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Insurance Manager

Location:
Silver Spring, MD
Posted:
April 12, 2016

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***** ****** ****.

Silver Spring MD *****

202-***-****

acubtk@r.postjobfree.com

TANYA A. SATTERFIELD

OBJECTIVE

To obtain and demonstrate my background as a Reimbursement Specialist

PROFESSONAL SUMMARY

Proficient in the areas of Healthcare Analysis, Electronic Billing and Coding Claims Submission, EMR, Credentialing and payment posting

Extensive experience in the execution of Manual, Automated and full cycle electronic billing, Posting Payment, Third party billing, WC, PIP, PI, Charity, Pharmacy, and Surgery billing etc.

Electronic health record or hybrid, EMR

Strong Experience in Customer Services

EXPERIENCE

PATIENT FINANCIAL COUNSELOR KAISER PERMANENTE MID-ATLANTIC REGIONAL

01/2016 to Present

Performs Financial Specialist functions through the accurate gathering of demographic, sponsorship or guardian data, insurance, financial and statistical information from a variety of sources, i.e., patients, patients families, physicians, physician office staff, county and/or governmental agencies. For patients without a payer source the Financial Assistance Specialist will ensure that the patient is screened and assisted with the applications for government, local or charity as well as Financial Assistance Program (FAP) for Renown. The responsibilities of the Financial Assistance Specialist includes but is not limited to the following: Obtaining and accurately entering demographic and financial information into the computer system. Identifying all insurance payer sources and payer order sequence. Verifying insurance eligibility and benefits .Timely insurance notification. Determining estimated cost for services being rendered Identifying and collecting patient financial obligation amounts, i.e., co-payments, co-insurance, deductibles, Facilitate the application process for financial assistance with all applicable and appropriate patients including pre-admission, bedside visits while in-house, and follow up after discharge through telephone, on site or field visits. Follow up with patients to obtain all supporting documentation for each application process. Maintain documentation on all work activity for each patient account in the appropriate systems. Maintain communication/correspondence with patients, representatives, designated family members, appropriate renowned staff and all government entities on all accounts served. Completes application summary forms for FAP Committee review and presentation. Monitors all cases processed for financial assistance and by the FAP Committee to completion. Completes documentation to justify adjustments for processing by the Central Business Office. Issues all decision letters to patients who apply for FAP Ensures all patient co pay balances are collected as a result of the FAP approval process.

EDI COORNIDATOR, ROCHESTER NY, MVP HEALTHCARE (WORK FROM HOME -CONTRACT)

09/2015 to 01/2016

I was part of the EDI Support department with duties included support to all electronic submitters in an inbound call center environment; track and follow up on all calls received by the e-support helpdesk. Establish and maintain positive communication with submitters through these telephonic inquiries. The Coordinator receives calls via an Automatic Call Distributions system and analyzes the problems presented. Through research using available in-house resources, technical reference material and system documentation, the Coordinator assists callers in resolving general system problems. Processes up front rejects and responses via direct or contracted vendors. Transaction testing when implantation of ICD10 and new platforms. Ensures receipt and successful processing of claims by Insurance Payers/Third Party Vendors. Monitor and evaluate electronic claim submission, denial type and volume management, and ERA/835, 837, 999, 270/277, 834, 2data gathering within MVP healthcare platform. Effectively communicates, Provider Enrollment Team, and Client Services Team regarding provider related rejections. Processes Claims and ERA provider enrollments within the MVP healthcare platform and other contracted EDI vendors. Address problems as they arise and to track levels of activity, compiling and tracking metrics for senior management. Also worked on claims 837 and 835 projects, HIPAA 4010 and 5010 validations for loops, segments, elements, qualifiers and code sets. Performed Load, stress and Performance Testing. Rewrite the Companion Guide for Health plan certification.

HEALTHCARE DATA ANALYST, ROCKVILLE MD, LINKIA

08/2013 to 12/2015

Act as a liaison between departments, billing and IT to resolving issues or creating solution. Provide utilization and outcome analysis, trend and other reports involving authorizations, claims, utilization and membership data. Analyze data in order to uncover underlying utilization patterns and identify clinical and medical delivery drivers of trends Work with trading partners, clients, management, technical and non-technical personnel to create use cases and system validation Worked with providers with Medicare and/ or Medicaid and commercial insurances entities to validate EDI transaction sets or Internet portals. This includes HIPAA 4010; 837, 835, 270/271, and others. Diagnoses problems with EDI processes, working with other technical and/or business resources as necessary for assistance. Troubleshoots application problems. May provide on-call application technical support for production systems. Oversees EDI & batch processes day-to-day to identify and address problems as they arise and to track levels of activity, compiling and tracking metrics for senior management. Also worked on claims 837 and 835 projects, HIPAA 4010 and 5010 validations.

REIMBURSEMENT SPECIALIST CASE MANAGER, THERACOM

04/2010 TO 10/2011

My position was to bill and manage case load Pharmacy charges of patients with tier 5 specialty drugs regulated from FDA. As part of the local pharmacy team, the Billing Specialist assists in posting and troubleshooting of unpaid claims. On a daily basis, I would be responsible for handling inbound phone calls responding to customers’ needs, billing inquiries, answering questions, address updates / changes. In addition, you will be responding to customer inquiries regarding account status. Researching customer’s accounts thoroughly and documents appropriately. Including, resolving discrepancies and preparing adjustments and refunds as necessary. Responsibilities for this role include, but are not limited to: billing for third party, self-pay and governmental billings. Providing customer service for insurance companies, self-pay clients and other telephone inquiries. Running reports and other logs for preparation of monthly charges. Assist working with the pharmaceutical companies of securing (PAP) Charity patient assisting program for uninsured or underinsure for high cost Tier 5 drugs. Support and educated the member on current benefits. Reach out to third parties to help the patient with appointment, travel arrangements and vouchers for travel. Educate the patient on FDA requirement and answer question as applicable.

BILLING MANAGER, KIDS PEDIATRIC STAFFING AGENCY

10/2011 TO 08/2013

Maintaining and ensuring that all billable procedures are correct and accurate prior to claim submission to all payers. Identifying and resolving claim errors prior to claim being submitted to payers. Working rejections on remittance advices when received and submitting proper documentation and/or adjusted claim. Monitoring all billing for timely submission to all payer guidelines and staying informed of changes in billing procedures that impact the filling of claims. Monitoring all outstanding accounts receivables and following up with insurance companies in a timely manner. Reporting status of accounts receivables to billing manager upon request. Performing cash posting duties as required by billing manager/director and maintaining all cash posting to patient accounts accurately and timely. Maintains HIPPA and other lawful practices when billing payers Directed all phases of billing service including contract negotiations and communication of complex patient and insurance inquiries. Handle all faculty credentialing needs with -in (CAQH). Trained new employees on software and medical coding, and policy and procedures. Improved client collections and cash flow by developing and implementing system for intensive and comprehensive follow-up for non-responsive insurance companies. Organized and maintained record keeping system as well as physician scheduling process. Managed and tracked accounts payable and accounts receivable. Responsible for timely submission and accurate billing process for prompt payment. Proven ability to successfully build working relationships with internal and external client

REIMBURSEMENT ANALYST, SCOTTSDALE AZ, MCKESSON

09/2009 to 04/2010

Researches all information needed to insure complete billing process including obtaining medical records and required data from physicians. Reviews coding information about procedures and diagnosis on charge. Assists in the processing of insurance claims including Medicare, Medicaid, Commercial and other third party payers. Prepares and submits clean claims to various insurance companies either electronically or by paper. Answers questions from patients, clerical staff and insurance companies to insure correct medical billing protocols have been performed. Identifies and resolves patient billing issues. Handles written correspondence and performs provider appeal issues with third party payers to insure maximum reimbursement has been received for the practice. Responsible for handling A/R based on insurance carrier’s assigned and ensures A/R is paid and processed correctly in a timely manner. Assists with error resolution and provides feedback for enhancement purposes. Processes payments from insurance companies and prepares a daily deposit. Performs various A/R actions including handling telephone issues from patients and insurance companies, correcting and resubmitting claims to third party payers. Assists with the balancing and preparations of the practice’s daily close. Maintains required medical billing records, reports and files. Participates in educational activities and attends departmental meetings. Maintains strictest confidentiality; adheres to all HIPAA guidelines/regulations.

FINANCIAL REIMBURSEMENT SPECIALIST, ST JOSEPH HOSPITAL

09/2007 to 09/2009

Organized and coordinated patient’s financial obligations. Assessed the financial situations of medical facility patients. Responded to patient's questions about financial issues and payment options. Obtained, verify and scanned patient’s insurance and medical cards into the registration system. Managed all calls and correspondence from lawyers regarding patient balances. Invoice or bill insurances when necessary (per contract). Completes and submits all necessary insurance forms and electronic claims to process the claims in a timely manner as required by all third party payers. Researches and resolves, electronic claim denials, rejections and underpayment of claims. Reports any reimbursement trends/delays to supervisor (e.g. billing denials, claim denials, pricing errors, payments, etc.). Communicates effectively to payers and/or claims clearinghouse to ensure accurate and timely electronically filed claims. Identifies billing requirements by requesting and obtaining information from the payers. Completes timely and accurate claim filing in accordance with targeted goals and department policy. * Ensures compliance with established department billing standards by analyzing, auditing, and taking action on unbilled claims.

TEAM LEAD REIMBURSEMENT SPECIALIST, MAXIM HEALTHCARE

04/2004 to 09/2007

Responsible for handling and managing a team of 10 full cycle billers, Onboarding and training for daily duties and special projects. Responsible for resolving major billing claims trends, resolving denied and rejected claims. Prepare and distributed the customer's invoice and bills. Responsible for the analyzing, researching and resolving customer issue. Conducted the research and reconciliation on transaction. Manages the reconciliation of accounts receivable on daily basis. Responsible for the Medicaid billing utilizing billing software management system. Responsible for the interview, hire and train the medical billing clerk. Understands payer contracts and claim submission requirements. Performs timely follow-up and research of outstanding accounts receivable. Maintain compliance with Medicare and other governing bodies. Completes and submits all necessary insurance forms and electronic claims to process the claims in a timely manner as required by all third party payers. Researches and resolves, electronic claim denials, rejections and underpayment of claims. Reports any reimbursement trends/delays to supervisor (e.g. billing denials, claim denials, pricing errors, payments, etc.). Communicates effectively to payers and/or claims clearinghouse to ensure accurate and timely electronically filed claims. Identifies billing requirements by requesting and obtaining information from the payers. * Completes timely and accurate claim filing in accordance with targeted goals and department policy. * Ensures compliance with established department billing standards by analyzing, auditing, and taking action on unbilled claims.

EDUCATION

STRAYER UNIVERSITY, TAKOMA PARK DC- CURRENTLY

CERTIFIED MEDICAL BILLING SPECIALIST

SOFTWARE

Mega West, Lytec, AS400, Reynolds and Reynolds, QuickBooks, Kwicks-Claims, Tapestry, Diamond, Health connect, Kmate

Med iSOFT, CBSI, ECO, Officemate, Enterprise, WordPerfect, Excel, Medical. Unlimited, Medical Manager, Great Plains, Ambiss, unicare, Mysis (tiger) Patients accounts, Artiva, RCO, SMS, CUBS Medicare FI, Medicare CWF, HIQA and HIQH. ROAR, SQL, Nextgen, McKesson, Health quest, Diamond, Health Connect, EPIC, Services now, Remedy, salesforce, CRM

LEADERSHIP

Currently serving as a board member of Takoma Park Boys and Girls Club.

REFERENCES

FURNISHED UPON REQUEST



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