Medical collections and appeal

Keisha L. Gray

**** ******** *****, #***

Houston, TX 77054

Phone 832-***-****

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

**/** ** **/** -Kelsey-Seybold Clinic, Insurance Follow-Up Rep II

. Maximize reimbursement for higher level of appeals, using coding

guidelines for CPT/ICD-9, medical necessity and clinical and/or payor

policy guidelines for successful appeals of previously denied charges,

processed appropriate adjustments of charges and other assigned

special projects

. Maintain and/or exceed department standards for productivity to

include several monthly quality audits. Minimum quality score to pass

is 95%

. Successful outcomes for collecting payments on aged accounts, and a

high success rate for interest penalty payment by using my analysis

for proper reimbursement.

. Provided one- on-one training for new hires, and other staff as

assigned. Co-author on department policy for Charge Review work-que,

including training presentations.

. Responsible for bundle rejections for medical coding denials on

procedure codes and evaluation and management coding.

. HMO adjudications for specialized care of multiple specialties such as

obstetrical, neurology, and pain management/orthopedic charges.

Repost charges for corrected claims, or for claims denied as past the

filing deadline when all charges are filed out separately.

. Back-up support for patient billing customer service call center,

business office calls from patients and payors

01/14 to 5/14 MD Anderson Cancer Center, PBS Analyst

. Responsible for the daily pre-bill edit rejections for claims to

Medicare/Novitas

. Responsible for medical collections for physician charges

. Responsible for responding to customer service inquires

02/09 to 05/09 -Dental Economics, Customer Service Representative

Call center representative, for government and commercial dental carriers

Keisha L. Gray

2686 Murworth Drive, #203

Houston, TX 77054

Phone 832-***-****

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

08/07 to 02/09 -Memorial Hermann Hospital Southwest, Patient Access Rep

II

. Insurance Verification, calculated patient estimated amount due prior

to service

. Met and exceeded department guidelines for 60% collection rate pre-

services

Patient registration, ER rotation responsibilities with PBX

responsibilities

07/06 - 08/07-Baylor College of Medicine, Patient Accounts Representative

II

. Maximized collections for a university physician practice, with

successful appeals outcomes for neurosurgery, cardiology, and

emergency medicine.

06/04-07/06-First Health/Coventry Healthcare, Member Service Representative

. High volume call center, self-funded medical insurance provider.

Provided verification of benefits and claim status for medical, dental

and prescription

. Responsible for re-processing claims, originally denied in error

09/03-06/04-UT Physicians/Per-Se, Billing/ Collections Rep (Neurosurgery)

. Filed successful appeals of denied claims, based on medical necessity,

Texas Senate Bill 418, payor guidelines, and Texas Department of

Insurance/TDI regulations

. Filed corrected claims. Posted payments and adjustments, processed

refunds

.

04/01-06/03-Blue Cross/Blue Shield of Texas, Claims Examiner II

. Processed physician and hospital claims, per contract and DRG rates.

. Audited prior paid claims for Special Projects team.

. I was a STAR recognized employee for 100% quality for over 15

consecutive months

Computer Skills: EPIC, IDX, Microsoft Office, Typing 50 wpm, 10-key by

touch

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