Connally, Michelle A

*** ******* ****, ***** **** TX 75104- 469-***-**** – acxxyz@r.postjobfree.com

Objective

Experienced healthcare professional seeks a position within a diverse organization that allows vast opportunities for growth and advancement professionally and personally.

Experience

Patient Account Representative

MedHealth, Dallas, Texas

May 2014 –June 2016

Processes billing calls, questions and correspondence related to patient accounts

Submits claims on a regular schedule to Medicare, Medicaid and other insurance carriers.

Initiates requests for patient payments by telephone or written correspondence.

Participates in the entire follow-up process on patient accounts until there is no balance or if needed report to a collection agency.

Posts payments from patients and enters into a payment system.

Posts all required information related to an account into a permanent record.

Researches all information needed to complete billing processes to ensure prompt processing and correct and maximum reimbursement.

Contacts insurance carriers to resolve claim issues or corrections.

Knowledge of billing practices and clinic policies and procedures.

Knowledge of ICD9/10 coding and CPT coding.

Examine insurance company explanation of benefits and other documents for accuracy and completeness. Must also be able to decipher this information to patients and other clients.

Performs mathematical computation and compute ratios and percentages.

Maintain strictest confidentiality in regards to personal, financial, and health records for patients.

Appeals Representative

United Health Group, Richardson, TX

July 2013 – May 2014

Provided expertise and or general support to teams in reviewing, researching, investigating, negotiating and resolving all types of appeals and grievances.

Analyzed and identified trends in appeals and grievances.

Researched and resolved written Department of Insurance complaints and complex or multi-issue provider complaints.

Analyzed and researched how claims were processed and denied.

Obtained/identified contract language and processes/procedures relevant to the appeal process. Determined where specific appeals or grievances should be handled and route to the appropriate department(s).

Ensured that all members obtained a full and fair review of their appeal or grievance.

Documented final determinations using appropriate templates or communication, within a required time frame.

Back up duties supplying data entry of incoming appeals

Maintained strictest confidentiality.

Financial Counselor III

Methodist Health Systems, Dallas, TX

September 2004 – July 2013

Coordination of the entire referral process for patients within a Family Practice Residency setting who are insured with managed care, government, private, or health maintenance organization plans.

Responsible for prior authorizations for outpatient services.

Responsible for verification of health insurance plans.

Responsible for educating patients, physicians, and other staff members in regards to health insurance rules and regulations.

Responsible for understanding and applying a working knowledge of all types of health insurance plans.

Responsible for maintaining a professional relationship with internal and external customers such as physicians, insurance company representatives, providers, hospital employees, patients and their families, vendors, and other customers.

Other clinic duties as needed, such as, scheduling of appointments, check in/out duties, and medical records.

Insurance Verifier

Baylor Healthcare Systems, Dallas, Texas

January 1992 – September 2004

Responsible for workers compensation approvals and a working knowledge of the laws and regulations.

Responsible for a working knowledge of health insurance plans and the ability to explain and apply said plans to patients and physicians.

Former PBX duties

Medical office duties such as registration, check out, scheduling, insurance verification, claims explanation, and medical record duties. Responsible for verification of benefits

Responsible for obtaining prior authorizations and referrals.

Education

Bachelors of Science in Healthcare Management

Dallas Baptist University, Dallas, Texas

August 2011

Graduate of Methodist Health System’s Leadership Institute- Emerging Leaders Program-December 2009

References

References are available on request.

Contact this candidate