Customer Service Insurance

ELAINE ZHANG

***-** ****** ********, ***#*D

Briarwood, NY 11435

E-mail: *********@*****.*** Mobile: 917-

***-****

PROFILE SUMMARY: Highly driven professional, organized, result and detail

oriented, creative problem solver with strong analytical skills, thrives in

a fast paced environment and capable and comfortable working independently

and in diverse, multidisciplinary team environments. Diverse experience in

healthcare leadership, management and delivery, proven record of success in

maximizing revenue capture, creating reports and financial analysis,

process/performance improvement, customer service and mentoring abilities,

marketing, policy and procedure creation/modification and

implementation, streamlining operations or using industrial engineering

initiatives to save money, partnering with physicians, and regulatory

compliance. Dedicated and diligent with solid work ethic, with an aptitude

for ongoing learning, and a commitment to excellence, quality and success.

PROFESSIONAL EXPERIENCE:

NYU Langone Medical Center, New York, NY 10/2012-Present

Cardiac Rehab, Cardiac Cath & EKG Dept Billing Coordinator

. Coordinate Professional billings for EKG & Cardiac

Rehab Dept to ensure charge submission, patient

inquiry, pre collect and follow up work ques by the

practices are required completion occurring on a

timely basis.

. Balances time of service payment collections and

prepares deposit slips for physician billing.

. Code billing diagnosis for compete EKG CPT Code, ICD-9 code

submission on a daily basis.

. Responsible for thoroughly reviewing procedure reports and super

bills to identify professional and technical CPT codes and

modifiers to ensure claim submit accurately.

. Train providers on appropriate coding and documentation as

needed.

. Participates in conference calls/meetings with Mckesson billing

service.

. Review accounts recommended for collection activity and submit

report for approval based on Division guidelines for physician

billing.

. Register new patients into Epic system and post offsite charges

for Cardiac Cath Dept.

. Scan medical documents into Epic.

. Follow up and research on provider credentialing process with

divisional administrator.

. Evaluate and charge correct invoices billed with incorrect

procedure codes, billed in error, diagnosis codes and modifiers.

. Analyze insurance payment and denial trends to

increase account receivable collection rate.

. Resolve all patient inquiries regarding hospital care, account

balances and overall billing procedures.

. Verify patient eligibility and obtain procedure authorization

approval through insurance phone calls.

. Direct billing service Mckesson on approval of account write

off, refund, adjustment and patient inquiries.

. Notify management regularly and requests intervention where

necessary.

. Run monthly encounter reports to ensure quantity of revenues

were billed accurately.

. Distribute insurance mails to the appropriate areas.

. Trained on ICD-10.

Memorial Sloan-Kettering Cancer Center, New York,

NY 07/2005-09/2012

Insurance Specialist, Physician Billing

Department

. Investigate and resolve claim denials in order to

obtain reimbursement for services.

. Utilize various medical systems and billing software

to research and document workflow in order to

effectively and

expeditiously resolve payment issues from insurance carriers.

. Devise and troubleshoot various solutions to problems

within the Insurance Billing process to reduce the

number of

rejections received by Insurance carriers.

. Prepare, keep track of appeals status with all

Commercial carries.

. Refund claim overpayments or paid in error to

insurance carriers and guarantors.

. Research & validate accuracy of high-volume charge

tickets against documentation.

. Evaluate and charge correct invoices billed with

incorrect procedures, diagnosis codes, modifiers or

billed in error.

. Analyze and cross-reference accuracy of insurance &

guarantor payments against checks and EOB

documentation.

. Reverse and repost incorrectly applied insurance and

guarantor payments.

. Assist in training new employees.

Ruohong Jiang, DDS, Dental Office, Flushing, NY

06/2001-07/2005

Dental Billing Specialist and Receptionist

. In charge of dental electronic billing and paper

billing to insurance carriers.

. Handled all insurance correspondence, such as post

payments, denials follow up.

. Resolved all patient inquiries regarding their

hospital care, appointments, insurances, and balance

accounts

questions.

. Performed office duties such as contacting patients

and other doctors' offices, answering phone calls,

faxing,

photocopying, bar coding, and scanning.

. Trained new staff on office protocol as well as

training when necessary.

Steinway Child and Family Services, Inc, Long

Island City, NY 03/2012-01/2014

Respite and skill building social worker (Part

time)

. Provide care and assistance to mentally disable

clients.

. Maintain professional contacts with client's families

and supervisor.

. Complete trainings and participate in compulsory

respite meetings.

. Ensure requirements and provide emergency support to

disabled consumer.

. Document work progress reports on a timely basis.

. Conduct supporting responsibilities as required and

suggested by supervisors.

. Offer skill learning to fulfill what the clients

need.

. Stay alert to change activities as required.

. Assure safety of the client and provide client's

needs timely.

Queens Medical Center, Hospital, Elmhurst, NY

1/2001-11/2001

Receptionist and Assistant (Part time)

. Perform EKG and PFT testing for patients.

. Schedule patient appointments.

. Provide customer service to patients.

EDUCATION

City University of New York, Hunter College, New York, NY

01/2007-12/2009

Bachelor of Science in Economics

City University of New York, La Guardia Community College, Long

Island City, NY

Associate of Arts in Social Science 09/2002-07/2005

SKILLS

. Medical terminology, ICD-9 diagnosis, Trained on ICD-

10, CPT medical, and ADA dental codes

. Proficient in Microsoft Word, Excel, PowerPoint,

IDX(GE) and Epic system

. Excellent verbal and written communication skills in

English and Chinese

Contact this candidate