Customer Service Medical

Barbara (Bosch) Boutwell

**** ******** *****, ******* ** 30040 ~ 770-***-**** ~ ********@*****.***

CUSTOMER SERVICE / ACCOUNTS RECIEVABLE

Medical Records ~ Office Management ~ Team Building ~ Client Relations

Office Professional with a background in customer service with expertise in office management,

education and training, medical record audits, cultivating and managing external and internal customer

relations, collection processes, data entry and production, insurance verification and transmission, prior

authorization, adjudication, payment posting. Strong knowledge of KO Trademarks and Brand. Proven

technical skills include SAP, Microsoft Office Products, Frameworks, QS1, Doctrak Citrix Web portal

and Nextgen.

CORE COMPETENCIES

Organization Insurance Billing Developing Operating Procedures

Collection Process Accounts Receivable Leadership

Client Relations Training / Education Detail Oriented

PROFESSIONAL EXPERIENCE

INFECTIOUS DISEASE CONSULTANT John’s Creek, GA April 2014 Present

Medical Billing Supervisor – contracted to NPS

• Managed all department (on shore and off shore) resources daily activities

o Hired / Trained / Mentored new employee (3) on financial office processes

o Created Standard Of Work for off shore team

o Assigned / review daily tasks for completion

• Implemented Navicure: billing, adjustments, processing

• Implemented Nextgen: charges, billing, reports, authorizations

• Responsible for all Medicaid (CMO): posting, denials, appeals

• Reduced outstanding collections by 6M

• Create Billing dept process, procedures

• Successfully engaged and completed insurance audit

• Call insurance companies regarding any discrepancy in payments/refund requests if necessary

• Identify and bill secondary or tertiary insurances

• Review insurance EOB, EOP and RA’s for accuracy and completeness and obtain any missing information

• Knowledge of insurance guidelines specializing in Medicare and state Medicaid

• Prepared appropriate documentation / information for the collection agency

• Investigate rejected/denied claims for viable resolution and subsequent reimbursement

• Investigate insurance fraud and report if found

• Responsible for strict adherence to HIPAA regulations

Barbara (Bosch) Boutwell

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

Patient Account Representative and Insurance Reimbursement Specialist April 2012 – April 2014

Patient account representative / Medical Reimbursement Specialist. Concentration on increased revenue thru collections and

accurate, timely electronic insurance claim submission. Developed customer relations to facilitate collection process and

payment plans to avoid legal action.

• Increased revenue (AR) for 3 medical practices thru patient account collection process

• Increased Medicaid revenue reimbursement from under $1200 a month to an average of $20,000 due to accurate

and timely claim submission and processing and dedicated follow up skills

• Developed a good working relationship with Medicaid to obtain preauthorization to file accurate and timely claims

• Communicated with insurance companies to collect maximum allowable revenue from Explanation of Benefits/

Remittance Advice and claims deemed not payable or collectable

• Collaborated with area hospitals to retrieve medical records necessary to process insurance claims

• Cleaned up patient accounts from archived records to bring patient balances current. Process patient payments

thru credit cards and checks

• Located / followed up with patients to apply insurance and set up payment plans

• Assisted Legal Recovery Resources to maximize collection revenue

• Eliminated 180+day past due backlog of outstanding patient account balances

• Created Standard Operating Procedure (SOP)/ training manual for financial department

• Responsible for maintaining web portal administration for Medicaid and other major medical insurance companies

• Trained / mentored new employee on financial office processes

• Followed necessary steps and procedures to update physician information on insurance web portals for accurate

and quick reimbursement

• Possess general knowledge of front office processes including but not limited to: insurance verification and

preauthorization, appointment scheduling, patient check in and checkout, creating encounters, creating charges via

super bill/fee ticket, payment processing and chart scanning and electronically filing patient files

COCA COLA Alpharetta, GA July 2011 April 2012

Communications Consumer Specialist

Blended communication specialist in the External Good Answer Division of Coca Cola Call Center. Responsible for

accurate and timely email and phone responses to external customers including; but not limited to, Chick Fil A, Hooters,

and Piccadilly Cafeteria

• Examine performance metrics to improve quality, speed, and capabilities to meet or exceed goals

• Trained in Call Center process, procedure and protocol

• Consistently rated at above 95% accuracy in Quality Assurance for email communication

• Over 95% production activities on live phone calls

• Successfully resolved all Customer email inquiries in the most efficient manner

WALGREENS LONG TERM CARE PHARMACY Marietta, GA 2007 – 2011

Customer Service Representative

Assisted living facility customer liaison. Developed and implemented internal workflow process. Conducted and oversaw

staff meetings as it pertains to implementation projects. Developed and managed external customer partnerships.

Page 2 of 4

Barbara (Bosch) Boutwell

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

• Initiated continuous improvement projects.

• Managed prior authorization, insurance verification and insurance transmission at point of adjudication

• Managed medical record reviews, updates, adjustments, printing and timely distribution

• Led Kaiser insurance audit – resulting in $100k in pharmacy prescription charge backs

• Maintained refill authorizations, minimizing processing time and reducing production budget

• Performed medication administration record reviews, minimizing medication errors within the long term care

environment, thus dramatically decreasing percentage of internal errors as they pertain to medical records, thus

increasing customer satisfaction

• Performed medication cart audits within the skilled nursing environment to ensure 100% success rate in regards to

state mandated inspections

Customer Service Representative, Seniormed, 2007 2008

Subsidiary of Walgreens Company Roswell, GA

A long term care pharmacy servicing assisted living and retirement communities.

Team leader for pharmacy acquisition. Supervised strategic transition during acquisition

• Supervised all aspects of medication cycle preparation and delivery

• Trained new employees on pharmacy software

• Implemented and maintained HIPAA approved storage process for medical records.

• Managed physician/pharmacy relations

• Evaluated proposed opportunities

TABSAFE MEDICAL SERVICES and 2004 2007

TABSAFE PHARMACY, LLC Roswell, GA

Customer Service Representative

A long term care pharmacy, specializing in geriatric consulting within senior assisted living and senior

retirement living communities.

• Supervised all aspects of medication cycle preparation and delivery

• Trained new employees on pharmacy software

• Evaluated proposed opportunities

• Trained new employees on various medication packaging systems

• Organized family nights within prospective communities

• Developed delinquent account/collection process

• Collected on delinquent accounts with an 85% success rate

• Implemented communities with a 100% conversion rate

EDUCATION

Page 3 of 4

Barbara (Bosch) Boutwell

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

Associate of Art Degree in Healthcare Administration and Medical Records

Phoenix School September 2012

CERTIFICATIONS

• Medical Transcription Certification

• ICD 9 Coding I Gwinnett Technical College

• ICD 9 Coding II Gwinnett Technical College

• Early Childhood Education Certification, Lanier Technical College

PROFESSIONAL DEVELOPMENT

• Basic Training for Supervisors, Gwinnett Technical College

• Coaching and Teambuilding Skills for Managers and Supervisors, Skill Path Seminars

• Numerous online webinars on management and medical transcription

LinkedIn http://www.linkedin.com/pub/barbara boutwell

Page 4 of 4

Contact this candidate