Medical Billing, Collections, Patient Representative

LAURA S. DILLEY

Vista, CA *****

********@*******.***

760-***-****(home) 760-***-****(cell)

SKILLS

Extensive front-office experience with excellent customer service skills. Professional telephone etiquette and strong interpersonal communication in written correspondence as well as excellent face-to-face skills.

Skilled in handling a high-volume of incoming and outgoing phone calls, similar to the activity of a ”Call-Center”, while managing billing information, daily office tasks, scheduling, & filing.

Deep knowledge and experience in handling CSR issues including data collection, verification and escalation policies and procedures.

Strong computer skills, working with EHR software: Medical Manager; MediTech; CompuMedic; Intergy; Xifin; MediSoft; Allscripts; NextGen. Experienced in Microsoft Word; Excel; Outlook, Power Point, & Quick Books Pro.

Over 15 years experience with full revenue cycle billing. Extensive knowledge of multiple clearinghouses, sub-mission of claims with multiple Insurance providers, California-care, Medicare, Medi-Cal, Work-Comp Contracts.

Persuasive and tenacious follow-up on claims status to appeal, re-bill and forward “corrected claims” for adjudication. Thorough understanding of collections with Federal, State, PPO, HMO, Work Comp, and Indemnity Plan structures. Worked various reports including aging, adjustments and credit balances on a weekly basis.

Fast comprehension of EOBs, insurance benefits, and requirements for authorizations.

Knowledge of CPT, ICD-9 and 10, HCPC and modifier coding practices. Knowledge and practice of HIPAA and laws protecting patient medical privacy, and PHI, and all Federal and State legislation pertaining to all billing-related matters.

EDUCATION

MIRA COSTA COLLEGE – Oceanside, CA (Certification 2014)

Advanced Medical Billing and Coding, Inpatient Hospital and Outpatient, CCS Candidate for Certification

SANTA BARBARA CITY COLLEGE – Santa Barbara, CA (Two Associate Degrees)

Associate Degree Medical Assisting & Medical Billing (Certification 1978): General Education

Associate Degree Nursing (retired), Anatomy & Physiology

WORK EXPERIENCE

ACCOUNTEMPS STAFFING: Assigned to Arch Healthcare Orthopedics, Escondido and Poway, CA

Health Information Management August 2016-August 2017

Full conversion of Medical Records from paper to Electronic Health Records. Responsible for Abstraction of Medical Records into the electronic medical record. Scanning of all current records and archiving of older records. Responsible for responding to “Requests for Information” from Insurance, Attorneys, Subpoenas, and the patient. Providing all information requested in a timely fashion, maintaining all laws regarding protection of privacy. Responsible for patient information

VALLEY RADIOLOGY CONSULTANTS – Escondido, CA

Patient Care Representative/ Customer Service Patient registration Front Office April 2016 – Jun 2016

Scheduled and confirmed patient appointments as ordered by physicians for Radiological Exams,

Obtained insurance authorizations as required, and verified insurance eligibility, providing information to patients regarding insurance, financing and benefits.

OFFICEWORKS HEALTHCARE STAFFING:Assigned to REVIVEORTHOPEDICS (Dr. Christan Bentley) – Encinitas, CA

Medical Billing Specialist Sep 2015 – Dec 2015

Prepared Orthopedic office to begin “in-Office” billing (Previously used Outsourced Billing Company).

Set-Up an online medical billing software system w/EHR. Performed data entry of all patient demographics.

Entered all coding required for insurance billing and initiated claims to payers and handling various billing issues.

AEROTEK TEMPORARY STAFFING: E.A. HEALTHCARE – Solana Beach, CA

Full Revenue Cycle Billing and A/R Collections Jan 2015 – Mar 2015

Medical collections and A/R projects for hospitalist Charges and Emergency Room Charges via a Third Party Co.

Medical collections from Commercial Ins., Tricare, Medicare, Work Comp- working with claims Adjusters.

CHMB, INC. – Escondido, CA

Accounts Receivable Representative Jan 2014 – May 2014

(Note: 5/2014 Medical incident required surgery & 6 months recuperation)

Medical collections and A/R for a very fast paced Medical Billing and Collections Company.

Answering customer service requests. Twice weekly responsible for all incoming calls for all accounts. Up to 70 incoming phone calls daily from patients regarding insurance benefits, payments, account, PT co-ins and EOBs.

A/R Reports & Spreadsheets by payer and age of claims ran weekly. Reviewed all accounts weekly with supervisor.

ACCOUNTEMPS STAFFING, A ROBERT HALF COMPANY

Medical Biller/Collection Specialist (2 assignments) Mar 2013 – Dec 2013

(1: North County Health Services 2: Pathway Genomics)

Patient CSR skills, Front Office Skills as required, excellent communication in discussing general clinic and billing questions. Patient registration correctly entering all demographic information.

Full Cycle Billing for all types of payers: Medicare, crossover claims, federal programs, and grants, Commercial, HMO & PPO, Medi-Cal and Medi-Cal HMOs. Additional responsibilities for collections on the A/R for claims billed.

Central Billing Site for 7 Clinics. Incoming/Outgoing phone calls, and walk-in patients. Ability to discuss Insurance, EOB’s.

Account balance management, application of insurance payments and adjustments per EOB or R.A.; Collect co-pays and document in account. Add payment to cash box, balancing after each payment. Responsible for end-of-day deposit.

ADVANCED PHARMACY HOMECARE – Escondido, CA

Medical Biller/Customer Service Representative (Contract) Jan 2012 – May 2012

Medical billing and collections for a small local Pharmacy and DME Company. Insurance billing and follow-up were involved. Excellent customer service & patient care. Assisted in set-up of Electronic Medical Billing

XIFIN, INC. – Carmel Mountain, San Diego, CA

Reimbursement Specialist Nov 2010 – Dec 2011

Handled billing for Molecular Diagnostic Laboratories - extensive appeal and follow-up on work, as claims were frequently underpaid or denied, requiring phone call follow-up for provider disputes & appeals. At least 25 appeals sent out daily with documentation.

Extensive customer service calls with patients regarding accounts concerns and other insurance questions.

Close working relationship with sales staff, CSR department, and medical billing department supervisors.

WALGREENS-OPTIONCARE PHARMACY AND HOME INFUSION/DME, INC. – Carlsbad, CA

Reimbursement Specialist II /Reimbursement Liaison Jul 2005 – Jul 2010

Handled and patient & customer issues. Financing, intake, authorization, HCFA, and electronic claims.

Answered heavy volume of calls, documented all information in patient account, and resolved all patient issues.

Full revenue cycle billing, understanding of payer contracts and the Division of Financial Responsibility.

Calculated patient co-insurance and negotiated payment plans. Collected all patient payments

Billed pharmacy claims, obtained pharmacy authorizations, completed forms for patient assistance programs with Pharmaceutical companies. Prescriptions billed through Medicare Part D.

CARLSBAD PSYCHOLOGY CENTER – Carlsbad, CA

Medical Office Manager/Medical Biller and Collector May 2002 – May 2005

Management of front office including scheduling patient appointments, maintaining checkbook A/P, A/R, administering payroll and taxes, answering questions regarding benefits, and payment collection.

Maintained insurance Billing: commercial, Work Comp, Medicare and Medicare Advantage, requiring frequent authorizations.

Maintained spreadsheet for HMO/PPO/ Work Comp authorizations required extensive follow-up and supplying medical records and additional documentation. Heavy appeals required, Vigorous follow-up abiding by HIPAA and PHI rules. Full responsibility for organization of office.

Contact this candidate