Denise Krouse

*** ****** ***** **** 862-***-****

Randolph, NJ 07869 acpydl@r.postjobfree.com

Objective:

Focused, motivated and ambitious Medical Biller and Coder seeking a position where I can use my administrative and academic medical abilities along with my strong customer service skills to positively impact the healthcare industry and its patients; possesses an outgoing personality with an extraordinary ability to work efficiently in a fast paced environment and will take initiative where needed and has an eagerness to learn new tasks.

Experience:

Biller/Comm PAR MedAssets 01/14-Present

Verify import of claims from hospital system to X-claim for University of Southern California and Norris Cancer Hospitals. Review claims in incomplete, hold or rejected folders. Identify missing or incorrect data on UB04 and correct claims in X-claim prior to submission to insurance carriers. Develop a working knowledge of payer websites for eligibility verification. Acquire a working knowledge of revenue codes and HCPCS codes. Resolved redundant billing error in X-claim. Secondary electronic and hard copy billing of claims with EOB’s from Accupost. Recreate UB04 for medical record requests. Follow up on all claims from billing through final resolution. Follow up on payment errors, low reimbursement, denials, etc. Review insurance EOB’s and initiate appeals as necessary. Print and mail UB04’s as necessary for account resolution. Keep current with all commercial and managed care pricing modules, rules and regulations.

Medical Records Tech/Support Services Med Assets 06/13-01/14

Posting transactions in host system for medical records. Monitor medical records/grids for patients’ accounts for all six sites of Barnabas Health System. Submitting medical records requests for non-federal, collection, denials/appeals and customer service representatives utilizing medical records process. Updating patient insurances with information received.(i.e. authorizations, new insurance and retroactive Medicaid) Posting adjustments, payments, balance transfers and transaction codes for billing and collecting. Report any noticeable trends received via correspondence. Contact patients as needed for missing information such as Protected Health information required for adjudication of claims. Contact insurance companies, attorneys and doctor’s offices as needed for insurance verifications, insurance addresses, patient authorizations and various other issues that require intervention to ensure accuracy of the account information.

Medical Billing Specialist/Claims Processor Horizon 11/12-05/13

Reviewed and processed insurance claims for accuracy of benefits based on eligibility and coverage according to each contract. Processed and adjudicated medical claims for payments and denials. Investigated pending claims and resolved discrepancies with billing issues. Maintained proper legal status and the overall fiscal health of the insurance company to ensure accurate health information and data was entered on claim forms. Heavy data entry and documentation in company’s database. Liason between payers, members and providers to facilitate resolution of claims and payment issues.

Customer Service/Billing Representative Cablevision 06/09-10/12

Assisted customers with technical inquiries and troubleshooting issues with cable equipment. Explained billing inquiries to customers and issued charges and credits according to protocol. Entered customer service information through direct/indirect keyboarding. Scheduled and confirmed appointments for technicians. Answered phone lines in a busy fast paced working environment. Worked simultaneously with multiple software applications to assist customers. Provided excellent customer service to customers with questions and concerns about services and products. Exceeded expectations for high call volume productivity levels and goals.

Work Sudy Sanford Brown Institute 06/08 5/09

Demonstrated overall support to staff with all necessary administrative duties while attending school; duties included but not limited to: generating memos, correspondence and reports, making copies, organizing files, oversaw inventory, supply ordering. Answered multi-line telephone system, transferred calls and recorded messages appropriately. Loaded software and performed minor PC repairs and maintenance on school equipment.

Education:

University of Phoenix Expected graduation date 05/2017

Associate of Arts Degree, Healthcare Administration

Sanford Brown Institute Graduated 05/2009

Certificate, Medical Billing and Coding

An intensive 600-hour course comprised of theoretical and practical essential medical billing and coding skills including:

• Medical Terminology, Anatomy and Physiology

• Hospital and Managed Care

• Administrative Duties

• Health Insurance Processing (computer usage, ICD9/CPT4, billing/coding, patient scheduling, claims processing and filing/charting)

Skills:

Nasco, OLI, RCOE, Navinet, RAS/RASI, Summit, Affinity, SMS, Xactimed, Chase Receivables Edge, Healthport, Medisoft, Microsoft Suites, Contract Manager, Cerner, PBAR, ViWeb, Accupost, ICD9/CPT coding, Internet Research, Light to heavy typing, Outstanding telephone etiquette, excellent problem solving skills

Certifications:

HIPPA Compliant, OSHA trained, CPR Certfied

References Available Upon Request

Contact this candidate