Accounts Receivable Follow Up
Resume:
Tonya R. Plump
Chicago, IL.
**********@*****.***
Executive Summary:
As an aggressive Physician/Hospital Accounts Receivable Specialist my goal is to recover full allowable reimbursement from payers by being adept at analyzing claims, exhausting options for collections and reducing denials. I have an ability to prioritize work activities with minimal supervision based on my background as being part of a remote team for 7 years. I have been recognized for creating tremendous impact on large hospital facilities by reducing outstanding AR within a short time frame. In my previous roles at Griffin Global Systems Inc. and Experis Healthcare I was honorably given the title “subject matter expert” because of the qualities that I possess both personally and professionally. Those factors combined with 18 years of experience in various areas from the life cycle of a medical claim to the reimbursement process will make me an asset to your organization. I am highly experienced in Blue Cross Blue Shield follow-up and denial management.
Remote Work Experience 2014-Present:
Acclara, Revenue Cycle Specialist 02/2022-Present
Complete understanding of insurance contracts, credit balances and appeals
Deep knowledge of HIPAA protocols
Basic knowledge of medical terminology (e.g., primary care, provider, benefits, EOBs, CPT & ICD-10 codes, HCFAs, UB04s, HCPCS, DRGs, and authorizations/referrals)
Experience with navigating EPIC to research corresponding billing information for AR, reimbursement, procedure codes, diagnostic codes, charge amounts, etc.
Experience with navigating EPIC to review associated patient’s demographics, and/or medical records
Experience with navigating payment portals, Availity and Navinet to review eligibility and claim status
Thorough knowledge of insurance follow-up processes involving Billing, Collections, Managed Care, Medicare, Medicaid, and Commercial Practices
Thorough knowledge of EOBs (explanation of benefits), CPT, ICD-10 codes, HCFAs, UB04s, HCPCS, DRGS, insurance contracts, and authorizations/referrals
E3Twenty Healthcare Consulting, Managed Care AR Coordinator (Contract) 07/2020-12/2021
Mentors, manages, and trains staff members within the managed Care AR Department
Solves complex issues in a timely and appropriate manner
Serves as a subject matter expert in all areas of reimbursement-related issues
Contact physician offices according to Department guidelines to request missing information from authorization requests or for additional information as requested by the Medical Director.
Assists with customer service/client relations communications with all parties involved in the Revenue Cycle Management process
Monitors internal benchmarks and checklists to ensure that all RCM services are being provided accurately and on a routine basis
Requests and communicates missing, incomplete, or inaccurate data needed to successfully perform all RCM related activities
SPI, Insurance Follow-Up Specialist (Contract) 12/2019-02/2020
Research and evaluate accounts and EOBs for proper reimbursement.
Follow up with third party payers regarding payment of claims.
Documents follow up activities •Document account for future follow up, write off, payer relations, etc...
Assists management staff in evaluating and improving recovery processes and workflows as appropriate.
Utilize scanning system capabilities to their fullest to maximize effect.
Pro-Spectus Inc., BCBS Billing Case Manager (Contract) 08/2018-10/2019
Identified and resolved payment issues between patients and providers.
Contacted responsible parties for past due debts.
Improved timely payment of bills by developing flexible payment plans for patients
Contacted patients regarding unpaid and underpaid accounts to resolve issues.
Handled claims consistent with client and corporate policies, procedures, best practices, and regulations.
Inputted all patient data regarding claims and prior authorizations into the system accurately
Reviewed insurance coverage for patients to determine which party was liable for payment.
Researched denied claims and contacted insurance companies to resolve these issues.
Routinely collaborated with department managers to correct problems and improve services.
Identified overpayments and processed refunds for insurance carriers and patients.
Communicated effectively with others through active listening and dynamic interpersonal skills.
Experis Healthcare LLC., Medical Claims Consultant (Contract) 09/2017-08/2018
Research and resolve underpayments
Follow government and third-party payer guidelines to ensure complete and timely follow-up on claims that have open balances, were rejected, or denied.
Performs appeals
Reviews payer contracts and fee schedules to perform underpayment collections.
Identify other payers and ensures that the filing order is current
Collaborates with management to identify patterns and interpret denial trends.
Minimized write-offs by exhausting all resolution options and performing thorough research/review of all appropriate resources.
Griffin Global Systems, Accounts Receivable/ Managed Care Consultant (Contract) 03/2016-09/2017
Securing outstanding balance payments
Generating payment reports using Excel and assigned practice management systems
Hospital Part A facility billing experience • Working A/R claims assigned on a daily, weekly, or monthly basis
Communicating with supervisor on a daily, weekly, and monthly basis regarding paid and outstanding claims
Maintaining work operations by following policies and procedures; reporting compliance issues
Protecting patient's collection and personal information by keeping it confidential.
Responsible for medical and dental claims denial management.
Broad-Path Healthcare, Accounts Receivable /Managed Care Consultant (Contract) 08/2015-02/2016
Adjudicate claims in accordance with policy terms and conditions.
Achieve / exceed set productivity and quality standards.
Interface effectively with internal staff to resolve customer issues.
Maintain accurate records and files as required.
Actively support other team members and the achievement of team objectives.
Identify potential process improvements and make recommendations to Team Leader
Dell Inc., HC & Insurance Ops Sr. Representative (Contract) 04/2015-05/2015 & 11/2015-12/2015
Ability to analyze and process transactions, with a strong understanding of Claims processing and utilization
Interact with customers and internal departments to resolve issues and accurately process claims
Properly adjudicate claims
Magellan Healthcare Technology Consultants, Clinical Specialist (Contract) 06/2014-09/2014
Adjudicate claims and adjustments.
Resolve claims edits and suspended claims.
Maintain and update required reference materials to adjudicate claims.
Provide backup support to other team/group members in the performance of job duties.
Full-Time Work Experience:
Advocate Medical Group, Medical Reimbursement Specialist 03/2013 -07/2014
Uses IDX/PCS work files to track timely follow-up of outstanding medical and dental claims.
Performs collection activity on open insurance claims exercising billing knowledge.
Review incoming insurance correspondence and responds with accurate written documentation
Uses a proactive approach in identifying and bringing patterns/trends to management’s attention re: coding and compliance, contracting, and credentialing for any potential in delay/denial of reimbursement.
Hospital Part A facility billing •submitted appeals to assure that the contracted amount is received from third party payers.
Complies and maintains the aging target for assigned payers.
The Washington Group, Hospital Reimbursement Specialist 08/2012-2/2013
Performed follow- up on accounts until there is zero balance or the account is turned over for collection.
Submit claim appeals with proper documentation as directed by insurance companies and processed claims for payment from all responsible payers
Submit electronic and paper claims to responsible parties for payment.
Research denied claims. • Hospital Part A facility billing experience.
Education:
Associate in Science Degree - Business Administration Concentration: Management
Technical Diploma- Medical Billing & Coding
EHR and other Software Experience:
Epic, IDX, Paragon, e-clinical Works, Cerner, Medical Manager, Meditech, EMR, Siemens, Emdeon, Facets, EZ-Cap, Rims, Q-Care, Next-Gen, Zirmed, Evicore, Click-time, Vericel Central CRM, Call Care Browser, HEALTH-suite, IMAX, Florida Shared, E-care, Navinet, C-Snap, Microsoft Word, PowerPoint, Excel, Outlook, Office, Office Suite, ERA, Ad-Hoc, HER, AS400, Lotus notes, Genelco, Sharepoint, Five9,Citrix, Diamond, ARU Content manager, HDTU,IDRS, EDSS, Knowledge Library, My-Coach, Cisco, Salesforce, Microsoft Teams, INEDSS. Availity
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