Patricia A. Caulley

***** *********** ** 214-***-****

Spring, TX 77379 actehd@r.postjobfree.com

SUMMARY

Highly motivated Senior Medical Biller Collector with successful experience in the Medical Insurance Industry. Also has experience as a dedicated independent contractor. Expertise in coding, contract review, auditing, and billing to optimize reimbursement performance. Proven track record of developing and maintaining effective relations that result in outstanding customer satisfaction. Demonstrated ability to quickly learn and apply new tools to improve speed of reimbursement and improve profitable cash flow. Utilizes strong communication skills to assist other team members and promote a winning work environment. Key competencies include:

Accurate Billing

Insurance Industry Knowledge

Quick Problem Solving

Fast Reimbursement

HIPAA Compliance

Medical Terminology

A/R Report Analysis

Electronic Billing

Mentoring

TECHNICAL SKILLS

MS Application: Microsoft Office, Excel, Word

Tools: Centricity CPP, EClinic, Fast Track, Rams, and GTESS Ten Key Touch.

Skills: ICD9, ICD10, CPT-4, HCPCS, Electronic Billing (Medifax, others)

Insurance: HMO, PPO, Medicare, Workers Compensation

PROFESSIONAL EXPERIENCE

Dignosis Pain & Treatment Center

April -2013 to Present

Billing & Colletion Specialist

Responsible billing and reimbursement the for Pain managerment Responsible for Workers Compensation, HMO, PPO, EPO and Medicare.

Reviewed and corrected billing errors related to CPT & ICD_9 code.

Reviewed remittance advice forms to improve the billing accuracy rate for prompt reimbursement.

Researched the patient records to improve coding accuracy.

Processed and followed-up on third-part collection to ensure timely reimbursement.

Verified billing information prior to electronic claims transmission to minimize payment delay.

Corrected third party coding to ensure prompt payment.

CAREPOINT PARTNERS

Mar 2011-Dec 2012

Reimbursement Specialist

Responsible for the largest and most complex accounts for billing for Hospice and Home Infusion therapy Point person to resolve complicated billing issues quickly. Also responsible for collecting on old account debt sitting inactive for over 1 year.

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Researched the patient records to improve coding accuracy.

Reviewed remittance advice forms to improve the billing accuracy rate for prompt reimbursement.

Researched the patient records to improve coding accuracy.

Processed and followed-up on third-part collection to ensure timely reimbursement.

Verified billing information prior to electronic claims transmission to minimize payment delay.

Corrected third party coding to ensure prompt payment.

Quickly resolved electronic billing issues to minimize hard-copy billing.

Handled billing and collections, denials and appeals, and checked claim status ahead of the filing deadline.

Received performance bonus when quarterly productivity standards were exceeded.

PEDIATRIX MEDICAL GROUP Jan 2009 –Jul 2010

Collection Administrator

Responsible for effective and efficient accounts receivable management of assigned payers.

Performed collections on outstanding accounts with heavy telephone contact with payers and patients for timely reimbursement.

Reviewed and worked the collection reports to improve the reimbursement cycle.

Reviewed correspondences and audited accounts for inaccuracies.

Updated patient accounts to maintain accurate data.

Received performance bonus when quarterly productivity standards were exceeded.

Performed required tasks for electronic billing and also accessed many payer websites.

OFFICE TEAM Feb 2008 –Sep 2008

Medical Collector

Responsible billing and reimbursement the for the client Heart Hospital and the Anesthesiologist. Responsible for Workers Compensation, HMO, PPO, EPO and Medicare.

Reviewed and corrected billing errors related to DRG codes, Revenue codes, CPT codes and Diagnosis codes.

Reviewed claim denials, made corrections, re-filed for fast and accurate reimbursement.

Made heavy daily phone contact with the insurance company for follow-up.

CERGIS BILLING COMPANY Apr 2007 –Feb 2008

Medical Billing Collector

Responsible for collecting on accounts past 120 days from the insurance company for the

the Pain Management and MRI clients.

Collected over $1 million on old accounts the first month on the job earning a performance bonus.

Appealed denied claims for fast refilling and quick reimbursement.

Reviewed diagnosis codes using the ICD-9 and the CPT-4 coding books for improved billing accuracy. Posted payment and billed claims in a timely manner.

PRESTON ROAD SURGERY CENTER Jun 2005 –Apr 2007

Medical Billing Collector

Responsible for the cleanup of old accounts some over 1 year old for the surgery center which were previously thought to be uncollectible.

Successfully collected $1 million dollars of old unpaid accounts.

Re-coded bills using the correct medical codes and refilled for prompt payment.

Called the insurance companies and patients about old unpaid balances.

Accurately posted all payments to the accounts and billed the patients for the balance.

Placed delinquent accounts with an outside collection firm after contacting the patient three times.

Wrote-off the amounts per contract with the insurance company.

EDUCATION

Central Piedmont Community College, 2201 Elizabeth Ave., Charlotte, NC

TRAINING

Medical Coding course at Collin County Community College

Self-Study for ICD-10-CM and ICD-10 PCS

PROFESSIONAL

Member of American Academy of Professional Coders

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