Customer Service Representative

Genia Williams

*** * ***** *** #*** Phoenix, AZ *5020 702-***-****

**********@*****.***

Experience:

**/****-******* ***** ****** Services Phoenix, AZ

Medicare/Commercial billing and collector

• In the Kinnser System and First Health systems bill with proper CPT & ICD9/ICD10 codes, collect, and post A/R payments for all therapies and nursing charges.

• Obtain prior authorization for commercial insurance companies.

• Backup for the intake department.

• Ensure prompt and timely payment and escalated issues as necessary. Evaluate payments/denials received for correctness and ensures that they are applied appropriately.

• Identify bad debts write-offs and A/R adjustments. Initiate write-offs and adjustments in accordance with policies and procedures. Ensure that secondary bills and patients invoices are accurately generated and submitted on a timely basis.

• Identify any overpayments and duplicate payments implemented the proper investigates and resolved issues as well as make necessary claim corrections for resubmission.

• Identify invoices for certain payers and post invoice to correct ledger.

• Identify denials and made proper corrections in the ZirMed electronic billing system.

• Send appeals letter on claim denied incorrectly as well as claim follow ups.

01/2015-10/2015 Assisteo Home Health Phoenix, AZ

AR Specialist (contractor)

• In the Kinnser System bill with proper CPT & ICD9, collect, and post A/R payments for all therapies and nursing charges.

• Obtain prior authorization for Aetna, BCBS, and UHC insurance companies.

• Backup for the intake department.

• Attending weekly billing and office meetings.

• Ensure prompt and timely payment and escalated issues as necessary. Evaluate payments/denials received for correctness and ensures that they are applied appropriately.

• Identify bad debts write-offs and A/R adjustments. Initiate write-offs and adjustments in accordance with policies and procedures. Ensure that secondary bills and patients invoices are accurately generated and submitted on a timely basis.

• Identify any overpayments and duplicate payments implemented the proper investigates and resolved issues as well as make necessary claim corrections for resubmission.

• Identify invoices for certain payers and post invoice to correct ledger.

• Identify denials and made proper corrections in the ZirMed electronic billing system.

• Send appeals letter on claim denied incorrectly as well as claim follow ups.

02/2014-12/2014 Walgreens Company Home Infusion Therapy Dept. Phoenix, AZ

Billing/Collections (contractor)

• Worked on excel spreadsheets processing refund requests, in accordance with policies, procedures and payer contracts.

• Ensure prompt and timely payment and escalated issues as necessary. Evaluate payments/denials received for correctness and ensures that they are applied appropriately.

• Identify bad debts write-offs and A\R adjustments. Initiate write-offs and adjustments in accordance with policies and procedures. Ensure that secondary bills and patients invoices are accurately generated and submitted on a timely basis.

• Make any necessary corrections regarding so the ICD9 & CPT CODES correlated to ensure correct payment.

• Identify any overpayments and/or duplicate payments, and investigates and resolves.

• Identify invoices for certain payers and post invoice to correct ledger.

11/2013-02/2014 Optum Phoenix, AZ

Transcriptionist (contractor)

• Entering patient medical files from old system CLM to new system NextGen.

07/2012-10/2013 Health Data Insight Las Vegas, NV

Claims System Analyst

• Review provider contracts for Medicare and Medicaid such as AmeriHealth Mercy, Well Care, Molina along several other government agencies.

• Audit Medicare and Medicaid for overpayment by comparing how provider contracts where being incorporated with the adjudication of the claim.

•Recover overpayments from Medicaid and Medicare for reimbursement due to not following the provider contract or improperly billed CPT CODE & ICD9 during claim processing.

• Develop queries and spreadsheets to research and recover overpayments due to system implementations to auto adjudicate claim payment

• Traveled to Well Care as well as Molina to see how Facets and QNXT systems worked behind the scenes along with learning how to navigate through their system to conduct the proper audits.

04/2011-06/2012 Healthcare Contractors Las Vegas, NV

Benefits Adjustor/CSR (contractor)

• Received inbound from policy holders and physicians’ offices regarding in and out of network medical, dental, FMLA, and vision benefits along with unpaid claim inquiries on the QNXT system.

•Assist physician’s inquiries regarding co-pays, precertification, deductible, out of pocket, along with lifetime maximums.

• Process medical, vision, dental, pharmacy, Medicare Parts A&B and Medicaid claims according to policy and procedures in a timely manner for varies companies under the Loomis umbrella.

• Received, reviewed, and entered prior authorization requests from hospitals, physicians, and DME companies.

• Billing and Collections for Orthopedic physician’s office for 6 month. Filed HCFA forms to insurance companies with proper ICD9 and CPT codes as well as follow up with the insurance companies inquiring unpaid, denied, or claims paid outside of the orthopedic contract as well as sending appeals.

04/2009-03/2011 Clearwire Las Vegas NV

Credit /Retentions Rep

• Received inbound calls from outside sales reps requesting credit checks on potential customers with credit block on their credit reports to unblock and obtain credit score to investigate it the potential customer qualifies to obtain the equipment requesting.

• Analysis of financial information and any other relevant information of assigned customers in order to assess credit risk and make necessary recommendations to the business.

• Build relations with relevant business partners to ensure a smooth cooperation between the Credit department and the business that own the assigned portfolios.

• Add value to the business by consistently improving processes and maximizing cash flow for the assigned portfolios.

• Update customer reconciliations of accounts as well as maintain credit data in SAP.

02/2003-02/2009 Schaller Anderson Phoenix, AZ

Claims Analyst

• Hired as a customer service representative for the Mercy Care Plan an AHCCCS plan where for 11months received inbound calls in a call center environment from physician offices with inquiries regarding claim payments, prior authorizations, encounter denials, coordination of benefits, and Medicare parts A, B & D.

• Advanced to Analyst III position that entailed working closely with the encounter team ensuring correct CPT-4 codes along with ICD-9 codes were billed properly according to services performed.

• Audited dental, catastrophic and behavioral health claims requiring additional payments for incorrect implementation of policies and procedures or adjusting claims accordingly.

• Re-pricing facility and professional claims for the State of Arizona, Harrington and other accounts under HIPAA guide lines on the Eldorado system.

• Fraud and abuse for behavioral health department investigate and research mental and nervous claims as well as provider of services who have been reported for fraud via an excel worksheet along with any and all system alerts we would receive thru an outsider vendor.

Education: 1986-1988 Robert Morris College Pittsburgh, PA

1985-1986 Connelly School of Trade Pittsburgh, Pa

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