charity adjustments.
Ensured timely service delivery from vendors.
Established and monitored Vendor monthly goals.
Performed Aged Trail Balance detail reviews for AR Strategy Reduction.
Monitored and tracked Vendor Returned accounts to ensure final disposition.
Grady Emergency Medical Services
Billing & Reimbursement Coordinator 2005 to February 2008
Generated and submitted electronic claims to Medicare, Medicaid and Commercial payers.
Increased EMS Collection activity by 55 percent.
Performed claim edit corrections for Medicare, Medicaid and NEIC claims.
Resolved issues with billing system software and claims submission.
Managed staff of 8 employees within the EMS Business Office.
Responsible for performing weekly employee productivity audits and annual CBE evaluations.
Examined guidelines and regulations, including Medicare and Medicaid provider requirements
regarding third party reimbursement and general reporting requirements; ensured that all EMS financial procedures
and activities were in compliance with applicable guidelines, rules, regulations, and laws.
Managed key day to day billing activities.
Responsible for tracking all outgoing and incoming claims on daily matrix.
Performed Quality Audits on Vendor invoices prior to Accounts Payable submission.
Managed GEMS Lockbox and departmental financial activity to ensure accurate reporting of revenue.
Developed and implemented departmental policy and procedures to ensure accurate financial records.
Ensured patient medical records were handled appropriately under HIPPA Compliance guidelines.
Interacted with Vice President of Finance and Director of Cost and Reimbursement to ensure effective processing
and accurate reporting of EMS financial activity.
Accumulated reports and other data from the Grady Health System accounting, finance department and external
vendors to effectively monitor reimbursement activity.
Liaison between Grady EMS and the Grady Health System Finance and Patient Access Departments.
Managed external EMS Billing & Medical Records vendors.
Assured contracting vendors were compliant with local, state, and federal regulations regarding financial
Accountability.
Grady Emergency Medical Services
Ambulance BillingSpecialist 2003-April 2005
Reviewed Medicare claims on the FISS and performed T-File corrections.
Reviewed Patient Care Reports and applied knowledge of ICD-9, CPT/ HCPCS and Medical Terminology to ensure
accurate coding of patient’s diagnosis.
Generated & worked Medicare credit balance reports for resolution.
Performed high volume data entry to ensure all billing data was entered into Sanitas Billing System.
Researched and verified patient insurance and demographic information for ambulance transports.
Reconciled, corrected and resubmitted rejected claims to Medicare, Medicaid and Commercial payers.
Researched misapplied/unapplied Medicare payments and contractual allowances for account resolutions.
Maintained daily matrix to track and monitor claims submitted for payment.
Performed 10 key batch posting of Medicare, Medicaid and Commercial Remittances to individual patient accounts.
Generated Crystal reports within EMS system to track and perform adjustments and track Medicare cash
collections.
Promoted to Billing and Reimbursement Coordinator within Grady Emergency Medical Services
EMPLOYMENT
Xtend Healthcare Revenue Cycle Solutions, LLC June 2012- Present
Medicare Biller- Travel Analyst Hendersonville, Tennessee
Grady-Patient Financial Services 2008-June 2012
Vendor Management Coordinator Atlanta, Georgia
Grady EMS 2005-2008
Billing & Reimbursement Coordinator Atlanta, Georgia
Grady EMS 2003-2005
Accounts Receivable/Ambulance Billing Atlanta, Georgia
EDUCATION
Herzing College 2003-2004
Medical Billing & Coding Atlanta, Georgia
Atlanta Area Technical College 2001-2002
Microsoft Office Certification Atlanta, Georgia
Grady High School 1987-1991
Diploma Atlanta, Georgia
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