Dalena Eaton

Medical Insurance Verification

Sacramento, CA 95823

ad1xjt@r.postjobfree.com

+1-916-***-****

Medical billing and collections specialist recognized as a team-player with a strong work ethic. Known for her professional phone communication, attention to detail, keen analytical skills and exceptional customer service. Applies high standards for herself to meet the needs of her employer. Authorized to work in the US for any employer

Work Experience

Accounts Receivable Specialist III

Xtend Healthcare - Remote

January 2019 to December 2019

Reviewed and resolved outstanding insurance balances on physician patient accounts.Analyzed and evaluated appropriate next steps for bringing aged account receivables to resolution.Ensured cash recovery goals were met and assigned hospital receivables were addressed per company, client and federal guidelines.

Revenue Cycle Analyst

Expeditive LLC - Remote

March 2017 to December 2017

Temp Assignment

Worked off an aged trial balance to ensure a 30-day follow-up on all patient accounts. Worked with third party payers to ensure proper reimbursement on patient accounts, identifying and preparing adjustments and write*offs as appropriate, follow-up on daily correspondence (denials, low pays) to appropriately work patient accounts, interfacing with insurance companies via telephone to check claim status, written correspondence to payers and patients. Interpreted contracts with payers to ensure proper payment, sending initial or secondary bills to insurance companies. Process refunds/reinstatements/ rejections of insurance claims, running reports on a weekly and monthly basis. Reviewed patient accounts and resolved them to a zero balance by researching, and investigating all outcomes. Analyzed and identify trends and provide reports as necessary. Followed up with the provider on all outstanding AR in a timely matter

Revenue Analyst

ABLM - Sacramento, CA

March 2016 to October 2016

Worked off an aged trial balance to ensure a 30-day follow-up on all patient accounts. Worked with third party payers to ensure proper reimbursement on patient accounts, identifying and preparing adjustments and write*offs as appropriate, follow-up on daily correspondence (denials, low pays) to appropriately work patient accounts, interfacing with insurance companies via telephone to check claim status, written correspondence to payers and patients. Interpreted contracts with payers to ensure proper payment, sending initial or secondary bills to insurance companies. Process refunds/reinstatements/ rejections of insurance claims,running reports on a weekly and monthly basis. Followed up with the provider on all outstanding AR in a timely matter.

Claims Processor

Anthem Blue Cross - Rancho Cordova, CA

September 2015 to January 2016

Processes Medicare claims, determines coordination of benefits, ensures accurate timeliness of filing claims. Determines denial process to get claim filed for payment during the adjudication process.etc.. Medical Collector

Surgical Care Affiliate/Ajilon Staffing -Medical Collector -Temporary Assignment - Sacramento, CA April 2015 to June 2015

Received In bound calls from patients and Providers regarding bill. Followed up on denials and rejected claims processed payments and made payment arrangements. Submitted appeals, Requests for reconsideration of denied claims. Received Correspondences via email, fax, scanner documents pertaining to the follow up process for refunds, adjustments, write-offs, adjustments and transaction requests. Billed secondary insurances such as HealthNet, Worker’s Compensation, Tricare, Aenta, Blue Cross, Blue Shield, Medicare etc…Pulled EOBS and UB04’s and dealt with Out of Network provider’s and negotiations. System Software utilized SIS, Sharepointe, Zyrmed, Cash point, Global Transport to process Credit Card Refunds and payments.Utilized software database such as SIS, Zirmed, Outlook, CashPRo etc Medical Reviewer Specialist Temporary Assignment Completed Maximus Federal - Sacramento, CA

July 2014 to December 2014

Coordinated Injured Workers' requests for independent medical necessity decisions. Reviewed data entered into case file for accuracy and correct logic. Reviewed case file to determine whether all relevant information has been submitted. Contacted appropriate parties for required documentation if not received.Provided oversight of review of documents for completeness and legibility. Succinctly summarized the facts of each case and the issues at dispute. Decided if case is eligible to be sent to Medical Professional Reviewer. Designated clinical match of Medical Professional Reviewer. Ensured correct documents provided to Medical Professional Reviewer. Prepared and disseminated the Final Determination letter, using the appropriate template. Acquired all necessary information involving cases and may have rendered a determination based on the information.

Medical Collector

Adventist Health - Santa Rosa, CA

July 2013 to June 2014

Facility insurance account follow-up with Commercial payers. Responsible for billed AR backlog reduction medical billing and collection experience in a healthcare environment, excellent customer service phone skills, high volume accurate data entry skills, and proficiency in navigating multiple computer systems. Supports preparation of special reports to document billing and follow-up services (e.g., pulling records, documents from systems, document imaging status, etc.) Worked with systems MS4, Aeous and CCS systems.

A/R Account Representative II - Temporary

Kelley Services - Sacramento, CA

September 2012 to June 2013

Responsible for Billing Accounts for Major payers like Aetna, Cigna, Blue Cross, Medicare, United Healthcare working claims in the follow up queue and Processing Denials. Corresponded with insurance providers regarding patient accounts and payment Assisted and researched reason for Coding/Billing delays of unbilled accounts by identifying necessary documentation from coding staff and routing as necessary, following up to make sure account is routed to coder when documentation is available, and calling or contacting physician offices regarding pending queries. Worked with systems like Epic. Transaction Processor/Data Entry

ACS Xerox - Sacramento, CA

November 2011 to August 2012

Responsible for processing billing reports for Medi-Cal and private vendor services such as HCFA 1500, CMS 1500, Inpatient and outpatient Medical claims, 84, 82 and roll outs, Pharmacy, RTD's, Reimbursements, claims etc... Egistics and Citrix software utilized. In a production based environment. Urogynecology Consultants

Medical Assistant Externship - Sacramento, CA

June 2010 to June 2010

Answered multiline phone for the front office for patient referrals, appointment scheduling and patient data maintenance in a computerized scheduling program which included pre-registration, authorization for services, ensuring accounts were ready for billing utilized IDX, EMR and Centricity Business, software, excellent verbal and written communication skills. Assisted Provider in patient rooms and maintained cleanliness and disinfection, set up patient rooms and equipment. System -Patient Biller II

UC Davis Health - Sacramento, CA

February 2008 to April 2009

Strong data entry skills were required for this position responsible for Billing Medical Claims Electronically for Private and Commercial Insurance, Blue Cross, Medi-Cal, Medicaid, and Medicare handled Secondary Billing and BLB's, FMS Reports, Emergency Room Billing, CPT 4 and ICD.9 Coding, Processed UB92 Claims, HCFA claims, and HMO, PPO Billing excellent verbal and written communication skills. Client Services Representative Program Contract

Maximus - Carmichael, CA

May 2006 to May 2007

Coordinated Injured Workers’ requests for independent medical necessity decisions. Reviewed data entered into case file for accuracy and correct logic. Reviewed case file to determine whether all relevant information has been submitted. Contacted appropriate parties for required documentation if not received. Initiated and maintained a productive relationship with participating parties including but not limited to DWC, Providers, Injured Workers, and Medical Professionals. Provided oversight of review of documents for completeness and legibility. Succinctly summarized the facts of each case and the issues at dispute. Decided if case is eligible to be sent to Medical Professional Reviewer. Designated clinical match of Medical Professional Reviewer. Ensured correct documents provided to Medical Professional Reviewer. Prepared and disseminated the Final Determination letter, using the appropriate template. Acquired all necessary information involving cases and may have rendered a determination based on the information. Performed other duties assigned by management. Intake Representative I

Health Net Federal Services - Rancho Cordova, CA

November 2004 to December 2005

Responsible for retrieving and reviewing all correspondence from Referral/Authorizations Health Care and associate queues provided initial non-clinical review and CCS data entry, Billed Medical insurance Claims for Military and Civilian Providers.

Education

Associate's degree in General Studies

CTU Online - Remote

November 2013 to May 2014

Certificate in Medical Assisting

Western Career College - Sacramento, CA

April 2010 to May 2011

High school diploma or GED in HS diploma

Luther Burbank High School - Sacramento, CA

September 1994 to June 1996

Skills

• Prism

• healthquest

• gensys

• Enthrive

• sovera

• crosswalk

• HIPAA

• FDCPA

• Privacy Act

• FCRA

• Aetna

• Cigna

• Blue Cross

• Medicare

• United Healthcare

• Medi-Cal

• HCFA 1500

• CMS 1500

• Egistics

• Citrix

• IDX

• EMR

• Centricity

• Medical Collection

• Accounts Receivable

• CPT Coding

• Medical Billing

• Microsoft Outlook

• Medical Records

• Epic

• Analysis Skills

• Communication skills

• Microsoft Excel

• Patient monitoring

• Documentation review

• ICD-10

• Medical coding

• EDI

• Computer skills

• HCPCS

• Data entry

• Time management

• Microsoft Office

• Microsoft Word

• Customer service

• ICD-9

• Hospital Experience

• Patient Care

• Insurance Verification

• Laboratory Experience

• Medical Terminology

Certifications and Licenses

CPR Certification

Certified Medical Assistant

BLS Certification

Assessments

Protecting patient privacy — Proficient

February 2022

Understanding privacy rules and regulations associated with patient records Full results: Proficient

Medical terminology — Proficient

February 2022

Understanding and using medical terminology

Full results: Proficient

Medical billing — Proficient

February 2022

Understanding the procedures and forms used for medical billing Full results: Proficient

Indeed Assessments provides skills tests that are not indicative of a license or certification, or continued development in any professional field.

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