BEATRICE J. SMITH

PROFESSIONAL SUMMARY

Follow up with insurance companies on open claims including some Hospice and Forensics.

Process all request for medical records (Commercial and Traditional Medicare).

Submitted insurance appeal correspondences with Emergency room medical records.

Edits Third party claims for submission to carriers, primary and secondary accounts. This includes initial billing, and rebills and late charges.

Completes daily batches, conducting research, communicating with insurance companies, attorneys and patients via telephone, and accumulating needed documentation to expedite the resolution of outstanding receivables

Billed all Inpatient/Outpatient, Emergency Room, Crossover and 2360’s claims electronically.

Billing to outstanding account, and collect and follow-up on accounts.

EDUCATION

Northeastern Illinois University – Chicago, IL

Business and Healthcare Industry

Moraine Valley Community College – Palos Hills, IL

Business and HealthCare Industry

SKILLS

IDX-term, Meditech, Nextgen, CIMCO, Medisoft, Centrix, NDAS, E-Premis, NEBO and Ecare. Excel and Lotus. Promise, Trac, On Demand, SMS Invision, Xactimed and Document Imaging. Typing 40-wpm. Code-correct. Healthquest and Emdeon, Microsoft Word, EPIC (Last used Michael Reese Hospital), Zidmed and GHP web portal

PROFESSIONAL EXPERIENCE

ApolloMD/ PaymentsMD – Atlanta, GA October 2016 – January2017

Denials/AR Coordinator

Reviewing EOBs to identify co-pays, deductibles and co-insurance

Post and investigate outstanding balances on denied claims by checking the EOBs and review secondary insurance payors and submit appeals.

Verify patient demographics and insurance eligibility

Correct billing/patient information and re-submit claims

Detailed system documentation of account

Emory Healthcare(Temp)- Atlanta, GA May 2016 – August 2016

Manage Care Specialist

Credit balance for Humana, Aetna and UHC

Medical review for Infusion Appeals

Followed up on billed claims for status with insurance company's.

Southern Regional Medical Center – Riverdale, GA September 2015 – May 2016

A/R Follow-up Rep/ DRG Denial and Appeal Coordinator

Follow up with insurance companies on open claims including some Hospice and Forensics.

Resubmit claims for payment to insurance companies.

Process Appeals and DRG Denials

Process all request for medical records (Commercial and Traditional Medicare).

Submitted insurance appeal correspondences with Emergency room medical records.

Corrected payment adjustments on all correspondences received from insurance on emergency room claims

Aria Health – Philadelphia, PA December 2014 – July 2015

Billing Representative

Reviews daily and monthly reports pertaining to charge control, specifically, OPD Service Report, Charge exception reports, 72-Hours Reports, and Inpatient/Outpatient monthly charge not matching service data reports.

Edits Third party claims for submission to carriers, primary and secondary accounts. This includes initial billing, and rebills and late charges.

Retrieves claims from Xactimed Archive, as appropriate, for resubmission claims.

Order medical records when not available in Chart One.

Completes daily batches, conducting research, communicating with insurance companies, attorneys and patients via telephone, and accumulating needed documentation to expedite the resolution of outstanding receivables

Prepared appeals for 180 days denied claims from Medicaid

University of Illinois – Chicago, IL October 2009 – November 2014

Medical Biller Specialist

Determine claims status, research, and collect on unpaid and denied Medicaid claims using NEBO.

Analyzed monthly reports, and reviewed aging accounts through a detailed Trail Balance Sheet.

Follow-up with third payers on payment cycle of each payer.

Reviewed registration insurance information and account coding were properly inputted.

Corrected and resubmitted claims when errors were identified through follow-up.

Making adjustments and write-offs to necessary accounts.

Billed all Outpatient, Emergency Room, Observation and Surgery claims electronically.

Billing to outstanding account, and collect and follow-up on accounts.

Billed all Physic and Reoccurrence claims.

Prepare necessary paperwork on refunds/credit balances for processing.

Billed all Medicaid claims on UB92 (UB04) and 2360. Verified eligibility.

Assist in new employee training.

Worked rejection/denial report.

Jackson Park Hospital – Chicago, IL October 2007 – May 2009

Medicaid/Medicare Biller

Billed all Inpatient/Outpatient, Emergency Room, Crossover and 2360’s claims electronically.

Monitor accounts to determine the timeless of collection/verified coverage and certified days.

Billing to outstanding account, and collect and follow-up on accounts.

Account receivable data, make inquiries to insurance carriers.

Prepare necessary paperwork on refunds/credit balances for processing.

Determine claims status, research, and collect on unpaid and denied Medicaid claims using NEBO.

Worked rejection/denial report.

Michael Reese Hospital – Chicago, IL January 2005 – October 2007

Revenue Cycle Coordinator

Billed all Medicaid claims on UB92 (UB04) and 2360. Verified eligibility.

Determine thru SASS which claims were Discharge Planning or CMH.

Verified certified/denied days and non-reviewable accounts with HSI

Making adjustments and write-offs to necessary accounts.

Work with case management for precertification HIM approved days for Inpatient

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