Customer Service Medical
Resume:
JEANIFER MCGOWEN
Highly skilled, knowledgeable, and proficient Medical Biller bringing extensive, specialized experience working in medical billing, collections, patient accounts management, and customer care capacities throughout hospital and independent medical billing environments. Recognized for a proven ability to efficiently process medical claims for major and private insurance carriers including HMO/PPO, Blue Cross/Blue Shield, Medicaid and Medicare
* Highly skilled with a demonstrated knowledge of medical terminology, ICD-9/CPT codes, No Fault, and Worker’s Compensation claims. Molina Billing, United Health Care Billing, Medicaid and Medicare,Blue Cross and Blue Shield
* Keenly recognize, investigate and resolve discrepancies leveraging extensive experience going through appropriate channels to facilitate medical claims review and appeal processes.
Medical Office Management
Personnel Management . . . Inventory Control/Purchasing PayRoll and Processing /Distribution . . . Accounts Payable/Receivable . . . Budget Control . . . Policy/Procedure Development . . .
Special Project Coordination . . . Patient/Physician Relations . . . Regulatory Compliance
Accomplished and innovative claim analyst, consistently recognized for effective operations and client relationship management and ability to develop sales and marketing strategies, delivering profitable solutions to attract and maintain accounts and customers, and propel company growth. Proactive with excellent interpersonal and communication skills, experienced in working with different personalities including clients and vendors as well as working on own initiative.
Possess admirable clerical skills to maintain an organized and functional business office
Documented success in progressively dynamic and challenging positions, with working knowledge of health insurance
Can learn proficiently and quickly specialized software applications/servers, Operates Facets and Macess like systems
Effective in collecting on aged accounts and obtaining maximum reimbursement
Experienced with medical terminology, CPT and ICD-9 coding, with continuance of education in field
PROFESSIONAL EXPERIENCE
A&C HEALTHCARE SERVICES INC
Office Manager -MEDICAL BILLER
OCTOBER 15 20008 – AUGUST 2011
Status account and document all work performed in the company and client computer systems.
Assess accounts to determine the next appropriate course of action in line with company policies and procedures.
Place outbound calls to insurance companies, guarantors, patients, doctors’ offices and/or facilities and handle incoming calls as necessary utilizing proper customer service protocol.
Process related correspondence from insurance companies and perform pertinent follow-up.
Reconcile balances and payments between insurance companies and clients computer systems.
PROVIDER SUPERVISOR MARCH 08, 2012- February 2013
Correcting any processing errors on complex claims to render full payment, documenting occurrences in customer’s file accurately
Monitored Aged Accounts Receivable, line by line, submits balance to appropriate payer.
Patient and Insurance balances accurately are dropped to appropriate carriers with cash application programs
Performs thorough insurance verification to determine accurate payer, understanding coordination of benefit rules
Applies explanation of benefits statement to correct claims, open account receivables, and interprets to customer with accuracy.
Maintains productivity and quality at high standards at 70 accounts per day to increase efficiency in denials team
Respond to, handle and resolve customer inquiries
Provide customers with product and service information
Process orders, forms and applications
Identify and escalate customer issues
Handle customer billing questions
LIVELONG HEALTHCARE
Billing Manager AUGUST 15 2011- PART -TIME
Inputs client/patient data accurately, identify, and resolve inconsistencies and billing complaints
Verifies patient eligibility and verification before rendering services
Intake of new patients and referral, provides discharges notification to patient and other fellow correspondences
Billing Medicare/Medicaid and managed care organizations with accuracy. Informing Billing Supervisor or CEO of any changes.
Responsible for appealing underpayments and technical denials within each payers contractual guidelines and government regulations
Obtains responsibility for obtaining accurate patient account information as defined by registration procedures
Constantly challenging self -improvement by reviewing quality and adhering to policy standards
Ensures number of visits paid according to recap sheet is matched with the verified number of visits in the computer billing program, and the notes in the computer billing program are matched against the clinical record
Overview of chart records on a day to day basis to ensure compliance with JACHO regulation
OTHER HOME HEALTH BILLING
KAPPA HOME HEALTH SERVICES
SOUTHLAND UNITED HEALTHCARE SERVICES
FEATHERLAND HEATHCARE
SPRINGWELL HEALTHCARE
EDUCATION
Medical Insurance Billing and Coding, Diploma, Everest Institute 2005
CERTIFICATION
MEDICAL BILLING AND CODING 2008
Skills
Claims Processors
Data Entry Specialists
Claims Adjusters
Customer Service Representatives
Annuity Specialists
Provider Relations Specialists
Supervisors & Team Leads
Risk Management Professionals
Prior Authorization Specialists
Claims Auditors
Policy/Application Processors
Enrollment Specialists
Eligibility Specialists
Member Services Representatives
Intake Coordinators
Case Managers
Reinsurance Analysts
In-Home Assessment Clinicians
Provider Reimbursement Specialists
Member Service Representatives
Auditors
Professional References
Mayra Marquez 832-***-****
Tiffany Williams 832-***-****
JEANIFER'S MEDICAL BILLING AND CODING
HOUSTON,TX
Here to provide your company with affordable Billing and compliance with Medicare and Medicaid rules.
What billing do you need
Medicare
Medicaid
Blue Cross Blue Shield
Amerigroup
United Health Care
Molina
Aps
DDE systems
and many more
call for
Contact this candidate