Rosalind Williams

Oak Park, IL *****

ad08ry@r.postjobfree.com

+1-773-***-****

Highly dependable professional with diverse experience in billing, collections, cash applications/ payment posting, claims, auditing, customer service and team leadership. Strengths in organization and detail, investigating, analyzing, problem solving and utilizing multiple computer systems to access information. Skilled in managing complex projects, defining project priorities and delegating tasks. Strong communication skills, comfortable with all levels of staff, customers and outside vendors. Exercises exceptional judgment and handles confidential, sensitive information. Excels in high pressure, high volume environments.

Work Experience

Claims Integrity Coordinator

SkinCure Oncology - Burr Ridge, IL

November 2021 to Present

Claims Integrity Coordinator May 2022 to Current

Publishes various reports and presentations.

Performs variance analysis, assists with medical claims reconciliation and payment process. Review claims, and physician notes and data to devise and refine procedures for identifying and resolving billing errors and provider billing practices.

Work closely with data analysts, clinical operations, accountants and operational teams. Individually monitors, analyzes and reports claims information including relevant healthcare trends and high cost claims by segment.

Work with the health plan provider team and the auditing team to develop ongoing processes for auditing provider bills, recording errors and tracking collections. Insurance Verification Specialist Nov 2021 to May 2022 Contacts Medicare, Medicaid and private insurance companies, by phone or internet tools, to obtain benefit and eligibility information. Obtains prior authorization for services being rendered. Efficiently and accurately verifies, reviews, documents and completes insurance verifications within a 24-hour turnaround time. Determines patient portions due, contractual discounts to be taken, or any other authorized discounts that may apply. Communicates this information with appropriate personnel for preparation of the scheduling process. Escalates recurring problem accounts, to management appropriately and in a timely manner. Maintains advanced knowledge of specialty and ancillary products to answer patient questions maintains a high degree of confidentiality at all times due to access to sensitive information. Follows all Medicare, Medicaid, HIPPA, and Private Insurance regulations and requirements

Medical Receptionist/Part time Evenings

Thrive of Lisle Rehabilitation Center - Lisle, IL

August 2021 to Present

Greeting all guests and patients politely. Monitor flow of lobby area. Keep lobby and reception area clean. Patient/Guest Liaison, ensuring patients and guest are informed of any changes, and/or urgent extras, dealing with requests for information, requests to speak to clinical staff, and/or administration, ensuring confidentiality and privacy. Answering and routing calls, as well as make reminder calls. Scheduling appointments (Doctors, transportation, caregiver, business office, social services, and meetings). Monitor/Update Census for facility. Process patient Background checks (CHIRP/ Criminal History Information Response Process, IDOC/Illinois Department of Corrections, SOR/Sex Offender Registration), Payment Collection (Room & Board, Medical Services, Laundry, Hair Stylist, Meals, and other patient services). Process new admission paperwork and assemble medical charts for all patients. Monitor/Maintain Office Supplies.

Medical Billing Specialist

Parathon Healthcare - Naperville, IL

February 2019 to September 2021

Audited medical files and claims for error. Performed extensive billing, insurance follow up and payment posting for local and out of state hospitals.

Gather request from third party carriers.

Created a spreadsheet format of an itemized billing summary for Medicaid, Medicare, and Commercial insurance.

Screened/Audited for incorrect ICD-9 and CPT coding. Review and analyze rejections and delays and report status to manager.

Respond to inquiries and/or provide information to correspondence. Contact insurers via phone to ascertain reflecting action taken.

Request additional information requested to obtain prompt payment from carriers through regulation compliance.

Utilize Florida Share Tracking System to check patient eligibility and to check if Medicaid or Medicare has paid or denied a claim.

Refund Analyst\Loyola Business Office

Ajilon Staffing - Westchester, IL

May 2017 to February 2019

Investigated overpayments received that caused credit balances for clients. Processed refunds, performed account adjustments, transfers and reversals. Run and maintained credit balances reports. Process weekly check run. Opened and sorted daily correspondence. Receptionist/Part Time

HCR ManorCare - Westmont, IL

May 2016 to September 2018

Greeting all guests and patients politely. Monitor flow of lobby area. Keep lobby and reception area clean. Patient/Guest Liaison, ensuring patients and guest are informed of any changes, and/or urgent extras, dealing with requests for information, requests to speak to clinical staff, and/or administration, ensuring confidentiality and privacy. Answering and routing calls, as well as make reminder calls. Scheduling appointments (Doctors, transportation, caregiver, business office, social services, and meetings). Monitor/Update Census for facility. Process patient Background checks (CHIRP/ Criminal History Information Response Process, IDOC/Illinois Department of Corrections, SOR/Sex Offender Registration), Payment Collection (Room & Board, Medical Services, Laundry, Hair Stylist, Meals, and other patient services). Process new admission paperwork and assemble medical charts for all patients. Monitor/Maintain Office Supplies.

Reimbursement Specialist

Addus Home Care - Downers Grove, IL

November 2015 to May 2017

Coordinate and facilitate all aspects of the timely billing for a defined set of locations (State of Ohio), and payers and clients. Works with assigned branches to obtain necessary documentation to process billing in accordance with and/or company guidelines. Submit electronic and manual claims adhering to strict deadlines. Manages unbilled report to ensure all billing for assigned areas is processed. Files supplemental billing for any late entries within payer filing limits. Provide billing guidance and support to the branch locations. Review accounts receivable reports regularly for any problematic accounts/ payers, trends and ensures timely follow up. Works with payer and branches to reach resolution on any unpaid claims. Complete write off/adjustments for uncollectible AR and routes as appropriate timely for approval. Maintain optimal communication and rapport with payers and branches. Offer input and maintain reporting requirements relative to assigned accounts. Identify and notify of changes in payer guidelines

Medical Collector/Account Auditor

Audit and correct claims for clean billing. Audit payment vouchers for payment accuracy, for four (4) hospitals. Appeal unpaid, denied claims. Review patient's bills for accuracy and completeness and obtain any missing information. Knowledge of insurance guidelines especially Medicare and State Medicaid. Check each insurance payment for correct reimbursement rate, and compliance with contracted discount. Call insurance companies regarding any discrepancy in payments if necessary. Identify and bill Secondary and/or Tertiary insurances. Answer and follow up on all insurance and patients telephone inquiries pertaining to assigned accounts.

Financial Counselor

Elmhurst Outpatient Surgery Center - Elmhurst, IL

April 2009 to October 2014

A/R Collections/Follow up for all major health insurance, Government, and Worker Comp carriers, as well as Self Pay accounts. Billing, electronic (Zirmed) and manual (Primary, Secondary, Tertiary, and Self Pay). Audit verification of daily registration forms to ensure proper billing. Process account liens, and collections forwarding. Investigates overpayments, process refunds, and adjust accounts accordingly. Prepare and files timely appeals on denials. Pre-Collect calls for Co pays, Deductibles, and Coinsurance. Customer Service: Answer patient inquires (over phone and walk ins) concerning account balances, their insurance, and supplies informative self-pay pricing. Process payments (Major /Debit credit cards, Care Credit, Cash, and Online Bank). NSF processing. Monthly BCBS Reconciliation (month end). Payment Posting of Bank Lockbox, Electronic Funds Transfer (EFT), Automatic Clearing House (ACH), and daily payment processing.

High Level Customer Service Team Lead

Revenue Cycle Solution (RCS) - Westchester, IL

October 2007 to June 2008

Assisted in supervising a staff of 15. Managed, coordinated, and directed the daily operation of a customer service unit that handled patient's issues in regard to billed charges, explaining the billing process, and patient's explanation of benefits (EOB). Trained reps on the different aspects two systems (Citris and Gynecologic), Set up payment plans, and client's charity care programs. Monitored reps calls for quality of service. Ran call list, and special project reports for reps to work. Monitored and scheduled phone coverage, and attendance/time off. Handled special VIP patients' accounts (Performing routine data entry duties, which included payment posting, denial notes, the billing of any remaining balances to other appropriate payers, and the adding and/or editing of insurance and demographic information). Review and track correspondence received from all payer sources on a daily basis in accordance with the company's policies and procedures.

Refund Analyst

Accordis Inc - Chicago, IL

January 2004 to February 2007

Investigated overpayments received that caused credit balances for clients. Processed refunds, performed account adjustments, transfers and reversals. Ran and maintained credit balances reports. Prepare and forward time sensitive, confidential patient information, insurance, medical, and payment reports to directors on a weekly basis. Follow up with insurance carriers on patients' behalf. Assigned to special projects as needed. Optimized knowledge in refund process and traveled off site to deliver training to the company's most demanding customers. Trained new employees on complex processes, ensuring a smooth transition following the sale of the organization.

Assigned to perform reconciliation for some of the most complicated accounts, which required skills in documentation, organization and detail.

Cross-trained on client protocols and SOPs. Overhauled department files, which was instrumental in ensuring that department passed audit.

Created and implemented an improved proved procedure for filing an appeal. Frequently contributed to the team by pitching in and helping co-workers meet critical deadlines. Creating and implemented a streamlined process for creating the monthly balance reports, reducing complication time by 50%.

Under critical time constraints, overcame a backlog of over 4000 credit balances to bring the account to current status and avoided costly legal penalties. Cash Application Specialist

Cash Application Specialist

2004 to 2005

Provided efficient, timely and accurate posting for EMS, self-pay and bad debt. Responsible for daily reconciliation of payments posted that was either received from bank lock boxes or payments reported by the clients.

Consistently exceeded company standards for accuracy and number of accounts. Completes various weekly reports, financial reporting and budget. Balance electronic payments. Perform month end closing for all payments receive Medical Biller

Specialized Medical Billing Service - Wood Dale, IL August 2003 to January 2004

Audit demographics, and insurance information. Insurance follow up. Charge and Credit entry. Payment posting of all received payments.

A/R for patient's responsibility=Early Stage Collections. Phones-inbound, and outbound. Process payments and refunds. Ran statements

Electronic claims billing to insurance companies. Bank Deposits. Patient Access Representative

Northwestern Medical Faculty Foundation - Chicago, IL December 2001 to August 2003

Primarily responsible for answering and appropriately managing incoming telephone calls. Responding to customers/patient's information needs.

Scheduling patients' appointments for 12 surgeons (7 GI/Endocrine, 2 Trauma, and 3 Surg Oncology). Performing various administrative and clerical duties. Maintenance of daily reports. Daily relief for reception (Patient check in), checking in patients arriving for their appointments, process medical notes/ records, prepare charts, and relate with patients. Daily relief of Patient Service Rep (Patient check out), checking out patients after their appointments, process monies (co pays, and/or payments due on their accounts), write up, batching of billing, and coding for services rendered, payment posting, make follow up/ return appointments, validate parking, and Bank deposits.

Education

High school diploma

Skills

• Medical Collection

• Medical Billing

• Accounts Receivable

• Auditing

• Insurance Verification

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