Insurance Medical

Theresa J. Phillips, NRCCS

**** ******** *** # *** 817-***-****

Fort Worth, Texas 76116 ********@*****.***

SUMMARY

Creative, enthusiastic with strong organizational, analytical, problem solving, communication and relationship management skills, seeking career in the health insurance field that will utilize my education and experience.

Skills:

Benefit Plan Configurations, Coding and Reimbursement, Claims processing/Claims adjudication

Provider Contracts; Build, test and implementation of contract, maintain yearly

McKesson; ClaimCheck, PAMs, User Defined Edits, Customization

Knowledge of Medicare, Medicare Advantage Plans, Medicaid, HMO, PPO, etc.

Insurance Billing and Coding, Insurance Verification, Prior Authorizations/Referrals, Medical Office Management, Credentialing, Medical Transcription, Data Entry.

QNXT, MediSoft, NexTech, MedForce, MedAct, AMS, Brightree, Microsoft Applications

Silverback TPA Fort Worth, TX 2015 - Present

Systems Analyst

• Benefit Plan Configurations; design and testing of new configurations. Coding and Reimbursement Methodologies, Claims processing and Claims adjudication process. Maintain all additions, deletions, revisions of CPT, HCPCS and ICD 10 coding.

• McKesson; ClaimCheck, PAM, Customization, custom implementations, maintain coding/logistics.

• Contract management, Implementation of Provider Contracts. Fee Schedule tables which consists of UCR and Custom builds, HHPPS (HUGS/RUGS), RBRVS, OPPS, etc. Implementation of Anesthesia, Ambulance, DME, PEN, LAB, Facility/Non Facility, Part B Drugs (ASP and AWP) fee schedules. Maintain contracts, benefits, and fee schedules.

Mediwell, Inc. Fort Worth, TX 2012 - 2015

Account Manager/Billing Department

• Account Receivables, Collections, and Medicare redeterminations.

• ICD-9 with some ICD-10, CPT, HCPCS, HIPPA, Insurance Authorization, Member Benefits, Medicare, Medicaid, Medicaid Title XIX, and complete patient documentation. CMN for Oxygen, Enteral Nutrition and General CMN’s for equipment.

• Communication with Physician’s regarding prescriptions for DME. Oxygen SATs, Sleep studies, and enteral nutrition.

Dr. Mc Alpine OB/GYN Fort Worth, TX 2014 - 2015

Medical Insurance Billing/Independent Contractor

Billing, Coding, EOB, Surgery/Physician assistant scheduling of pre-op and post-op scheduling. Certification/Authorizations for procedures.

ICD-9, CPT, HCPCS, CMS 1500. Insurance verification. Medicaid, Medicare, Aetna, BCBS, Federated, third-party and more.

Account Receivables, Daily billing and receipting, denials, re-submittals, Physician Credentialing

Mediwell, Inc. Fort Worth, TX 2012 – 2015

Documents Specialist

Documentation, HIPPA, Insurance Authorization, Member Benefits, Medicare, Medicaid, Medicaid Title XIX, and complete patient documentation.

Mediwell’s profit and loss was approximately 60k, reduced to 13k within year, Medical collections, ICD-9, CPT, CMS 1500, UB-04, and a little ICD-10

Rajan Dermatology and Skin Care Fort Worth, TX 2011 - 2011

Medical Office Specialist Externship (160 hours)

Medical billing and coding, scheduling, charting, patient referrals

Insurance verification, filing, co-pay collection, accounts receivables, patient check in/out,

Created new patient charts, pre and post-op surgical scheduling, medical office inventory, set-up office procedural books.

EDUCATION: English/Criminal Justice, University of Texas San Antonio, TX - Pending

Medical Office Specialist, Kaplan College Ft. Worth, TX - Sept 2011

NRCCS Certification, Kaplan College Ft. Worth, TX - May 2011

CPR/AED Certification Current

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