Insurance Customer Service

Dorothy J. Reynolds

*** ********* **** ********** **. 60193 email: *************@*****.*** cell: 708 • 466• 7850

EDUCATION

South SUBURBAN COLLEGE Chicago, IL

• Certification of General Office Skill

WORK EXPERIENCE

Healthcare Financial Resource Inc. 03/15 to present Schaumburg, IL Medical Billing Account Receivable Analyst

• Focus on results in a professional, ethical, and responsible manner when dealing with customers, vendors, teammates, and others.

• Track and identify missing claims activity in the form of missing IDOCs as well as incorrect processing of claims by internal staff.

• Verify details of patient account about service dates, insurance payment amounts.

• Utilize various systems, Meditech, Citrix, SSI, Healthlogic, Availity, Navinet, Epic and insurance web sites for claim detail status

• Submit insurance claims with UB04/CMS1500 and verify that secondary insurance will include the primary insurance EOB (explanation of benefits) in order to process the claim payment on the date of service.

• Verify patient date of service and investigate reasons for why the insurance non-payment, underpayment, or denial.

• Submit claim appeals or corrected claims based on denial reason (missing modifier, invalid procedure/diagnosis/revenue code, no

Authorization, claim substantiation, insurance termination, non-covered service, not emergent, not medical necessity etc.

• Call patients to verify accurate details of corrected active coverage insurance info. Send letters to patient if unreachable via phone.

• Update correct patient info and insurance in Medcollex. Process claim adjustments if the claim was over paid, global, offset, non-

Covered benefits, and if claim payment is based on different rates (Medicare APC rate, Medicaid rate, paid per client contract)

• Submit patient’s bills for copayment, coinsurance, and deductible amount after insurance payment.

• Accept being accountable and responsible in work practices and expectations. Deliver what is promised.

• Foster a collaborative, team-oriented attitude. Communicate effectively with others with clarity and transparency.

• Use innovative critical and creative thinking to evaluate and solve work and customer issues.

• Seek assistance in solving work problems through collaboration and information seeking.

Cardio Specialist Group Ltd

Billing and Patient Accounts Specialist 7/08 to 03/15 Olympia Fields, IL

• Responsible for overall coordination and processing of reimbursement of tracking claim under Medicare, Commercial Insurance

And Managed Care for the Cardiologist.

• Review and resolved electronic claims rejection.

• Reduce and stream line outstanding balance on medical claim and submitted appeals to Medicare and Blue Cross Blue Shield.

• Collect copay amounts. Explain Medicare policies to patients. Explain commercial and government insurance plans.

• Work with both internal and external customers to ensure that orders are processed. Resolve prescription insurance issues.

• Processed work files on a daily bases to insure accounts receivable objectives are maintained.

• Prepare, review and submit patient claims, explain benefits coverage to patients.

Med3000

Patient Accounts Representative collector/biller Analysts 1/07 to 01/08 Tinley Park, IL

• Reviewed various insurance programs and verify medical billing procedures. Review and verify appropriate diagnosis codes.

• Adhered to company protocols, policies and procedures. Advice first level provider appeals of coverage decisions.

• Verified insurance coverage for new and existing patients to process prescriptions while providing excellent customer service.

• Used various systems and databases to submit and check claims.

• Assisted patients with account analysis related to Physician billing inquiries.

• Corrected and resubmitted insurance claims for reprocessing.

• Followed up and verified insurance claims for payment.

• Reduced delinquent accounts over 180 days by 40%.

• Received recognition of exceeding patients calls above 60%.

Neurosource Inc.

Reimbursement Specialist 11/98 to 6/05 Chicago, IL

• Managed pharmacy inventory, assist newer pharmacy techs in learning different processes and procedures.

• Resolved customer problems regarding collections, reimbursement and billing questions.

• Negotiated insurance payments and contractual adjustment using the following systems: IDX, Nextgen and Medic Application.

• Obtained billing rules and guidelines for Managed Care Companies and Third Party Payers.

• Reduced outstanding collections from 30 to 20% of aging delinquent accounts over 120 days.

• Worked with Commercial, Workman’s Comp, BC/BS, Managed Care, Medicare and PPO Carriers.

SKILLS & INTEREST

• Strong background in all phases of Credit Collections and Accounts Receivable.

• Familiar with all medical procedures including Mysis, Nextgen, IDX, Allscripts, Outlook, and Excel

• Experienced with various system in medical field to check claim information status (Medcollex, Meditech, Citrix, SSI, Availity, Navinet, and Epic)

• Demonstrated record of high performance standards, including attention to schedules, deadlines, budgets and quality work.

• Experienced in collections and accounts reconciliation.

• Familiar with medical terminology including ICD-9, CPT codes, HCFA 1500 and EOB’s.

• Expert in handling diversified portfolio of self-pay accounts.

• References available upon request

Contact this candidate