Professional Summary

Familiar with commercial and private insurance carriers.

Expertise includes verifying insurance coverage and records reviews Customer service-oriented

Skill Highlights

Maintains strict confidentiality

Knowledge of HMO, PPO Medicare and Medi-Cal

Strong work ethic

Good written communication

HIPAA compliance

Team player with positive attitude

Deadline-driven

Exercises good judgment

Professional Experience

Patient Account Representative II

December 9, 2013 – December 31, 2015

Turning Point Revenue Cycle Solutions

Responsible for all aspects of follow up and collections, including contacting patie nts, insurance carriers, accessing payer websites and follow up on unprocessed t hird-party claims

Reviews, researches, resolves insurance overpayments, underpayments, denials,

Responsible for handling late charge report on a daily basis to reconcile payment s through adjustments/re-billing of primary, secondary and third party claims

Utilizes A/R reports and EOBs to identify and reconcile all outstanding balances t o a zero balance

Act as back up for customer service to handle the overflow of calls as warrants

Responsible for Medicare crossover claim billing

Willing accepts and perform other duties as assigned by Manager/Supervisor Patient Account Representative II/Medicare

February 2006 to November 2012

Sutter East Bay Region Medical Ctr. Oakland, CA

Responsible for full collections of accounts assigned within the Medicare Accounts Receivable (included but not limited to initial collections and denials)

Responsible for reviewing, researching and completions of all denied accounts.

Thoroughly investigated past due invoices and minimized number of unpaid accounts.

Demonstrated analytical and problem-solving ability by addressing barriers to receiving and validating accurate information.

Carefully reviewed medical records for accuracy and completion as required by insurance companies.

Strictly followed all federal and state guidelines for release of information.

Examined diagnosis codes for accuracy, completeness, specificity and appropriateness according to services rendered.

Acted as a liaison between the business department, billers and third party payers in resolving billing and reimbursement accuracy.

Demonstrated knowledge of HIPAA Privacy and Security Regulations by appropriately handling patient information.

Confirmed patient information, collected co-pays and verified insurance.

Completed appeals, filed and submitted claims.

Posted charges, payments and adjustments.

Submitted refund requests for claims paid in error.

Responsible for running daily production reports

Responsible for communication between patients, insurance carriers and all third party carriers

Patient Account Representative II/Non-Government

November 2001 to March 2000

Summit Medical Center – Oakland, Ca

Review and call weekly on accounts greater than $50,000 (7 days from bill date)

Review and call within a 30-day time frame on accounts greater than $5,000(15 days from bill date)

Review and respond to Correspondence/Action Forms

Acquired insurance authorizations for procedures and tests ordered by the attending physician

Apply adjustments to reconcile claims to a zero balance

Responsible for re-billing primary and secondary accounts

Responsible for all other duties assigned by the Supervisor/ Manager Senior Claims Examiner/Claims Service Representative September 1999 to August 2001

North American Medical Management – Oakland, Ca

Processed claims through computerized claim payment system

Claims included Primary Care Physicians (PCP), Specialist, In/Out

Professional/Facility claims, Medicare and COB Claims

EDI claims processing (Electronic Data Interchange)

Responsible/Completed various functions related to error reports of electronic/scanned claims

Adjust, reversed and re-adjudication of claims due to system/Examiner error

Communicated with patients, insurance carriers and other third party providers through phones, and written correspondence

Interpret benefit plan provisions

Researched, reviewed, referred and release claims on hold including EDI claims

(Electronic Data Interchange)

Maintained daily log of phone correspondence and production

Preformed special projects/other duties as assigned by supervisor and claims manager

Education and Training

High School Diploma- McClymonds High School

Associate of Arts – Business

Alameda Junior College – Alameda, Ca

Additional Information

Certificate of Completion in Workforce Confidentiality Certificate of Completion in Compliance Training

Certificate of Completion in Annual Health & Safety Training

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