J. Dior Wilson, MSHSA

Raleigh, North Carolina ***10 919-***-**** ad1lc9@r.postjobfree.com

EDUCATION

M.S. Health Services Administration Concentration in Public Health – Strayer University, Online - 2022

Medical Billing and Coding Diploma – Ultimate Medical Academy – Online

A.A. Business – University of Phoenix – Online

B.S. Health Administration- University of Phoenix - Online

PROFESSIONAL SUMMARY

High performance and dedicated Healthcare Professional with a passion for developing compassionate and caring long-term assisted living facilities. Offer an entrepreneurial attitude with proven abilities in strategic business planning, financial management, marketing, and operational management. Diverse background in Billing, Education, and leadership, with the ability to motivate teams and lead by example to implement a strong sense of mission and purpose that aligns with corporate values. Skilled in identifying and capturing new clients through targeted marketing and negotiation skills. Excellent communication and interpersonal skills with the ability to quickly build relationships and form trust with people from various backgrounds.

CORE ACCOUNTING QUALIFICATIONS

Applied Mathematics Audit Tracking Payment Posting

Correspondence Writing Payment Reconciliation Accounts Receivable Management

Accounting Reconciling Charges Medical Claims Submission

Records Maintenance Change Healthcare (RPA) Health Fusion, CMS, Palmetto GBA

MS Office Suite NCAS, EMR, NextGen, EPIC Commercial Payer Provider Portals

Insurance Verification Accounts Receivable Management Collections, Medical Terminology, Medical Billing ICD 9 Meditech

PROFESSIONAL EXPERIENCE

DHHS – Raleigh, NC 12/2018 – Present

Behavioral Health, Alcohol and Drug, and Neuro Billing and AR Accounting Technician III

Analyzed healthcare Medicare, Medicaid, and Commercial Insurance Explanation of Benefits, utilizing paper and electronic formats utilizing RPA, and Health fusion.

Analyzed posted transactions and audited patient healthcare accounts to ensure correct reporting of payment; identifies inconsistent reimbursement totals; trends.

Entered data on complex excel worksheets and submitted to DHHS Regional Fiscal Offices, DSOHF Patient Relations Officer and CBO Management using Microsoft office.

Prepared daily receipt logs and completed weekly and monthly projects by established deadlines as assigned by CBO Management.

Used working knowledge of heatlthcare patient accounts and associated billing and collections to audit and resolve patient account balances.

Pivot Physical Therapy – Garner, NC (Contract) 04/2018 – 08/2018

Revenue Specialist Billing Analyst

Conducted audits to ensure print charges are correct and processed accurately using NextGen.

Research, appeal and resolve claim rejections, underpayments and denials and respond to written payer communications as shown with proper action.

Document daily in billing system all follow up and communication on patient account in consistent and concise format and logging daily in Excel accounts worked.

Processed claims and appeals by gathering information, starting and/or creating via payer portals, scanning appeals, filing electronic or paper re bills and mailing to insurance company promptly.

Patient Financial Group – Morrisville, NC 08/2016 – 4/2018

Accounts Receivable Specialist

Reviewed and analyzed claims given for accuracy of Billing whether electronically or submission through regular US mail.

Ensure all claims are appropriately followed up to ensure correct processing and payment is being made following protocol through Medisoft.

Entered and supports Patient account information file data.

Make phone calls to third party payers to obtain current account status information and vendors.

*References provided upon job offer*

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