Insurance Home Health
Resume:
DARLENE BLAYLOCK
• **** OLD NORTH BELT DR APT ***
HUMBLE, TX 77396-2561
• ****************@*****.***
Work History
Avatar Home Healthcare Agency, LLC, The Woodlands, Texas
Billing/Coding Specialist
Aug 05, 2013 - Oct 03, 2014
Created and submitted Home Health, Skill Nursing and Attendant Service Claims.
Follow-up's, appeals, and denial's for all departments.
Post payment, create receipt and invoices for patients.
Maintained Insurance Monthly Account Receivable on spread sheet.
Work A/R reports weekly.
Maintain private pay patient accounts.
Retrieved patient medical records for providers and medical personnel.
Processed patient admission or discharge documents.
Request authorization from Insurance.
Tillman Dental & Orthodontics,LLC, HOUSTON, Texas
Insurance Billing
Feb 04, 2013 - May 21, 2013
Compiled data, compute fees schedules and charges.
Adjudicated dental claims and insurance follow up; posting payment; scanning all documentation
in system.
Reviewed patient chart described by the doctor and explain treatment plans and various financial
planning options.
Verified insurance and determined the best options for patient.
Inputted patient information along with clinical notes in system
Assisted with answering phone; scheduling appointments.
Submitted authorization and referrals.
Handled A/R report daily.
Assist with other task as needed.
UT Physicians, HOUSTON, Texas
Provider Enrollment Specialist
Jan 23, 2012 - Sep 14, 2012
Processed Medicare CSHCN/Medicaid and Railroad applications
Submitted license updates to Medicare and Medicaid
Processed license list from UT System for PLI update
Assisted with preparation for monthly Credentialing meeting and audits
Prepared files and process initial and re-credentialing application
Sent expired license notices on the 1st and 15th of every month to department.
Requested updated licensing and passport
Coventry Healthcare, Houston, Texas
Claims Examiner/CSR
Oct 15, 2008 - Jul 06, 2011
Ensures accurate payment of high dollar accounts
Monitor Medicaid and Medicare claims regularly to assess impact to network
Conduct and maintain claims processing and fee schedules
Prepares and distributes claims, denial, and appeals; also investigate member reimbursement,
and providers complaints by phone, electronic mail, faxes and in writing
Communicate with other departments to obtain information for resolution;
Ensure claims, appeals, complaints and inquiries are processed within the timeframe
Monitor new claims initiatives and customer services duties as needed..
Methodist Hospital, HOUSTON, Texas
Collector/Billing
Mar 09, 2007 - Aug 19, 2007
Responded to all incoming claims calls, faxes, and emails from providers and members
Insurance follow-up on corrected claims, claim status,appeals, EOB's, denials, adjustment and
check traces;
Documented all inquiries in spreadsheet;
Maintained pass due account from AR report
Maintained and conduct all daily charges from units, and pick up and make daily bank deposits
run.
Kingwood Pine Hospital, KINGWOOD, Texas
Coordinator/Biller
Apr 24, 2004 - Feb 28, 2007
Coordinated staff to ensure all inquiries are priority and fall within the timelines
Assisted physician with patient benefits and eligibility
Adjudicated and process mental health claims, refund, and credit balances
Posted charges, insurance payments, members payment, contractual and adjustments, audit
accounts and DRG's;
Ran daily reports and new admission report daily for morning meeting;
Collected co pays, deductibles and admission fee up front and log on daily log sheet
Picked up daily charges off units.
United Behavior Health, Texas
Data Entry Processor
Oct 01, 2001 - Mar 01, 2003
•Adjudicate and process mental health claims on HFCA 1500 and UB92
•Submitt correspondence to provider, patients, and insurance companies
•Process appeals, denial, refunds, and solve priority issues daily.
•Maintain daily production and quality
Kelsey-Seybold, HOUSTON, Texas
Claims Processor
Aug 01, 2001 - Oct 01, 2001
.•Review insurance benefits and eligibility.
•Maintain daily production and quality
•Submit correspondence to providers and insurance companies.
•Organize work load, date stamp, sort and batch incoming mail daily.
•Post or attach information to claim file.
•Set up new vendors for providers
•Transmit claims for payment or further investigation.
•Contact insured or other involved persons to obtain missing information.
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