Customer Service Medical
Resume:
Lisa M. Murray
************@*****.***
Charlotte, NC 28214 704-***-****
EDUCATION: BENEDICT COLLEGE
Columbia, SC
Political Science
SKILLS: Microsoft Word and Excel
Experienced in Allscripts and EPIC Revenue Cycle Software Knowledge of benefits & eligibility determination
Knowledge of Medical terminology
Knowledge of Medical coding
Knowledge of records storage, retention and disposal regulations
Utilization management experience
Database development and maintenance
Customer service experience
Grant writing experience
Front desk operations experience
Staff management and training experience
Policies and procedure manual development and implementation
Claims and provider contract research both HMO and PPO
Federal and state insurance HIPAA, COBRA & ERISA mandates
EXPERIENCE: NOVANT MEDICAL GROUP 2009-Present
Charlotte, North Carolina
Physician Office Manager II
Manages, supervises and coordinates all functions and activities related to the operations of two small physician practices
Create and manage an annual budget according to Novant Health’s guidelines
Successfully manage two clinics with a total of six providers and fifteen employees
Carry-out the policies that are governed by Novant Health
Onboard new providers and employees to the clinics
Act as a liaison between Novant Health administration and providers
Maintain a lucrative revenue intake for both clinics
Insure that all federal mandates are met within both clinics
Revenue Cycle Advocate
Act as a liaison between various clinics and the Central Business Office
Maintain the Accounts Receivables for assigned clinics
Providing Clinic Management as well Operations Directors with Denial Management Solutions
Act as a Patient Customer Service liaison
Assessing staffing needs and interviewing applicants to fill open positions within the clinic’s front desk
Providing job performance feedback for employee annual reviews
Complete financial and social assessment for Novant Charity care approval as well as other community aid organizations
Establish payment arrangements for services prior to patient appointments
Track and trending issues in Epic and executing a plan of resolution
Creating and implementing workflows for the Front Office staff in an effort to lower the Insurance Denials Metrics
Providing training to Front Office staff and updating them on any procedural changes
Monitoring Financial Work queues in EPIC and provide feedback to management on the concentrated effort of lowing their volume(s)
Tracking and trending errors made within the clinic and submitting training requests based upon the most often seen mistakes
Creating, distributing and interpreting reports for various clinics in an effort to achieve lucrative revenue
Acting as a liaison between government payors including Medicaid. Medicare, Champus Tricare and VA Fee Basis services
PROMOTED TO THE ABOVE POSITION
Patient Accounts Representative III-Estates and Bankruptcies
Provide billing support to decedent survivors and individuals that have filed bankruptcy
Assess and correct all invoices for any billing/coding errors
Filing the necessary liens to estates with the survivors and Clerk of Superior Court for the applicable county of residency
Filing the necessary documentation in the PACER Website for any Bankruptcy cases
Performing the necessary insurance denial follow-up on any unpaid claims
Making the appropriate account write-offs for any unpaid balances
Contacting estate administrators and attorneys for any information request or case updates
Notifying guarantors of any changes to the financial balances in Bankruptcy cases
Providing any written documentation requests to trustees and guarantors in Bankruptcy cases
PROMOTED TO THE ABOVE POSITION
YOUTH HOMES INCORPORATED 2007-2009
Charlotte, North Carolina
Records Manager
Manage the storage and distribution of protected client information in an HIPAA and Medicaid compliant environment
Supervised and trained the Medical Records staff as well insuring entering payroll and vacation benefits information
Execute the initial client intake registration process to insure necessary documentation for the initial Medicaid, IPRS/Local Management Entity funding as well as the concurrent authorizations
Reconcile and post payments received from Medicaid
Maintain the cost containment/referral process for Medicaid as well as private insurers
Filing Medicaid consumer commercial insurance claims
Create client charts after the initial intake process
Manage and schedule monthly chart audits and reviews
Process internal and external client chart requests
Organizational lead for HIPAA law amendments
Create and maintain a database to track and trend client funding authorizations
CIGNA HEATLHCARE CORPORATION 2000-2006
Charlotte, North Carolina
Appeals Intake Specialist 2005-2006
Audited and processed electronic correspondence within a highly-sensitive timeframe for review
Processed member and provider appeals according to diverse compliance regulations
Processed member Quality of Care and Service concerns
Reviewed claims/appeals for provider contract disputes
HIPAA Analyst 2003-2005
Performed several tasks that were all associated with protecting member healthcare information base upon Federal HIPAA regulations
Retrieved and prepared member medical records upon request
Created and maintained a privacy address database
Evaluated and executed Power of Attorney and Personal representative requests
Appraised requests to access, restrict and amend Protected Health Information by members
PROMOTED TO ABOVE POSITION
Claims Gatekeeper 2002-2003
Reviewed and researched electronic claims and correspondence for proper handling and resolution
Implemented workflows for the proper handling of escalated claim adjustments
Prepared and distributed daily as well as monthly claim tracking reports
Trained other gatekeepers of system enhancements and new processes
Maintained a balanced workload for the Work-at-Home staff
PROMOTED TO ABOVE POSITION
Customer Service Associate 2000-2002
Provided customer service to both members and providers by telephone
Quoted medical, dental and vision benefits
Prepared claims for electronic processing
Scanned and properly routed Claims Unit correspondence
Prepared Healthcare Reimbursement statements upon
PROMOTED TO ABOVE POSITION
GREENVILLE PHYSICIAN’S IMAGING
Greenville, South Carolina
Medical Office Assistant 1998-2000
Provided many front office medical and financial duties
Scheduled patient appointments
Verified insurance and obtained pre-authorizations from insurance providers
Retrieved and prepared medical records and x-ray films for review
Electronically billed claims for review
REFERENCES: Available Upon Request
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