Medical Insurance Collector
Resume:
Marlena Gardner
Houston, TX 77006
*******.*********@*****.***
www.linkedin.com/in/marlenagardner
PROFESSIONAL SUMMARY:
I am a skilled and experienced Revenue Cycle Specialist, with extensive knowledge of medical coding & billing practices. I have experience billing freestanding ER physician and facility billing, coding and collections. I am proficient in billing through the collections process, with specialties such as, workers compensation, third party, commercial insurance company and government programs, refunds and reimbursements. I am both confident and poised in interactions with individuals at all levels, and extremely versatile when it comes to handling any challenges that come my way. I am most comfortable working in a fast paced environment. I have strong and efficient organizational skills. I am trustworthy, ethical, dedicated, and professional.
CAREER HIGHLIGHT:
I single handedly conducted an investigation outside of assigned job duties and initiated an investigation with Aetna Insurance into the processing of Aetna patients claims to address claims that were being paid incorrectly for the 2yrs prior to my hire. I wrote a letter to TDI and Aetna, when Aetna would not reprocess claims on my many requests. My appeal was to have all claims for the prior two years, under the company tax id to be reprocessed. A hearing was held, which led to Aetna being found liable. Aetna had to reprocess all claims and a lump sum payment was issued to Endeavor Medical Systems due to the investigation, in the amount of $192,000.
SKILLS:
Microsoft Office (all versions), PowerPoint, Excel, EMR, Intergy, Medisoft, Mysis, Allscripts, Payerpath, Realmed, Dentrix, Facility and Physician, Emergency Room Billing, Patient Payment Resolution, Scheduling, Scanning, Secondary Claims, Medical Records Management, Insurance Collections, Referrals & Authorization, Charge Entry, Insurance Verification, C.O.B., Aged Accounts, Payment Posting, Refund Requests, Medical Terminology, Denial Follow-up, Appeals, Data Entry, Medicare, Medicaid, Workers Comp, Third Party, EOB Follow-up.
EXPERIENCE:
Endeavor Medical Systems, Houston, TX, Aug 2009 to Nov, 2014
Medical Revenue Cycle Specialist/Billing & Collections/Support
Manage the clients A/R for Free-standing Emergency Room. Create a positive and caring image of the billing department for the facility, and still maintain high revenue. Take ownership of the accounts. Follow up on all primary and secondary unpaid claims. Ensure timely billing in accordance with established internal and third party payer requirements. Run and work the aging and delinquent reports. Update claims with correct insurance information and re-file claims. Appeal claims with documentation. Work with the coding department to ensure proper billing. Properly document accounts with action taken on the claim. Negotiate with insurance to have improved positive impact on cash flow. Answer all client and management emails within the expected time frame. Review of delinquent reports. Report to management any issues or concerns that may impact cash flow. Help in the education of the clients. Have open communication via email or phone with the clients and patients. Manage patient accounts. Perform all other tasks consistent with the goals and objectives of this position. Provide training to new employee’s and assist with in introduction to the company.
Kidney Associates, Houston, TX, 09/2008 – 03/ 2009
Patient Account Specialist
Investigate aged accounts, verify insurance, improve collection returns, and execute all appropriate follow-up. Contact insurance plans to resolve unpaid claims. Obtain prior authorization. Appeal claims as necessary. Data entry, payment posting, patient demographic entry, and other related information. Investigate and process refund requests. Review EOB’s and electronic claims reports for resolution/follow-up. Reconcile outstanding and aged patient accounts. Manage patient check-in/out, and scanning. Schedule and confirm patient’s diagnostic appointments, surgeries and medical consultations.
M & J’s Drive Inn, Houston, TX, Night Manager, 01/1999 to 01/2008
Manager/Supervisor
Directly in charge of staff recruitment, interviewing, hiring, training, and scheduling. Supervised 3 employee’s in day to day operations. Oversee all operations including but not limited to shift organization, cash and stock management, and customer service. Responsible for generating and maintaining daily revenue reports, ordering stock, open and close balancing of the books and inventory control. Order all supplies and was the primary point of contact for all vendors. Organize and executed specialized fund raisers and other promotions.
Trans Pacific Stores, Houston, TX, 01/1985 to 01/1986
District Managers Assistant/Administrative Support
Assist District Manager in all functions of day to day operations of District office. Process invoices for payment, code and batched invoices, attended to accounts payable’s and accounts receivables. Correct data entry of employee’s information weekly. Perform random cash/sales audit’s for 25 retail service stores. Assist in all open preparations for new stores along with all final closing procedures for closing stores. Responsible for all physical inventory and was primary contact for interaction with all vendors.
McDevitt & Street, Houston, TX, 1984 to 1985
Jobsite Receptionist/Secretary
Work with the Senior Project Manager to provide any and all clerical support. Work from jobsite trailer on construction project and provide the following team services: maintains job site files; answers phone, handles calls or takes messages; matches invoices/delivery ticket, assists with payrolls, including certified payroll; processes pay applications; coordinates meetings, inputs daily job logs; scans submittals; and maintains project contract logs by keeping track of contractual obligations such as contracts, insurance. Run all errands and other duties given by Senior Project Manager. Assist with end of month billing.
EDUCATION:
Texas School of Business, Medical Office Specialist, Vocational, Certificate, Houston, TX
Houston Dental Assistant School, Dental Assistant, Vocational, Certificate, Houston, TX
American Career Academy, Word Processing, Vocational, Certificate, Houston, TX
Tech High School, General Studies, Indianapolis., IN
SPECIALITY SEMINARS:
Nephrology Billing Seminar, Houston, TX
Medicaid Billing Seminar, Houston, TX
Medicare Billing Seminar, Houston, TX
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