Insurance Management

Sheila Brown

**** ***** ****

Upper Darby, PA ***82

267-***-**** ************@*****.***

Professional Summary

Billing Representative Professional with over 20+ years of experience in providing an innovative approach to all types of billing issues. A creative thinker who can analyze any and all situations in assuring bills are paid in a timely manner while maintaining the patient relationship. Able to determine trends and issues and provide a variety of solutions to Senior Management. A highly organized individual with strong ethical standards.

Professional Experience

Children’s Hospital of Philadelphia, Philadelphia, PA 1992 - 2013

Billing Representative

Processing of all hospital bills as well as the follow-up process. Analyze trends to determine issues for possible work processing changes.

• Processed manual bills to approximately 30 commercial insurance carriers and electronic billing to all HMOs for submission utilizing various systems.

• Monitored edits for trends and issues and report finding to billing management team.

• Documented billing activity on patient accounts in EPIC to ensure hospital compliance and federal regulation (HIPA).

• Researched and resolved all Explanation of Benefits (EOB) cases that were rejected as well as other issues on outstanding accounts.

• Monitored and researched all unpaid claims and resolved the majority of cases.

• Submitted secondary claims upon processing of patient’s primary insurance.

Osteopathic Medical Center of Philadelphia, Philadelphia, PA 1989 - 1992

Inpatient Biller

Responsible for processing all inpatient billing as well as resolving patient’s concerns on outstanding issues.

• Processed all Medicaid, HMO and commercial carriers both electronically and manually. Interacted with both insurance carriers and patients.

• Handled all correspondence from insurance companies.

• Maintained database on a consistent basis as well as keeping all patient demographics current.

• Ensured all financial records met appropriate confidentiality requirements.

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Education

Community College Of Philadelphia (Associates Degree) 1991 - 1993

Technical Skills

Knowledge of: Premis, EPremis, IDX, SMS, NEIC, Claims Logic, EMC, Payer Websites, MS Excel, Epic

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