Rhea Edmond

Medical Collector/Biller/Analyst

Plano, TX 75093

ad0ahi@r.postjobfree.com

+1-469-***-****

I am very thorough and compassionate. Very ambitious to strive for greatness and success. Highly driven and motivated. I have a passion for fashion. Customer service background. A lot of Sales Experience and a great deed of education background and hands on skill training. I have a college degree earned.Wide experience with partnering with health insurance companies, physicians, and pharmacist. Familiar with health regulations and guidelines that complies with office practice. Multitasker with phones, appointment scheduling, and faxing. Implemented creative ideas, strategies, and techniques with office staff/management for company growth. Expert with claims collecting, researching with payments, submitting prior authorizations, precertification's, referrals, appeals and Letter of Medical Necessity.

Willing to relocate: Anywhere

Authorized to work in the US for any employer

Work Experience

Medical Collections Specialist

North Texas Kidney Disease Associates - Lewisville, TX June 2016 to Present

• Confirm and correct any billing errors and make sure they are revised

• Posted payments received from patients and concerning insurance multitasker verifier, collector, and negotiating payments at the same time.

• Answer questions concerning billing related charges and or statements even online Collection on patient's account to obtain huge amount of company revenue Maximum company’s profit up to 80% of sales goal concerning payment strategies of getting more payments in

Compassionate about healthcare providers making the expectancy of level of service they desire as well as compassionate on claim representatives who help make a difference with working together to see things through

Collect up to 50% of Collection Goals daily

Familiar with ICD 10, and electronic payer info with various insurance policies: Medicare, Medicaid, secondary and commercials

Strategize with maintaining effective procedures to get all claims paid quickly and efficiently Discuss and inform patients concerning benefit options concerning payment plans and options concerning insurance policies

Bill electronic/paper claims

• Follow up with claim status to maintain and effective 90-100% goal daily of over 100 claims daily.

• adjust and handle with any delinquent accounts

• Strategize with maintaining effective procedures to get all claims paid quickly and efficiently.

• Obtain medical records diagnostic charting info/chart note info to file claims correctly and accurately

• updated billing statements accurately while collecting balances

• Boost the Associates revenue by providing accurate verifications for medical and injection benefits.

• Increase the nephrologists profit gain by obtaining and initiating valid referrals/ authorizations.

• Up to 100 accounts per day are timely verified for multiple nephrologists

• Maximized clinical profits by calculating and computing speedy/accurate injection/office/admin/lab pricing charges

• Considered specific ICD10 and billing coding necessary for authorization approvals.

• Partner with prominent insurance network /payers, credentialers, physician offices Boost the Associates revenue by providing accurate verifications for medical and injection benefits. Increase the nephrologists profit gain by obtaining and initiating valid referral/ authorizations A/R Collections Specialist

PAM Health - Plano, TX

September 2021 to September 2023

• Assisted the client with collecting almost a million dollars in revenue with claim follow up

• Reprocess claims for the client if need be; did redeterminations,reconsiderations, 1st level of appeal and 2nd level of appeal claims

• Review, research and collect important correspondence to provide claim payment

• Mailed and scanned necessary claim correspondence and patient letters in the system

• Communicated with billing,posting, and revenue analyst team for research and updates on claim Billing Specialist

BayMark Health Services - Lewisville, TX

May 2020 to January 2021

Increased revenue for 5 clinics by obtaining correct insurance COB.

• Assisted with updating payment information on the account and also for account purposes

• Partnered with EMD representatives to assist with billing out clean claims through the clearinghouse.

• Updated billing information to bill out to the appropriate insurance carrier

• Did insurance adjustments when needed

Revenue Cycle Analyst

First Baptist Medical Center - Dallas, TX

November 2019 to May 2020

November 2019 to May 2020

• Negotiate high dollar claims from up to 100,000 to 500,000 billed charged amounts

• Helped negotiated high dollar claim up to 150,000 of a total billed charged.

• Negotiated 86% of a billed charged amount with a 3rd party Company Viant

• SAP experience concerning working A/R, cash tracking, concerning invoice tracking; generated statements

• Wrote SOP for Revenue Cycle Analyst

• Collected and negotiated payment arrangements from patients

• Manually assist with reprocessing claims request as well as strategically appealing claims when needed.

• Did settlement offers of over 200,000 dollars worth of settlement offers with third payer/vendors concerning

• Submit medical records and applied strategic medical terminology/pathology studies to assist with claim payment; received negotiation settlements of up to 200,000.

• Posted Insurance checks based on batch information and full remittance viewer

• Assisted view requesting for recoupement info concerning revenue cycle and virtual credit card info concerning payment posting

• Adjusted and posted Insurance claim charges according to EOB

• Worked with Commercial Payer’s and Provider Relations Reps to get providers in network

• Assisted with billing charges by pointing out charges that need claim correction

• Assisted with ( if needed) any and all dedicated claim/account status that needed approval for write off/adj to assist with A/R

• Top Senior Collector with all Aetna, UHC, miscellaneous payers claims

• Post EFT payment remittances under under patient accounts to assist with A/R.

• Worked with third party negotiations such as Multiplan and Viant (under United Healthcare)and GCS

(under Aetna)

• Spoke with Attorneys and law firms with assisting a providing medical records (assisting HIM roll) along with providing a small fee to assist with sending out medical records; dealt with filling out subpoenas that required such pertaining to medical records

• Spoke and emailed attorney's 3rd party medical audit review companies, and patient's concerning medical request and sending communicating with them via, email, phone and fax.

• Familiarized and worked with EDI systems concerning claims submissions and tracking Site Coordinator/Reimbursement Coordinator

Lash Group/AmerisourceBergen - Frisco, TX

October 2015 to May 2016

• Increased the percentage of patients with drug coverage by initiating approved prior auth and appeals.

• Collaborated with insurances with getting summary of benefits for patients.

• Pharmacy verification of benefits were initiated promptly and accurately to ensure drug coverage for patients.

• Satisfied physician's expectations by initiating and submitting accurate pharmacy EOBs.

• Ensured quick RX triaging to specialty, mail order, and retail pharmacies for patients.

• Teamed with pharmacists for RX fills and nurses for medical labs related to diagnoses.

• Maximized drug coverage for patients by promoting assistance drug programs. Part Time Collector Agent

CMI - Carrollton, TX

May 2015 to October 2015

• Was the top collector or with the top 5 collectors in the dept to maximum companies revenue; had a specialized people skill

Accessed computerized financial information to answer to questions related to specific accounts.

• Resolved account payable discrepancies with friendly customer service and system research

• Saved the capital losses by collecting, calculating, and negotiating past due payments. HRA Health Claims Representative

Payflex Systems USA - Richardson, TX

August 2014 to May 2015

• Helped top fortune 500 companies' employees maximized medical, RX, and vision out of pocket expenses back to their HRA.

• Ensured employees over and under payments were reprocessed correctly

• Partnered with employees, providers offices, attorneys, and other insurance companies concerning claims

• Improved employee knowledge concerning considerable medical expenses and appropriate letters of medical necessities.

Sales Associate/Receptionist

Massage Envy - Frisco, TX

May 2014 to August 2014

Sold Murad products and was the top seller

• Professionally and courteously verified appointment times.

• Manual and electronical medical record were organized and kept up to date.

• Greeted clients adeptly managing a multi-line phone system.

• Prepped and kept front office neat and clean.

Patient Care Giver

Home Instead Senior Care - Dallas, TX

May 2013 to July 2013

• Enhanced the quality of life for elderly patients by being an emotional and physical support system.

• Provided behavioral/emotional support and supervision for elders such as those with dementia and Alzheimer's.

• Evaluated patient care needs, prioritized treatment, and maintained patient flow.

• Improved patient's daily functions and ensured safety. Education

Bachelor of Science in Economics, Financial Literacy, Ethics, Statistics, Texas Woman University - Denton, TX

2014 to 2024

Associate in I’ve studied Psychology, Sociology, Biology, Business Management

Collin County College - McKinney, TX

2016

High School Diploma

Plano East Senior High - Plano, TX

2007

Skills

• ICD (2 years)

• TYPING

• MEDICAID (2 years)

• MEDICARE (2 years)

• HIPPA

• Insurance Verification

• Medical Billing

• Medical Insurance

• Prior Authorization

• claims

• Collections

• Accounts Receivable

• Filing

• Accounts Payable

• CPT

• Data Entry

• Billing

• Microsoft Office

• Quickbooks

• coding

• Receptionist

• Sales (10+ years)

• Medical Terminology

• Microsoft Excel

• Outlook

• Training

• Excel

• Accounting

• Customer service

• Sales

• Front desk

• Beauty & cosmetics sales

Certifications and Licenses

driver's license

Additional Information

Skills

• Excellent with maintaining and establishing good rapport amongst other

• Strong ability to adapt and learn new tasks

• Quick and proficient typing skills

• Manual and super fax system

• Work with commercial payers, Medicare, Medicaid, 3rd party payers

• Great phone etiquette, oral, and listening communication skills

• HIPPA compliant

• ICD-10/Electronic Payer Expert

• EMR expert

• Microsoft Word, Excel, Outlook

• Medical terminology

Contact this candidate