Customer Service Insurance
Resume:
Michelle Mikell
Taylors, SC 29687
OBJECTIVE
To obtain a position in a professional field where my education and work
experience can be utilized to its fullest capacity.
PROFESSIONAL EXPERIENCE
2013-Present Government Hospital Biller
Bon Secours Health Systems-St Francis
Validate and/or make corrections on the UB04/1500 for accuracy of billing. Review claims before submission for missing charges and validates claims against the coding abstract to ensure accurate billing of procedures. Work billing edits daily, correcting discrepancies before claim submission. Split inpatient claims as appropriate, per Medicare guidelines submit claims with the appropriate attachments. Assists in the daily transmit of all electronic claims to the billing clearinghouse. Knowledge of (CPT) and ICD9/ICD10 codes. Knowledge of Federal, State, and billing guidelines. Ability to maintain a working relationship with other departments within the organization.
2007-2013 Lab Registrar/Billing Specialists
Bon Secours Health Systems- DePaul Medical Center
Performed data entry and clerical duties which include entering alpha and numeric data into SMS and Misys computer systems, diagnosis coding and insurance billing in a prompt and accurate manner. Responsible for accurate timely review of Xactimed billing system for rejected claims. Promptly responds to all outpatient and physician billing inquiries for Clinical, Cytology and Anatomic Pathology departments. Responsible for filing, and sorting information pertinent to the registration and billing process as well as obtaining accurate information and verifying insurance criteria. Acquires and performs all statistical data required for billing compliance. Responsible for turnaround time to improve customer service in relation to billing and informational inquiries. Exercises excellent Customer Service Skills, including responding quickly and appropriately to telephone calls. Possess working knowledge of the Medical Necessity guidelines associated with Medicare and ICD-9 diagnosis coding. Knowledge of all insurance rules, and compliance guidelines.
2007- 2009 Pre-Authorization Assistant
Amerigroup Corporation- Virginia Beach, VA
Primary responsibilities included telephonic assistance to members and providers,
the ability to explain the health benefits available to membership in various markets.
Coordination, authorization, fulfillment, monitoring, and tracking of health care services.
Utilizes knowledge of community resources; refers members to case management or care management as indicated. Arranges for services as identified by the care manager or case manager, utilizes excellent customer service principles to assist internal and external customers. Follows HIPAA guidelines, call center quality performance standards and guidelines for aux work usage.
2003-2005 Account Representatives
Artic Solutions Inc., North Brunswick, NJ
Responsibilities included contacting insurance carriers and/or patients to resolve
and collect open balances on hospitals and physicians aging account receivables
in a timely manner. Review insurance Eob's and initiate appeals as necessary for denied claims. Follow-up on claims mailed and submit electronically as necessary for accounts
resolution.
2002-2003 Medical Biller
Medcon Financial Services Rutherford, NJ
Billing anesthesiologist in-patient and outpatient claims to all insurance’s.
Enter charges and payments on a daily basis. Experienced with ICD-9 and CPT coding. Knowledge of 3rd party billing and electronic billing claims. AR follow-ups such as research payments histories, insurance contracts and eob's. Resolve patient and insurance issues.
2001-2002 Front Desk/Receptionist
Stuart M. Homer, MD Avenel, NJ
Managed all aspects of front office including scheduling appointments, answering
telephones and general patient assistance. Medical aspects of job included managing medical records, and collection of co-payments.
1999- 2001 Biller/AR Representative
Medifinancial Solutions Inc., Iselin, NJ
Billing hospital in-patient and outpatient claims of all insurance’s.
AR follow-ups such as research payment histories, insurance contracts and Eob's.
Resolve patient and insurance issues. Knowledge of ICD-9 and CPT coding.
SUMMARY OF SKILLS
Professional Medix 6.0, Word Perfect, Windows, Excel, Escort, Maxpro, Rumba,
IDX, Epic, Medical Manager, Microsoft Office, Data Entry, DDE, SMS, Misys
EDUCATION National Health Career Association Fairfield, NJ
Introd. To Clinical Laboratory, Concepts of Pathology, Centrifuge, Blood and Urine Specimens, Patients Disease, Identification, Anatomy, Physiology, Hematology, Routine Urine Lab Safety, Quality Assurance Control, Microbiology, Serology, Phlebotomy, & EKG Training Certification.
REFERENCES Available upon request
Contact this candidate