Data Entry Billing Specialist

ALLANA ALEXANDER

LANCASTER, TX *****

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

PROFESSIONAL EXPERIENCE

AMERITA, Remote April 2023 -

Billing Specialist (Contract)

• Reviewed delivery tickets for accuracy and completed claims per payer specific guidelines

• Worked Resolved unbilled tickets within 24 hours to ready or next status for resolution

• Managed ready to bill queue on a daily basis

• Processed confirmed tickets in an unworked status within 48 hours of confirmation date, assigned appropriate status to ensure proper handling by branch and billing staff

BAYMARK HEALTH SERVICES, Lewisville, TX June 2018 - July 2021 Billing Specialist (March 2020 - July 2021)

• Responsible for submitting claims and following up with insurance companies

• Responsibilities also included posting and managing account payments as well as travel when necessary

• Data entry of charges and billing of claims to various insurance companies

• Medical AR follow-up procedures included reviewing and working on aging reports, denials, and insurance correspondence from various insurance carriers

• Ability to audit and analyze patient accounts

• Required vast awareness of different medical software or the ability to learn new customized software quickly

• Payment posting and account reconciliation

• Reviewed and processed adjustments and refunds on patient accounts Credentialing Coordinator (December 2019 - March 2020)

• Processed and reviewed applications for completeness and accuracy

• Prepare for review - initial and renewal facility licenses and credentialing applications

• Created and carried out various credentialing processes in relation to center practitioners (medical and counseling personnel)

• Collected and processed verification and accreditation information

• Maintained and updated databases for facilities and practitioners

• Maintained close communication with practitioners, leadership, and licensing/credentialing entities - both locally and in other states

• Worked with an array of departments and leadership (HR, legal, accounting), both locally and in other states in order to obtain information and process required applications Billing Specialist (June 2018 - December 2019)

• Responsible for submitting claims and following up with insurance companies

• Responsibilities also included posting and managing account payments as well as travel when necessary

• Data entry of charges and billing of claims to various insurance companies

• Medical AR follow-up procedures included reviewing and working on aging reports, denials, and insurance correspondence from various insurance carriers

• Ability to audit and analyze patient accounts

• Required vast awareness of different medical software or the ability to learn new customized software quickly

• Payment posting and account reconciliation

• Reviewed and processed adjustments and refunds on patient accounts

• Supported Programs by responding promptly and accurately to inquiries INTREPID September 2017 - June 2018

Insurance Collector/Biller

• Performed all billing services in accordance with state/federal regulations; compliant with the plan of care/treatment; and consistent with professional practice

• Coordinated accumulation and verification of all necessary documentation required for billing

• Processed correspondence and telephone calls from all payors regarding all claims

• Responsible for the timely resolution of all claims including appeals

• Communicated with agency personnel on incorrect payor data that was identified

• Verified billing frequency, required forms, and general billing requirements

• Followed up on accounts for billing and on overdue accounts for collections via phone calls, re-submissions and adjustments for billing errors

• Maintained an acceptable % goal of outstanding AR depending on the plan

• Effectively working and resolving billing edits in a timely manner

• Managed clearinghouse and payor accept/reject reports timely TEXAS GENERAL HOSPITAL, Farmers Branch, TX July 2016 - January 2017 Denials Management Specialist

• Consistently followed up on unpaid /denied claims utilizing monthly aging reports

• Filed appeals when appropriate to obtain maximum reimbursement and establish

• Reviewed claims that failed on Front End Edits and analyzed the root cause

• Reviewed and analyzed insurance claims with accounts receivable balances

• Accessed denied claims and queried claim status, effectively researched the claim, and resubmitted or appealed as necessary

• Processed payer/patient refunds due to over-payments when applicable

• Identified underpayments and took necessary steps needed to receive the full insurance allowable as per the contract

• Completed follow-up with patients to obtain additional information when necessary

• Negotiated out-of-network claims for payment

NORTH TEXAS CARDIOVASCULAR ASSOCIATES, Dallas, TX February 2014 - July 2016 Billing Manager

• Responsible for billing all commercial, Medicare, and Medicaid, Managed Medicaid and Medicare claims

• Payment posting for office

• Responsible for precertification for procedures performed by the cardiologist

• Responsible for hiring staff members for the department

• Responsible for building reports to be used for A/R collections

• Performed write-offs and adjustments when needed

• Assisted the office manager with any other job duties when needed HICKORY TRAIL HOSPITAL, Desoto, TX November 2010 - July 2013 Business Office Coordinator (May 2012 - July 2013)

• Responsible for billing all commercial, Medicare, and Medicaid, Managed Medicaid and Medicare claims

• Payment Posting and bank reconciliation for the hospital

• Managed denial and worked closely with UR on appeals

• Responsible for reporting the census for the facility daily

• Responsible for maintaining payroll for staff

• Also worked closely with the Business Office Director as well as the CFO monitoring the A/R for the hospital

• Verification of Benefits

• Patient Registration

• Worked with local County Indigent programs and Medicaid qualifiers

• Performed write off and adjustments

• Submitted refunds when necessary

• Keyed Charges and Adjustments

• Ordered supplies for the office

• Trained all new employees in the business office Patient Account Representative / Collector (November 2010 - May 2012)

• Responsible for the appeal follow-up on the denied accounts

• Responsible for secondary billing, follow-up, and collection of assigned patient accounts by contacting patients, insurance companies, and third-party payers to resolve all outstanding owed balances on accounts

• Responsible for documenting accurately and timely all of the interactions with third-party payers and patients

• Posted cash payments to the patient accounts

• Also, met with the patients to collect co-payments and any amount due up front CONCENTRA URGENT CARE, Addison, TX October 2009 - August 2010 Medical Collector

• Billed and collected payments from insurance and patients, responsible for ensuring that all patients meet medical criteria for prescribed services, (responsible for gathering pertinent referral information, and preparing appropriate documentation)

• Verified insurance, and obtained authorizations and re-authorizations using CPT and ICD-9 codes required by payors

(commercial insurance, Medicaid, and/or Medicare)

• Reviewed EOBs and benefit letters, account reconciliation, communicate with hospitals, patients, and/or families regarding coverage and payment

CAREGUIDE, Dallas, TX November 2007 - May 2009

Medical Collector

• Heavy data entry, medical collections on current and past due accounts (exceeded monthly goal- one of the top 5 collectors)

• Account reconciliation, maintained daily report of all inbound and outbound calls with the IVR system

• Provided excellent and quality customer service to patients and insurance companies, knowledge of insurance payment guidelines and filing dates in network/out of network (such as private, Medicaid/Medicare, and commercials,)

• Patient follow-ups on the phone, in person, and/or by email, analyzed accounts and made proper adjustments (if needed) for rebilling or payment, analyzed E.O.B's, (determined patient or insurance responsibility), filed electronic claims, insurance verification, requested and processed refunds, reviewed treatment codes and analyzed diagnosis, and ability to problem solve and make recommendations of possible resolutions and other clerical PATHOLOGY PARTNERS, Irving, TX December 2005 - December 2006 Billing Specialist

• Processed patient lab results, insurance information, and codes into the system

• Entered appropriate CPT and diagnosis codes into the Quadex system for billing EDUCATION

DUNCANVILLE HIGH SCHOOL

High School Diploma

SKILLS

• Advanced MD

• CMS1500 forms

• Customer Service

• Data Entry 8000-9000 KS

• Emdeon

• Excel

• Inventory

• Medical Coding

• Medical Insurance Billing

• Medical Manager

• Medical Terminology

• Medical Transcription

• Medisoft

• Nextgen

• Outlook

• Practice Insight

• Practice Velocity

• SAMMS

• UB04 forms

• Word

• WordPerfect

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