Customer Service Representative

Ms. Trayce L. Walker

PO Box ******

Memphis, TN *8130

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

901-***-**** cellular 901-***-**** home

Career Objective

To contribute to the overall success of a progressive, growth-oriented organization that will benefit from my knowledge and skills acquired through education and work experience, and that will provide me with an opportunity to grow professionally.

Key Qualifications:

Prior team lead experience or supervisory. Possess specialized, advance knowledge of the billing of collections. In-depth understanding of cross-over claims. Knowledge ICD-9CM, and CPT coding and insurance payers.

Working knowledge of Medicare CWF/HIQA, and denial resolution. Follows up on claims using the online Medicare billing systems (FSSO) and other systems as appropriate.

Understanding claim processing turnaround time and potential impacts to collections.

Experience in the appeals, denials, reimbursement process of Medicare.

Serves as the go-to person for answer questions of team members (admissions and registration)

Proactive thinker/Team oriented. Home Health Billing, Rules regulations – Compliance with Medicare

Ability to adapt in a dynamic work environment and make independent decisions. Ability to identify and analyze root cause. Strong and knowledge expertise in Medicare and Medicare Managed Plans (HMO).

Ability to set priorities and meet time lines for performance expectations; work independently with minimal supervision and demonstrates initiative. Experience Wound care/Hyperbaric billing

24/48 Overlapping episodes, Experience in combining 1st occurring account to 2nd occurring accounts based on the overlapping rules from Medicare. Medicare Secondary Payer (MSP), Interim Billing, Medicare IME Billing and DME Billing. Precertification and Authorization. Work on high level projects when needed.

Work Experience

09/10 to 9/15 Delta Medical Center Memphis, TN

Lead Medicare Representative

Maintains Medicare compliant billing and payment record system in support of submitted claims and annual Medicare cost report. Responsible for reviewing for accuracy of information requested and received in regard to precertification and/or authorization numbers received as well as supporting documentation.

Approves Medicare overpayments and refund requests. Regularly writes off balances that are uncollectable for denied claims including above denials as well as timely filing denials, death denials, and competitive bid write-offs. Perform AR transfers are necessary. Ensures that appropriate medical records are maintained according to HIPAA guidelines. Initiates action with insurance companies and the Social Security Administration as necessary to correct discrepancies or errors related to Medicare benefit coverage.

Responsible for completing Medicare Requests for Additional Information (ADR) letters. Medicare claim audit requests and responds to written and oral requests for billing justification. Transmit Benefit Exhaust and No pay claims monthly. Complete month end in a timely manner.

Works remittance advice from Medicare ensuring accuracy of payments: changes account financial class as appropriate; corrects account balance in accordance with Medicare disposition; follows up on denied claim

Average AR days maintain 36 days. Averaging aging over 90 days 14%.

Be able to resolve Medicare Denials and read and interpret EOBS (Explanation of benefits)

Adhere to all practice policies related to Medicare compliance and HIPAA.

Ms. Trayce L. Walker

Resume

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06/08 to9/10 Methodist Healthcare Memphis, TN

Medicare Representative

07/05 to 07/06

Medicare Secondary Biller

Verify Medicare claims receipt within 24 hours of submissions. Record all Medicare Bad Debt on logs.

Knowledge of Medicare procedures and policies guidelines. Work on high level projects when needed.

Post Medicare charge adjustments/corrections to include LCD, late postings and other credit and debit adjustment as applicable. Averaging AR days maintained 36 days. Averaging aging over 90 days 14%.

Responsible for completing Medicare Requests for Additional Information (ADR) letters.

Medicare benefits include inpatient psychiatric and ancillary benefits (Part A), and physician and professional services (Part B) benefits administered by the Medicare Intermediary, Carrier, Railroad retirement systems, and Medicare Replacement/HMO plans. Compose and submits appeals of denied services with supporting documentation to Medicare. Posts write-offs and contractual as needed.

Ensure all claims are processing in the Medicare DDE system, claims in RTP (Return to Provider) are corrected daily and all claims are adjusted by accurate search.

Overlapping Account Resolution, Quarterly Medicare Credit Balance reports, High Dollar Review, Recurring Account. Clearly and concisely document all actions taken. Initiate refund requests when necessary. Conduct oneself with the highest degree of honesty and integrity in every interaction.

Audit and follow up on unpaid Medicare balances, using the electronic inquiry system to resolve problems in claim processing. Transmit Benefit Exhaust and no pay claims monthly.

Bill all co-insurance and deductible as Medicare A/B; remits received. Complete month end in a timely manner.

09/07 to 06/08 Con-Way Express Memphis, TN

Customer Service Representative/Billing Clerk

Key vital information from customers bill of ladings into billing system, breakdown bill of ladings as drivers bring them in looking for exports, hazmat, bills with no description and special service bills

Skeletal billing, scan bill of lading and delivery receipts, enter delivery receipts into AS400

Trace shipments, give rate quotes, schedule delivery appointments for outbound freight put appointments into AS400 system, work undelivered freight report, fax delivery appointment to customer for approval

Process incoming faxes; EDI exceptions and pended items including HAZMAT orders and required documentation. Verify multiple container orders ensuring that all moves are properly billed; interface with both internal and external customers in a professional, proactive and polite manner

Responsible for processing the documentation that accompanies the movement of freight, including entering freight shipment information into computer system to generate freight bill and performing other administrative duties as necessary in the daily operation of the service center

Education

Currently attending National College of Business obtaining Associate Degree Health Information Technology

Associate Degree in Business Administration, August 1990,

Southeast College of Technology, Memphis, TN

Received Diploma Whitehaven High School, May 1988 Memphis, TN

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