Paralegal/Medical BIller
Resume:
Alicia Alli
Dallas, TX 75230
***************@*****.***
CAREER SUMMARY
Results driven Medicare and Medicaid Billing and Collections Specialist with
extensive experience with Medicare HMO’s and Texas Medicaid. Proven initiator
and strategic thinker with effective analytical, organizational, communication
and leadership skills. A multi tasked, detail oriented, results-driven team
player with a service-focused attitude who exceeds all goals and requirements in
dynamic, challenging work environments. Acquired competencies include:
Medicare HMO Subject Matter Expert
Excellent Problem Solving Skills
Resolving Medicare HMO Credit Balances/Overpayments
Corporate Integrity Agreements
Accounts Receivable
Experience with Claims Appeals
Resolution of processing adjustments and write off’s
HIPAA
PROFESSIONAL EXPERIENCE
Health Management Systems- Irving, Texas
New Jersey Medicaid Caseworker
2010-current
Value Medicaid claims for the State of New Jersy Medicaid. Value claims for
accident/injury attorney's to determine the payback to the state of New Jersey
Medicaid Department. Handle all pro rata reductions and compromises. Deal with
over 100 different attorney's and beneficiaries on a daily basis. Value HMO
claims for 5 different companies.
INTREPID USA HEALTHCARE SERVICES - Dallas, TX
2008 - 2009
Medicare HMO Billing and Collections Specialist
Billed and collected on Home Healthcare services in accordance with CMS (Centers
for Medicare and Medicaid) regulations for a total Medicare HMO portfolio of
$7.6M annually. Handed over 300 Medicare HMO recipients in 20 different
States. Processed written correspondence and telephone calls from 45 different
Medicare HMO payors and Intrepid USA agencies regarding all claims. Trained
new staff on processes, procedures and overall requirements for Medicare HMO
billing and collections. Extensive knowledge with Corporate Integrity
Agreements, NPI, HIPAA, electronic billing and payment facilitation, along with
manual CMS-1500 claims.
Decreased DSO for Medicare HMO from 62 days to 31 by focusing on rejected and
denied claims.
Moved 12 Insurance payors from paper billing to electronic billing expediting
the payment cycle by 30-40 days.
Handled the largest Medicare HMO portfolio generating $635K in revenue
monthly.
OUTREACH HEALTH SERVICES – Garland and Weatherford, TX
2005 - 2008
Payroll, Billing and Accounts Receivable Specialist
Assisted Texas Medicaid recipients in the Consumer Directed Services (CDS)
program, Medically Dependent Children Program (MDCP) and Transitional Assistance
Services (TAS) program with enrollment, attendant back ground checks including
employee misconduct registry and nurse aide registry. Maintained all referral
sources, client and attendant information for the entire State of Texas.
Generated attendant payroll checks for 350 clients on a bi-weekly basis, and
filed quarterly employer payroll taxes with Texas Workforce Commission (TWC).
Billed and collected on all outstanding accounts receivable and maintained the
agency’s accounting records. Ensured compliance with CMS (Centers for Medicare
and Medicaid Services) rules and regulations along with Texas Medicaid licensure
rules and regulations.
Performed duties necessary in order to transmit Medicaid billing to TMHP
(Texas Medicaid Healthcare Partnership) for 350 clients on a weekly basis.
Billing submission included services for CBA, MDCP and TAS programs.
Answered all phone calls that came into the agency 800 line from potential CDS
and MDCP clients.
Communicated with State caseworkers on any client registration issues needing
corrective action on their part.
Provided technical assistance and monitoring to ensure accuracy, completeness,
and timeliness of paperwork.
COMPUTER / TECHNICAL SKILLS
Proficient in PC applications such as MS Excel, Word and PowerPoint. Thorough
understanding of Lotus Notes, TDHconnect, Focus XP, Outlook, Windows XP, 2000,
NT, 98 and 95. Expert in McKesson / Horizon Home Care.
2008 - 2009
Medicare HMO Billing and Collections Specialist
Billed and collected on Home Healthcare services in accordance with CMS (Centers
for Medicare and Medicaid) regulations for a total Medicare HMO portfolio of
$7.6M annually. Handed over 300 Medicare HMO recipients in 20 different
States. Processed written correspondence and telephone calls from 45 different
Medicare HMO payors and Intrepid USA agencies regarding all claims. Trained
new staff on processes, procedures and overall requirements for Medicare HMO
billing and collections. Extensive knowledge with Corporate Integrity
Agreements, NPI, HIPAA, electronic billing and payment facilitation, along with
manual CMS-1500 claims.
Decreased DSO for Medicare HMO from 62 days to 31 by focusing on rejected and
denied claims.
Moved 12 Insurance payors from paper billing to electronic billing expediting
the payment cycle by 30-40 days.
Handled the largest Medicare HMO portfolio generating $635K in revenue
monthly.
OUTREACH HEALTH SERVICES – Garland and Weatherford, TX
2005 - 2008
Payroll, Billing and Accounts Receivable Specialist
Assisted Texas Medicaid recipients in the Consumer Directed Services (CDS)
program, Medically Dependent Children Program (MDCP) and Transitional Assistance
Services (TAS) program with enrollment, attendant back ground checks including
employee misconduct registry and nurse aide registry. Maintained all referral
sources, client and attendant information for the entire State of Texas.
Generated attendant payroll checks for 350 clients on a bi-weekly basis, and
filed quarterly employer payroll taxes with Texas Workforce Commission (TWC).
Billed and collected on all outstanding accounts receivable and maintained the
agency’s accounting records. Ensured compliance with CMS (Centers for Medicare
and Medicaid Services) rules and regulations along with Texas Medicaid licensure
rules and regulations.
Performed duties necessary in order to transmit Medicaid billing to TMHP
(Texas Medicaid Healthcare Partnership) for 350 clients on a weekly basis.
Billing submission included services for CBA, MDCP and TAS programs.
Answered all phone calls that came into the agency 800 line from potential CDS
and MDCP clients.
Communicated with State caseworkers on any client registration issues needing
corrective action on their part.
Provided technical assistance and monitoring to ensure accuracy, completeness,
and timeliness of paperwork.
COMPUTER / TECHNICAL SKILLS
Proficient in PC applications such as MS Excel, Word and PowerPoint. Thorough
understanding of Lotus Notes, TDHconnect, Focus XP, Outlook, Windows XP, 2000,
NT, 98 and 95. Expert in McKesson / Horizon Home Care.
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