Human Resources Expert Level
Resume:
TY GIBSON
PH: 443-***-**** EMAIL: ad1ul7@r.postjobfree.com
Experienced, knowledgeable, self-motivated and looking forward to the opportunity to transition into a position that will allow me to maximize my growth potential.
CORE COMPETENCIES
Knowledgeable Experienced Self-Motivated
Attention to detail Problem Solving Skills Leadership Skills
Diligent Excellent Communication Reliable
WORK EXPERIENCE:
G.E.T Transportation, LLC
Jan 2020 – Present (Part-time 25 HR/WK)
Human Resources Assistant (Expert Level Experience)
Provide full cycle recruitment support to hiring managers in all areas of personnel management including processing/posting job announcements, in-processing new employees, and office automation support.
Initiate and tracks requests for hiring actions and provide guidance and assistance on completion of personnel actions to administrative points of contact and/or hiring manager.
Answer basic human resource policy inquiries/issues and work actions with unusual circumstances or that require additional coordination.
Coordinate job duties with hiring manager and create/post job openings to Indeed.
Evaluate applications for job-related criteria and review resumes for experience, training, and performance in relation to required job skills, knowledge, and abilities.
Schedule interviews with hiring manager and administer video interview with candidates.
Checked candidate references and coordinate background checks.
Review candidate MVA driving history and verify valid CDL license and D.O.T regulated certificates.
Provide candidate selection recommendation to hiring manager and generate/extend offers.
In-process new hires and register new hires with FMCSA for random drug testing (Federal Motor Carrier Safety Administration)
Ensure hiring manager is informed throughout the hiring process.
Create, manage, and maintain employee profiles.
Use ADP software to assist with weekly payroll processing for supervisor.
Produce forms, reports, spreadsheets, and general correspondence.
Ensure accuracy and timeliness of information, spelling, grammar, punctuation and presence of necessary correspondence.
GBMC
April 2020- Present (Full-time 40 HR/WK)
Medicare Patient Account Specialist (Expert Level Experience)
Ensure accurate and timely charge capture for clinic and hospital-based services.
Possess in depth knowledge of general accounting, collections and third-party payer procedures including federal, state and local collections regulations.
Responsible for patient billing and balance inquiries.
Answer patient questions regarding their insurance policies and explain options, entitlements, billing procedures, benefits, and rights.
Review each charge for consistency, accuracy, and completeness of data.
Research patient records, reconstruct incorrect or missing medical information required to prepare a valid insurance billing when data received is incomplete.
Recognize and interpret trends and patterns for various insurance payers.
Create reports to make recommendations to leadership as needed.
Identify and communicate potential roadblocks; work with leadership for resolution if needed.
Develop and maintain training documents and routinely train staff.
Manage account receivables balances and make timely and appropriate resolution of all assigned accounts for third-party payers.
Analyze patient data received, take necessary actions such as charging audits, processing credit balances, and claim adjustment processing including bad debt and charity.
Report bad debt accounts and recoveries to the assigned external collection agency as determined.
Routinely resolve complex collections and accounting billing issues.
Work independently and complete daily activities with minimal supervision.
Prepare a variety of vouchers, recurring reports, spreadsheets, and correspondence as required.
Assist supervisor in establishing goals and assume duties in the absence of my supervisor.
Address conflicts related to mission work by providing guidance, tracking resolution and elevating critical situations.
Conduct team meetings to collaborate and delegate assignments, projects and deadlines.
Plan, execute and monitor workload, lead the daily work of suspense’s and tasks, and formal tracking of short term and long-term work progress.
Create and train team on standard operating procedures and processes and understanding and execution of goals and priorities.
Johns Hopkins
April 2019-April 2020 (Full-Time 40HR/WK)
Billing/Collections Specialist II (Expert Level Experience)
Prepared and processed insurance billing documents for medical treatment/services received by patients.
Ensured accuracy of diagnosis, procedure, patient demographics, and other required data. Compiled dates of hospitalization and breakdown of standardized daily charges and ensured medial documentation matches codes.
Reviewed bills based on current coding information, procedures and guidelines of the insurance industry.
Entered a variety of patient information/data into the computer system; verified accuracy, consistency and completeness of all information/data entered to generate bills using automated billing systems.
Return bills to clinical coders for approval/disapproval of changes to codes, diagnoses, and procedures.
Post receipt of payments, compare amounts received against billing transmitted and determine reason if payment is fully or partially denied.
Followed-up with insurance companies for partially or fully denied claims, or those where no answers are received from insurers. Obtained reasons from insurers for discrepancies in the amount claimed and paid, or explanations for delay or denial of payment.
Verified amounts received against amounts billed. Computed percentage of bill paid; closed the account when less than received amount is deemed correct or re-billed the insurance company for the difference with an appeal letter.
Filed appeals on claims denied in error.
Met established Quality, Accuracy, and Productivity standards as defined by policies.
Received and responded to a wide variety of correspondence (i.e., requests for additional information and denials) and telephone inquiries generated by third party insurance carriers, beneficiaries and others relating to billing.
Resolved routine and complex issues, within level of responsibility, with insurance companies on a routine basis.
Create excel spreadsheets for reporting requirements and analyze billing data.
Brief leadership on trends, atypical situations, or other issues that may require special consideration or procedures.
Manage multiple conflicting priorities while supporting the various medical departments.
Ensure the adherence for payments of multiple commercial, government and private payers, insurance policies, insurance regulations, medical terminology, claims forms, HIPAA and documents required in the various procedural steps in the processing of claims.
University of Maryland
November 2009- April 2019 (Full-Time 40 HR/WK)
Patient Account Specialist/Biller (Team Lead)
Established goals and assumed duties in the absence of my supervisor.
Routinely assisted supervisor in planning, coordinating and direction of daily work activities of account specialists and billing staff.
Led the daily work of suspenses and tasks and tracking of short term and long-term work progress.
Addressed conflicts related to mission work by providing guidance, tracking resolution and elevating critical situations.
Conducted team meetings to collaborate and delegate assignments, projects and deadlines and discuss and resolve issues.
Created standard operating procedures and processes and routinely trained staff and new hires to perform daily duties.
Monitored, reviewed and reconciled patient account balances.
Billed patient accounts and assured accuracy by reviewing and verifying patient charges, coordinating benefit level, type of coverage, and/or approval for coverage.
Ensured billing codes were based on current coding information, procedures, and guidelines of the insurance industry.
Pre-authorization/Pre-Certification submission.
Forwarded bill to third party payers, and/or enters billing information into computerized billing system.
Interpreted data and reports to determine work priorities and resource allocation across multiple billing and collection tasks.
Collected insurance accounts by contacting insurance carriers and other third-party payers to verify receipt of billing and other information needed to process claims, secure approximate date of payment, negotiate with claims staff for prompt payment and resolve discrepancies in billings within appropriate time frames.
Communicated with staff at all levels of the organization (internal and external).
Contacted and participated in meetings with internal and external customers to resolve difficulty payment or process issues.
Developed productive relationships with insurance payer representatives to secure timely payment of claims.
Reviewed payments and Explanation of Benefits (EOB) received from the insurance companies.
Researched and followed-up unsatisfactory third-party responses (i.e., claim denials, inadequate payment, non-response to bill) to ensure maximum patient account reimbursement to the medical treatment facility.
Documented all information received from the insurance company.
Investigated and resolved insurance claim rejections and determined whether denied claims should be written off, appealed for further action, or referred to the legal office for further collection action.
Contact patients on past due accounts.
Set up payment plan arrangements, perform account adjustments and audit patient electronic health records.
Review and prepare delinquent accounts for collections with CCU (Central Collections Unit).
Address patient insurance and billing questions.
Practice Specialty included Urgent Care, Oral Surgery, Radiology, Screening, Special Needs and Geriatrics clinics.
Health Care Data Management
March 2008- November 2009 (Full-Time 40 HR/WK)
Full Cycle Medical Biller (Beginner/Entry Level Experience)
Code each bill based on current coding information, procedures, and guidelines of the insurance industry.
Contacted the healthcare provider for additional information when services rendered to patient were not clear, or when more details were needed to complete the forms.
Ensured that services provided were entered with the correct code which was key to charge generated per visit and maintained in accounting record.
Charge entry via superbill.
Entering patient demographics.
Medical claims submitted via paper and electronic filing.
Post checks received from the insurance companies to appropriate ledgers.
Verify amounts received against amounts billed.
Investigated and resolved insurance claim rejections and determined whether denied claims should be written off, appealed for further action, or referred to the legal office for further collection action.
Reviewed payments and Explanation of Benefits (EOB) received from the insurance companies.
Analyzed Accounts Receivable for assigned claims in a timely manner to determine status of claims errors or obstacles that could delay/prevent payment.
Resolved issues related to improperly coded or formatted bills, claim appeals and denials.
Corrected billing documents to facilitate payment of disputed or rejected bills.
Maintained suspense records on all claims and correspondence.
Developed and maintained tracker for delinquent bills.
Research and follow-up unsatisfactory third-party response (i.e., claim denials, inadequate payment, non-response to bill) in order to ensure maximum patient account reimbursement to the medical treatment facility.
Documented all information received from the insurance company.
Prepared patient statements, responded to patient billing inquires, set up collection accounts.
Prepared various monthly reports for physician’s review.
Worked with multiple specialty practices including Internal Medicine, Chiropractic, Maternal fetal, Nurse Practioner, and Mental Health.
Auto Accident and Workers Compensation claims billing as well.
Received and responded to a wide variety of correspondence (i.e., requests for additional information and denials) and telephone inquiries generated by third party insurance carriers and patients.
Resolved routine and complex issues.
Maintained patient files (HIPPA compliant), instructions, regulations, notices and correspondence.
EDUCATION:
Community College of Baltimore County
Baltimore, Maryland
Certified Medical Biller and Coder Specialist (CBCS)
Walbrook Senior High School
Baltimore, Maryland
High School Diploma
SOFTWARE SYSTEMS:
Epic, ProtoMed, Practice Manager, Allofactor, Practice Mate, Axium, Romexis, Mipacs, Emdeon, Platinum, Tims, Brightree, Epic, word, Word Perfect, Access, Application Extender, ADP, Outlook, Excel, PowerPoint, Teams, Zoom, Skype.
REFERENCES:
Melanie Carey (Manager)
G.E.T Transportation, LLC
ad1ul7@r.postjobfree.com
Loretta Maya (Manager)
GBMC
443-***-**** (HR Dept)
ad1ul7@r.postjobfree.com
Michele Corrado (Manager)
Johns Hopkins
ad1ul7@r.postjobfree.com
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