Resume of Maria Hurson

617-***-****

Education

Salter School, Boston, MA December 2012

Medical Billing and Coding Program

Skills

• Medical Records • Medical Scheduling

• Epic Cadence and Radiant • Medical Billing/ Coding

• Medication Administration • Meticulous attention to detail

• Multi-Line Phone Proficiency • Microsoft Word/ Office

• Microsoft Word/ Office • HIPPA Compliance

Professional Experience

Tufts Health Plan, Watertown MA

Intake Coordinator May 2021-present

Receive incoming authorization requests from providers, via telephone queue line (or other means) and obtain necessary administrative information and work to resolve non-clinical issues[such as checking on authorization status or claim question]. Clinical calls will be triaged to a care manager.

Contacts provider offices for further details on referrals, if necessary. Researches member eligibility and primary care selection to complete entry of referral and precertification event.

Documents and maintains all telephone calls and enters a note on each call/inquiry made. Documents all admissions, and referrals. Maintains flow and storage of information such as messages, forms, and logs.

Provides assistance to the clinical staff by requesting discharge dates, updates on Home Health Care referrals, updates on post-acute inpatient referrals, VNA, CSP, and/or other necessary information.

Working with providers and other members of Clinical Services to solve complex and urgent issues. Ensures that appropriate person/department from across the organization is appropriately involved with applicable issues.

Data entry of Authorization Requests for all Inpatient stays -- Outpatient requests as needed, into information system and send out authorization letters to facilities/offices. Identify any outliers and triage to care manager for review.

Mount Auburn Hospital, Cambridge MA March 2021- May 2021

Unit Coordinator

Greet patients and direct them to appropriate waiting area, ensuring efficient patient flow

Answer incoming calls, direct calls, take messages, use overhead paging system, answer questions and return calls to patients with instructions from physicians and nurses

Receive and process patient orders, reviewing for completeness and entering of data into Epic

Schedule outpatient exams with patients and private physicians. Coordination of multiple schedules to include IR, CT, Ultrasound and OR departments as needed.

Related clerical duties including printing of daily schedules and preparing files for patient visits. Collates patient test results for RN/MD follow-up.

Processing work orders as needed including environmental services, biomedical, engineering, transport and lab specimens

Beth Israel Deaconess Medical Center, Boston MA January 2018-July 2020

Unit Coordinator/ Patient Billing Liaison

Organization and updating of medical records

Maintenance of office supplies and paperwork

Scheduling and coordination of outpatient procedures

Admission and discharge of patients

Crisis resolution and management

Requesting and sending of reports

Ordering of tests for patients

Transcription of medical orders

Process patient and insurance correspondence.

Handle requests for billing related documents and EOBs.

Audit hospital accounts and investigate disputed charges.

Review of benefit information with patients. Resolve customer inquiries via e-mail, telephone, USPS.

Handle Self Pay accounts while investigating alternate insurance options available.

Provide client with weekly spreadsheets regarding reimbursement updates, demographic updates and

insurance balances.

Dana Farber Cancer Institute, Boston MA October 2017 – January 2018

Patient Accounts Representative (Contact)

Handle intake by phone, e-mail and EPIC inbox of CSE’s regard to Patient Billing and Statements,

Insurance questions, EOBs, Billing and coding inquiries and other patient concerns.

Post patient payments by mail and phone. Patient payment plans for self-pay and outstanding bills.

Research and print detailed bills for attorneys, patients and insurance companies.

Work adjustments and write offs from EPIC Work que, work refunds by wire transfer, credit card and bank checks.

Return addresses to correct billing statements for patient payments. Use Meta Viewer to resolve patient payments by check.

Bookkeeping and Business Services, Methuen, MA June 2015– January 2017

Medical Biller

Use coded data provided by the Doctors and Clinicians to produce and then submit to insurance companies for payment.

Enter all reimbursements from the EOB into Practice Management and Kareo.

Accurately enter patient demographics and insurance information to software programs.

Work directly with insurance, patient, and mental health professionals.

Knowledge of insurance guidelines, especially Medicaid and Medicare.

Follow up in discrepancies for payment.

Review of patient bills for accuracy and completeness. Posted to all accounts in a timely manner.

Prior authorizations, as necessary.

Use coded data provided by the Doctors and Clinicians to produce and then submit to insurance companies

for payment.

Enter all reimbursements from the EOB into Practice Management and Kareo.

Timely submission of secondary billing with appropriate supporting documentation. EDI reports, denials.

Network Health Company, Medford, MA November 2013-October 2014

Medical Management Review Coordinator

Triage all short stays of inpatient admission requests to the appropriate inpatient review nurse and

performed data entry into the CCMS system.

Monitor and resolution of pended events.

Requests by telephone or fax from physicians or hospitals for the Together, Forward, and Choice and direct products.

Obtain required information from caller and perform data entry into the CCMS system according to

department documentation standards and following all department workflows.

Notification to the requesting provider of the inpatient admissions, notifications, numbers.

Generate and process daily designed reports letters delegated discharge logs and workload.

Process OON forms for MM Clinicians.

Make event changes from Inpatient to Observation and vice versa.

Monitor business object pended reports to ensure timely turnaround decisions.

Timely coordination with the Care Management and nurses to ensure that the inpatient admission is

immediately conveyed in order to update the admission record.

Worked closely with MM Clinician staff to coordinate the front-end reconciliation process and day to day resolution of pended cases.

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