Customer Service Insurance
Resume:
Exes Hankerson
Snellville, GA 30078
********@*****.***
PROFESSIONAL SUMMARY
Ability to work harmoniously with Hospitals, Physicians, Customers, Vendors and Members. Strong and articulate communicator. Ability to oversee complex projects from concept to completion while ensuring project deadlines are met. Organized and detail-directed problem solver a high degree of self-motivation, versatility, flexibility and extensive knowledge of the Healthcare revenue cycle.
15 years of experience with hospital and physician billing and collections.
TECHNICAL SKILLS
*Epic Hospital and Physician Billing *Anasazi Central, E-Clinical, MMIS HP Portal
*Cerner, PMB (Pharmacy Benefit Manager System) *Athena, Navicure, Availity, Healthland, Navinate
*NextGen, EMP, EMR, HDX, SSI, FSSI (DME), CPSI *A/S 400, Nebo, EFR Manager, Emedeon
*SharePoint, Prebill, Loxogon, Healthport *Microsoft Office Suite, Medical Manager
*BMS Oracle, IDX, Medisoft, Xactimed *Florida Shared Systems, Invision (SMS)
*Medicaid and Medicare DDE, CT Vision *Smart Systems, Quadex, Med Assets
*E-care, Medical Manger, Health Logic *Profit & Pivot Tables System
*EPremis, Citrix, Passport, Sequoia, Group-wise, Eagle System
*Siemens Document Imaging, Siemens Medical Solutions (SMS), Siemens Soarian
*In-Vision, SNF, Amisys, Provider Complete, McKesson- HBOC, STAR
CORE COMPETENCIES
*Hospital and Physician’s Revenue Cycle *Professional, state, and federal compliance
*Hospital & Physician Billing (UB04 & 1500 claims) *Proficient with Hospital and Physicians Eob’s
*Insurance claims and collections (UB04 & 1500 claims)
*Strong Knowledge of medical terminology, correcting claim edits and denials.
*Accounts Receivable (A/R), Medicare, Medicaid, Commercial, HMO, PPO, POS, CMO’s
EXPERIENCE
Avery Partners Temporary Staffing Children’s Hospital of Atlanta
Medicare Billing Specialist 10/15- Present
*Verified insurance for all patient admissions for Commercial and Government insurances.
*Ongoing education regarding changes concerning rates, procedure codes, policy changes, and authorizations.
*Responsible for billing Insurance claims for inpatient, outpatient and pharmacy claims. Provide written correspondences on remittance denials, additional information letters (ADR) and review EOB’s.
*Responsible for performing Medicare audits, patient charts audits, and daily patient reconciliation.
*Responsible for coordinating resolution of patient complaints, late postings, adjustments, credits, and explanation of services rendered.
*Identifies weekly rejection reports, maintaining log medical necessity, and production with location Director.
*Transcribing and managing patient care orders, processing admissions, transfers, and discharges.
*Provide secretarial and administrative support to Location Director, and Clinical Director.
*Correct my own edits from Clearinghouse
*Liaison Reports
*Face to Face interaction with patients.
Expeditive Healthcare
100% Healthcare Traveling Consultant/Remote 06/15-10/15
*Worked EOB's resolving non-payment and short payment issues. *Updated patient insurance information into the computer
*Updated patient insurance information into database.
*Identified and processed any necessary adjustments to claims.
*Responsible for re-files and/or resubmissions of worked claims.
*Processed Medicare insurance claims using HCFA 1500 and UB UB04 claim forms.
*Posted payments and adjustments from insurance EOB. Processed claims correction in Medicare Florida Shared Systems
*Worked Denial Management Reports for bundled, non-covered, and not medically necessary procedures.
Advanced Bottom Line Management (ABLM)
100% Healthcare Traveling Consultant 08-2014- 3/2015/ ER Patient Registration Specialist
Wake Forest Baptist Hospital
*Efficient with Emergency Room & admissions and outpatient ancillary registration and physician’s billing and Hospital billing using Epic system
*Worked on hospital Epic system with concentration on registration, claim edits, financial clearance, and work queues in in all departments
*Focus on helping correcting NPI, insurance, and demographic errors.
*Obtained authorizations, verified patient eligibility, to help facility with clean claims
*Greeted patients and entered all the patient demographics in the hospital system –Assisted with patient admissions.
*Requested patient Form of ID and their Insurance card s to be scanned into system.
*Verified eligibility and benefits for patient insurance coverage.
*Requested medical history from patient
*Informed all new medical cases to the nurse on call.
*Making decisions based on confidentiality.
*Obtained signatures and HIPPA forms
*Gathered information from patient’s family/care taker/ friends if patient was severely injured.
*Communicates hospital's financial policies to all patients. Identifies patients who require early financial counseling intervention
*Collected on self-pay accounts, co-pay, and deductibles, Documents financial arrangements.
*Maintains thorough understanding of insurance, registration, scheduling, referrals, authorizations, and account follow-up.
Piedmont Healthcare
Patient account Follow-up rep II 12/2011-01/2014
*Research and collect on facility & professional charges billed for different types of Specialties/Physicians.
*Follow-up with insurance companies for improper payment for incorrect denials, payment dates, and tracking resubmissions.
*Monitor and work high dollar accounts until complete payment is received from the insurance.
*Follow-up with patients when necessary to inform of incomplete or missing insurance information.
*Process charge corrections, file appeals, & post proper contractual adjustments when needed.
* UB04 and HCFA 1500 claims billing and processing.
*Able to interpret Medicare, Medicaid, Commercial, CMO’s insurance explanation of benefits (EOB’s) and Post payments and contractual adjustments.
Promise Healthcare
Medicare Biller Rep Aug. 2005- Nov 2011
*Responsible for the primary, secondary, and tertiary billing, collection and resolution of Medicare accounts for inpatient and outpatient claims for the hospital and physicians.
*Coordinate re-billing and adjustments of accounts based on Medicare responses and hospital audits.
*Attend Medicare and other government billing and follow-up compliance training to support the changing environment, high quality, productivity, performance and ongoing departmental development.
*Manage and achieve high clean claims billing pass rate, low discharge not final billed claims, low discharge not final submitted claims, and high collections and low accounts receivable days outstanding.
*Post and reconcile insurance payments, research and resolve incorrect payments and contractual, EOB rejections, and other issues with outstanding accounts.
*Extensive experience with contacting Medicare regarding denied claims.
*Correcting claims on the Medicare Florida Shared System
Holy Cross Medical Group
Patient Care Specialists May 2003- June2005
*Responded to members/providers questions via telephone and written correspondence regarding insurance benefits, provider contracts, eligibility, and claims.
*Analyzed problems and providers information/solutions.
*Provided superior quality outcomes by taking ownership of customer service and claims to ensure timely resolution and follow-up.
*Excellent knowledge of hospital and professional claims and products, including the grievance and/or reconsideration process.
*Familiar with government regulations, coordination of benefits, and healthcare terminology.
*Customer Service/Call Center experience.
*Adjusted denied claims for payment after careful review.
*Strong verbal communication skills including active listening.
EDUCATION
Dillard High School 1979-1982 Diploma June 7, 1982
Capella University 2013- present
Pursuing a Bachelor’s Degree in Business Management (Medical Office)
References upon request
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