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Customer Service Medical

Location:
Houston, TX
Posted:
April 15, 2016

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Resume:

Charlene Scott

**** ****** ** ** * Apt ****

Houston, TX 77070

PH:281-***-****

acudft@r.postjobfree.com

OBJECTIVE

Diligent, detailed oriented professional with knowledgeable of all office functions. Excels at multi-tasking in a fast-paced environment, completing projects within time and budget constraints, while assisting team with daily work flow issues. Superior intrapersonal skills and very dependable.

OFFICE SKILLS

Technical Skills

All Microsoft Applications

Production Targeting

Problem solving

Customer Service

Goal Oriented

EDUCATION

Medical Office Specialist - American Commercial College - Shreveport, LA 2006-2007

R.H.I.T- Lonestar Community College- Houston, TX, Tentative Graduation date May 2016

EXPERIENCE

Patient Accounts Rep II Baylor College of Medicine– Houston, TX 2015

Undertake special projects as assigned

Investigate claim denials & rejections

Respond to payer correspondent/EOB

Analyzed patient accounts to determine patient responsibility.

Resolved patient responsibility balances through proven debt collection techniques. Payer accounts included all Managed Care payers, including HMO, PPO, and POS benefit plans.

Performed area-specific functions to ensure adequate reimbursement

Assisted with day-to-day planning, operation and problem-solving

Follow up claim status

Preform adjustment/write-off

Expedites and maximizes payment of insurance medical claims by contacting third party payers and patients

Identifies patients accurately and assigns the patient a unique identification number

Secures patient accounts in order to maximize reimbursements in a customer service oriented fashion

AR follow-up Contacts insurance companies via telephone /website concerning unpaid accounts receivables.

Contacts third party payers and patients to determine the reason for non-payments or delays in payments of medical claims

Assists with inquiries from outside parties regarding account status

Drafts letters to the insurance company's Medical Review Board to expedite payment

Evaluates if payments were made according to contract. Researches and appeals insurance denials

Resolves any unusual denials, low payments, or requests for information, including appeals

Worked with Medicaid, Medicare, And Commercial Payers such as BCBS, Tri-Care, United, Aetna etc

Patient Accounts Rep II Dean's Professional Services (Baylor)– Houston, TX 2014

Undertake special projects as assigned

Investigate claim denials & rejections

Respond to payer correspondent/EOB

Analyzed patient accounts to determine patient responsibility.

Resolved patient responsibility balances through proven debt collection techniques. Payer accounts included all Managed Care payers, including HMO, PPO, and POS benefit plans.

Performed area-specific functions to ensure adequate reimbursement

Assisted with day-to-day planning, operation and problem-solving

Follow up claim status

Preform adjustment/write-off

Expedites and maximizes payment of insurance medical claims by contacting third party payers and patients

Identifies patients accurately and assigns the patient a unique identification number

Secures patient accounts in order to maximize reimbursements in a customer service oriented fashion

AR follow-up Contacts insurance companies via telephone /website concerning unpaid accounts receivables.

Contacts third party payers and patients to determine the reason for non-payments or delays in payments of medical claims

Assists with inquiries from outside parties regarding account status

Drafts letters to the insurance company's Medical Review Board to expedite payment

Evaluates if payments were made according to contract. Researches and appeals insurance denials

Resolves any unusual denials, low payments, or requests for information, including appeals

Worked with Medicaid, Medicare, And Commercial Payers such as BCBS, Tri-Care, United, Aetna etc.

Medical Collector 1960 Family Practice – Houston, TX 2012-2014

Collected on insurance and patient accounts for all physicians

Worked with Medicaid, Medicare, And Commercial Payers such as BCBS, Tri-Care, United, Aetna etc.

Interprets and enforces third party payer rules and regulations; including Medicare requirements.

Works with physician offices to resolve coding issues to ensure claims were paid

Responsible appeals and denials on claims

Worked OON Claims including Follow up

Followed up on all insurance including Government Insurances

Worked AR 14,30, 60 and 120 days which most of the review and follow up was online at the payer website, called only when consistent mistakes were made by payer or if claims were not paid timely

Audits accounts to assure compliance with applicable laws and regulations relative to fraud and abuse issues.

Monitors Medicare reimbursements and maintains files.

Worked UB04 and HCFA 1500

Knowledge of coding policies and procedures; established in accordance with HCFA and third party payers.

Maintains knowledge of Medicare and third party contracts as it relates to ASC’s.

Assisted with day-to-day planning, operation and problem-solving

Assists Director and Revenue Manager with all updates on the process of new providers.

Follow up claim status

Submit appeals on denied claims

Preform adjustment/write-off

Medical Collector Addison Group – Houston, TX 2012

Undertake special projects as assigned

Investigate claim denials & rejections

Respond to payer correspondent/EOB

Submit appeals for denied claims

Analyzed patient accounts to determine patient responsibility.

Resolved patient responsibility balances through proven debt collection techniques. Payer accounts included all Managed Care payers, including HMO, PPO, and POS benefit plans.

Performed area-specific functions to ensure adequate reimbursement

Assisted with day-to-day planning, operation and problem-solving

Assists Director and Revenue Manager with all updates on the process of new providers.

Follow up claim status

Submit appeals on denied claims

Preform adjustment/write-off

Medical Billing and Coding Instructor American Commercial College - Shreveport, LA 2011

Prepares lesson plans using industry-standard approaches (e.g., multimedia, adult learning methodology).

Teaches courses as assigned, instructs and evaluates students, develops students’ skills and encourages growth, and tracks their attendance, performance, and grades.

Participates in various administrative activities (e.g., attends faculty/staff meetings or in-service meetings).

Participates in graduation ceremonies, as assigned

Participates regularly in continuing professional development activities.

Performs other duties or special projects as assigned.

Contract Medical Biller XAM – Houston, TX 2008-2011

Billed/Coded Insurance Claims (Medicaid & Medicare)

Basic level-specific activities related to research projects and studies

Data Entry/I 0 Key

Abstracts and/or assigns appropriate CPT 4 and ICD 9 and ICD 10 codes

Resolved Grievances and appeals

Worked on SSI(Medical billing software), and Meditech

Assisted with day-to-day planning, operation and problem-solving

Assists Director and Revenue Manager with all updates on the process of new providers.

Follow up claim status

Submit appeals on denied claims

Preform adjustment/write-off

Undertake special projects as assigned

Investigate claim denials & rejections

Respond to payer correspondent/EOB

Submit appeals for denied claims.

Analyzed patient accounts to determine patient responsibility.

Resolved patient responsibility balances through proven debt collection techniques. Payer accounts included all Managed Care payers, including HMO, PPO, and POS benefit plans.

Performed area-specific functions to ensure adequate reimbursement

Medical Billing and Coding Instructor Remington College - Shreveport, LA 2010-2011

Prepares lesson plans using industry-standard approaches (e.g., multimedia, adult learning methodology).

Teaches courses as assigned, instructs and evaluates students, develops students’ skills and encourages growth, and tracks their attendance, performance, and grades.

Participates in various administrative activities (e.g., attends faculty/staff meetings or in-service meetings).

Participates in graduation ceremonies, as assigned

Participates regularly in continuing professional development activities.

Performs other duties or special projects as assigned.

Insurance Clerk/Receptionist Dr. Mitchell & Dr. Montgomery - Shreveport, LA 2007-2008

Greeted Patients

Scheduled patients

Billed/Coded Insurance Claims (Medicaid & Medicare)

Utilize PC to enter and retrieve patient data

Answer multi-line phone, operate fax and copy machine

Data Entry/I 0 Key

Collected on accounts

Financial Advisor Jean Simpson (Brentwood) - Shreveport, LA 2006-2006

Answered phone

Collected on accounts

Updated patient charts

Admitted & Discharged Patients

Data Entry/10 Key

Handled large amounts of cash

Contract Medical Biller Healthcare Revenue Resources - Shreveport, LA 2005-2006

Billed/Coded Insurance Claims ( Medicaid & Commercial )

AR Collections specialist

Answer multi-line phone, operate fax and copy machine

Data Entry/10 Key

Assisted with day-to-day planning, operation and problem-solving

Assists Director and Revenue Manager with all updates on the process of new providers.

Follow up claim status

Submit appeals on denied claims

Preform adjustment/write-off

Worked on SSI(Medical billing software), and Meditech



Contact this candidate