Customer Service Manager
Resume:
Cherese Foster
Stone Mountain, GA 30087
(Cell) 404-***-****
Email:*************@*****.***
OBJECTIVE
To obtain a position that will enable me to utilize my strong organizational skills as an experienced Payment Review Analyst, Collector, Appeal Specialist, Contract Specialist, Patient Account Representative,Underpayment Analyst and Denial Management.
QUALIFICATIONS
Over 12 years’ experience in business office functions, contract analyst cash posting, administrative, collections, appeal letter writing, customer service and billing.
Working directly with: Dispute Manager, Dispute Supervisor, Patient Finance Manager and staff with daily responsibility to ensure reimbursements are properly paid and posted to correct accounts accurately and timely, also providing knowledge of EOB information for Non-Government, Government and Managed Care payers.
Addressed correspondence, confidential reports according to HIPPA regulations.
Written Appeal Letters and Reconsideration Letters for all underpaid claims.
Handled all patient accounts with co-pay, deductible information, overpayments and refunds.
Demonstrates analytical skills, communication, written, and knowledge of Managed Care contracts and adjustments.
Accustomed to meeting deadlines, resolving issues and escalating payer trends efficiently.
Strong knowledge of medical terminology, ICD-9 coding, policies and procedures.
Strong computer skills including detailed knowledge of MS Office, Word, Excel, Ecare, Outlook, various E-Mail and Internet Applications.
Detailed oriented. Accustomed to working in a structured and fast paced environment.
Proficient in IMACS, On Demand, ACE, Visual Info, Star Navigator, and Pbar.
DEI, Host, Artiva, Erequest, Web Discrepancy Tool
Encore, Image Freeway, Wiki
Trained new employees
PROFESSIONAL EXPERIENCE
PSA-Pediatric Services of America –2015 Present
Working and collecting delinquent A/R accounts.
Documenting collection efforts in Encore to include payer contracts, Issues, action taken.
Identify and work all types of denials from all payers.
Keeping team lead /supervisor, and location personnel informed of any collection payer or processing issues.
Submitting adjustments in an accurate and timely manner.
Ensuring claims are refilled and or billed to insurance in a timely manner.
Reviewing and responding to correspondence received from payers which need technical appeals. Work rejection reports, denials, files appeals, re-file claims and patient billing.
Transmitting claims with multiple insurance web portals.
Parallon Business Solution
2014-2015
Resolves underpaid claims from various Payer products including Managed Care HMO, PPO Products, Commercial, Non-Government and Government Payers.
Responsible for second validation of claims from Contract Modeling and logging Departments.
Contact Insurance companies via phone or review correspondence and Initiate request for payment.
Calculating expected reimbursement for claims and submitting dispute letters for the underpaid charges.
Escalating contract or trended issues to upper management.
Conifer Health Solutions (The Company new name)
Appeal Writer Specialist (Denial Claim Management)
2005-2013
Responsible for validating dispute reasons following Explanation of Benefits(EOB) review, escalating payment variance trends or issues to National Insurance Center management, and generating appeals for denied or underpaid claims.
Ensures coding in DCM is accurate and reflects the denial reason.
Coordinate with the Clinical Resource Center (CRC) for clinical consultations or account referrals when necessary.
Generate an appeal based on the dispute reason and contract terms specific to the payer.
Follow specific payer guidelines for appeals submission.
Escalated exhausted appeal efforts for resolution
Tenet Healthcare Regional Business Office
1999-2004
AR Contract Specialist
Responsible for reviewing contracts from all managed Care providers and insurance carriers.
Responsible for requesting secondary bills and changing financial classes.
Verified Lockbox and post payments to all accounts.
Reviewed and researched discrepancies in contracts and reimbursements.
Help construct the contract adjudication systems through thorough contract canalization.
Utilize Med Asset (IMACS) contract application for verification of proper contractual write off.
Perform duties as a Payment review analyst.
Bill secondary payers weekly on all Non-Government accounts.
Assist in training new employees.
EDUCATION
Degree Program: Fairleigh Dickerson University- East Rutherford, New Jersey
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