Customer Service Medical

Darya D. Sanders

**** ****** **** ******* **** Apt 3551- D

Doraville, Ga. 30340

Phone: 404-***-**** Email: *****.*******@*****.***

Professional Summary:

I am a well-seasoned medical professional whom is Self-motivated, dependable, loyal, and very reliable. Becoming skilled in every aspect of the medical office has allowed me grow into being an awesome team player and a great asset to the medical office. Problem solving and troubleshooting issues are some of my stronger points and I work very well under pressure. I always give a 110% and insure that my tasks are done quickly, proficiently and accurately. Throughout the years I have gained experience in my profession by starting off as a front desk coordinator and working my way up to greater positions such as front office coordinator, billing manager, patients account representative, Patient financial consultant, medical administrative assistant and front/back office medical assistant. I am a fast learner and I am always eager to learn new things.

Experience:

Pediatric Services of America

Account Receivable Collector: Contract to Perm 03/2015- Current

Responsibilities

Works and collects delinquent A/R accounts

Documents collection efforts in Encore notes screens to include payer contacts, phone numbers, issues, actions taken, etc.

Maintains current AR at an acceptable percent.

Maintains DSO at an acceptable level.

Achieves cash goal on a quarterly basis.

Keeps supervisor, and branch location personnel informed of any significant collection payer or processing issues.

Submits adjustments in an accurate and timely manner.

Requests Bridge Tickets to correct and update Encore.

Works with Biller to ensure claims are refiled and/or billed to the second insurance in a timely manner.

Understands payer specific requirements for submitting claims (i.e. includes CMN's, nursing notes, invoices, etc.).

Understands and enforces SOX 404 controls

Reviews and responds to correspondence received from payers.

Reviews and submits guarantor statements as required. Responds to questions from patients

regarding statements.

Addresses denials in an accurate and timely manner.

Completes document request forms and forwards to location as required.

Provides exceptional customer service

Payments MD

Accounts Receivable Rep: 90 Day contract 05/2014- 04/2015

Responsibilities:

Responsible for the timely submission and payment of claims.

Follows up on delinquent third party claims until they are paid, denied or written off.

Interacts by telephone and/or mail with third party carriers, provider representatives and patients relative to claims processing.

Processes and resubmits claims when necessary, utilizing a variety of EDI technologies and relevant billing systems.

Completes account receivables report. Reviews, troubleshoots and resolved assigned aged accounts receivable reports.

Reviews, troubleshoots, and remedies credit balance report and requests approval for refunds when appropriate.

Completes contractual adjustment report and posts adjustments to patient accounts as appropriate.

Reviews and determines whether denied claims were properly adjudicated and performs

the appropriate follow-up actions.

Sorts, prepares and processes incoming insurance correspondence.

Maintains detailed documentation on individual account activity such as correspondence, phone conversations, and the like.

Responds to third-party inquiries and reports.

The Blood and Marrow Transplant Group of Georgia

Patient Financial Advocate: 90 Day contract 12/2013 – 02/2014

Responsibilities:

Follow up on A/R reports, Collection letters

Medicaid/ Medicare and Other commercial HMO UB92 billing

Obtain referrals for Medicaid and Commercial HMO policies

Prior authorization for DME and medications

Insurance verification

Appeal letters

EMR, ATHENA

Plastikos Plastic and Reconstructive Surgery Center

Front Office Coordinator/ Patient Account Rep 09/2012 - 12/2013

Verify insurance, consult and explain coverage and responsibility to patient

Schedule appointments, Pre-certs and prior auths for surgery, collect co pays

Charge entry

Post EOBs, patient payment posting, batch balancing, post deductibles, co pays, and zero payments, balance transfers, process refunds and over payments.

Process all insurance claims, denials and appeals, adjustments, write offs, and referrals for resubmit.

Daily EDI transmission and retrieval of electronic claims and re-bills. HCFA and UB04 and workers compensation claims

Schedule Labs, x rays,and ultrasounds, dispense and call in prescriptions, triage patients

EMR, NEX TEC

Trilogy Health and Wellness 10/2010-07/2012

Billing Manager: Contract

Verify insurance, Financial Consults for new and existing patients

Post charges and apply co pays

Follow up on insurance claims

Send invoices to patients with balances

Check in and check out, medical records

Lab draws and triage patients

Copy checks and deposit slips for bank drops

Medical records

Post insurance payments

Schedule appointments

Pre-cert office procedures

Credential new Doctor, Accounts payable and account receivable

Pain Specialist Corporation 8/2008 - 5/2010

Medical Administrative Assistant

Check in and check out

Collect co pays and co-insurance

Schedule appointments

Verify insurance: Obtain referrals for Medicaid, Tricare, and HMO commercial insurance

Pre-certs for surgical procedures

Obtain medical records, X rays, and MRI

Order office supplies, Accounts payable and receivable

General office duties:

Medical records request: Send invoices, collect and log payments, obtain medical records consent forms, submit records

Workers compensation claims: Obtain referrals and authorization from adjusters, make sure adjusters receive updated medical notes

Triage patients: Vitals, weight, prescriptions, UDS (if needed), make sure correct procedure forms are on chart if patient scheduled health assessment.

Billing: enter and apply charges. and EOBs

Center for Pain

Front Office Assistant 11/2006 – 4/2008

Check patients in and check out

Verify insurance

Schedule appointments

EMR

Enter patient demographic and ensure that all patients information is updated

Obtain insurance referrals for Tricare, HMO, workers compensation, and patients with Attorney Liens

Schedule, send invoices, and collect payments for depositions and medical records

Assist billing department with aging reports, collections, and posting EOBs collect co pays, and post them to patient account, Enter charges

Triage patients

Obtain medical records, X ray, MRI, and referrals, and medication history for new patients

Counsel and screen new patients

General office

Print batch sheets, separate patients by insurance, self-pay, turn all money in to office manager and submit claims to insurance company.

United Family Medical Center

Front Desk Receptionist 08/2005 - 10/ 2006

Check in and check out

Verify insurance

Obtain insurance referrals for patients: if we refer a patient make sure patient has a valid referral and send medical notes to the physician’s office.

EKG and X rays, Phlebotomy: blood and urine specimens, finger sticks for glucose test

Triage patients: vitals, and health assessment

Collect co pays and post to patient accounts, Apply charges, Assist billing department with aging reports

Schedule lunches with drug representatives

Set up home health, physical therapy, lab test, etc.

St Francis Hospital 1/2001 - 5/2002

Phlebotomist

Collection of blood and urine specimens, Label and process samples

Venipuncture, capillary, and finger sticks, Glucose test, timed blood test, paternity, drug and alcohol test

AAFES 2/1997 – 1/2001

Customer Service Representative

Sales of store merchandise, Layaways, returns, adjustments, rain checks

Process store credit card applications and payments

Distribute cash registers to cashiers, Count registers and enter into logs

Education:

Georgia Medical Institute 1/2005- 8/2005

Billing and coding

Columbus Technical College 8/2000 - 1/2001

Phlebotomy

Carver Sr. High School 8/1994- 6/1996

Interpersonal Relations

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