Felicia Adams

Charlotte, NC *****

ad2493@r.postjobfree.com 774-***-****

Work Experience

SAII Recruitment Specialist

American Red Cross Blood Services

Charlotte, Nc March 2020- April 2021

• Identify, investigate and retrieve suspect products associated with post-donation information, donor deferrals, abnormal or unexpected test results.

. Maintain Blood Services records in accordance with ARCBS directives and FDA, state and federal regulations. Researches donor records to retrieve the requested information. Work in a collaborative team environment to meet operational objectives while advancing donor and recipient safety.

. Perform all duties and responsibilities in compliance with standard operating procedures, Safety Quality Identity Potency Purity (SQUIPP), regulations outlined in the Code of Federal Regulations

(CFR), Occupational Safety and Health Administration (OSHA) and other applicable Federal, state and local regulations.

. Follows department and organizational policies and procedures as well as adheres to all applicable regulatory, contractual and compliance requirements Benefits Enrollment Verification Specialist

Amerisource Lash Group (Talentbridge Agency)

Fort Mill Sc October 2018- January 2019

• Working directly with the insurance company, healthcare provider,

• Verify patients insurance benefit information.

• Verifying patients' insurance coverage

• Enter insurance into data for specific diagnosis for eye injections

• Enrolled Member’s for new benefits and change of benefit plans. Handles all authorization requests timely and accurately, Follows department and organizational policies and procedures as well as adheres to all applicable regulatory, contractual and compliance requirements Lead Medical Biller

First Stop Medical Center LLC

Charlotte Nc April 2018- September 2018

Coded data to produce and submit claims to insurance companies

• Working directly with the insurance company, healthcare provider, and patient to get a claim processed and paid

• Reviewing and appealing unpaid and denied claims

• Verifying patients' insurance coverage

• Answering patients' billing questions

• Handling collections on unpaid accounts • Managing the facility's Accounts Receivable. Compliance Healthcare Administrator

Rogerson ADHC

Roslindale, MA

October 2016– March 2018 (full-time)

• Billing

• Monitor Patient Care

• Create New Policies and Procedures

• Verification of insurance.

• Ensuring that confidentiality is maintained

• Keep up to date with Mass health Regulations.

• Communicate with weekly meetings with RN’s CM, And staff to be incompliant. Create new admission charts with medical info and documentation. Patient Account Enrollment Represenative

Brockton- Signature Healthcare (Part time evenings job) Brockton, MA

March 2015 March 2018

•

• Perform a variety of Data entry and general Registrations.

• Perform bedside registration, bed assignment transfers and discharge patients.

• Verification of insurance.

• Scheduling appointments.

• Verify Insurance, Update Patient info in the ED Dept

• Enrolled new patients on to Mass health.

LTTS Authorization Specialist

Commonwealth Care Alliance

Charlestown, MA (Contract)

August 2014– Febuary 2015

• Conducts decision review for services requiring prior authorization in LTSS leveraging technology and guidelines as available

• Applies clinical and benefit administration policy guidelines to requests for authorizations

• Communicates results of reviews in the centralized enrollee record for the primary care team and clinical reviewers

• Works closely with Team Lead to facilitate escalated reviews in accordance to Standard Operating Procedures

• Assures accurate documentation of clinical decision and works with Team Lead to ensure consistency in applying policy

• Determines the need for additional structured clinical data for completion of service decision request

• Handles all authorization requests timely and accurately, adhering to performance measures

• Follows department and organizational policies and procedures as well as adheres to all applicable regulatory, contractual and compliance requirements Patient Account Specialist

Beth Israel-APG

Needham, MA (Contract)

June 2013 August 2014

Responsibilities

Identifies problem accounts with payers; investigates and corrects errors, follows-up on missing account information, and resolves past-due accounts. Answers inquiries by phone regarding past-due accounts and insurance guidelines; researches incorrect addresses for past-due accounts. Contacts responsible party to resolve delinquent accounts;

Submit claims to Mmis and all Mass health Products Dailey for Inpatient and Out Patient services. Directs accounts to outside collection agencies when necessary. May contact attorneys, employers, physicians, and others necessary to obtain information for resolution of credit and collection matters. Prepares reports to identify and resolve accounts receivable and referral problems posts data; verifies and performs mathematical computations; maintains Composes and types routine correspondence, memos, letters, etc. Performs

• or signature as necessary; follows up on their return in a timely manner Provider Service Rep II

Network Health

September 2010 to May 2013

• Provide Providers with Benefit and Claim Status information.

• Provide Members and Internal Departments with updated insurance issues.

• Submit claims back for adjustments to claims review.

• Provide Members and Internal Departments with updated information on claims.

• Contact Internal Departments regarding claim and Appeal Issues.

• Take Inbound Provider calls Dailey.

• Submit Eob' Dailey by Right Fax to Providers.

• Process Provider/ Member Correspondence Once a week. Lead Team Billing Specialist

Five Star Rehab and Wellness

June 2008- August 2010

• Process centralized billing for approximately 25 Assisted/Independent Living communities.

• Close Medicare for end of month billing cycle monthly for all Outpatient facilities.

• Post payments, entering census changes, entering ancillary charges daily.

• Produce monthly statements and perform monthly reconciliation.

• Follow up with multiple insurance companies on unpaid claims.

• Process and run all month end Medicare claims for all 25 facilities.

• Handle incoming calls from patients and insurance companies regarding claims and patient balances

• Assisted with failed bill and claim reports generated by the clearinghouse and insurance carriers.

• Reduce DSO for Medicare, Third Party commercial insurance and Medicaid by 8 days from January to June the in the last 6 months consecutive.

• Trained Staff on Medicare denials and Medicare Collections.

• Other duties as assigned

Medical Billing Territory Coordinator

Beacon Hospice/ Vna

June 2006- April 2008

• Update Census on Local sights for new admits and ongoing patients on a monthly basis from Inpatient to Routine services and Continue care.

• Generate invoices to sights for correct rate to bill insurance for services matching the dates of services for both Routine and Inpatient services.

• Resolved AR for Medicaid, Medicare and Private Insurances.

• Follow up on Mass Health Election Forms to submit to Mass health for our Elected and reelected patients at Vna facilities, as well as sending out the discharged and revoked forms to keep Mass health system accurate and updated with the changes in Hospice Vna services.

• Input insurance information, processes EOB’s rejections and re-billings.

• Generate and review claims before submitting them to the insurance carriers assist four other billers with questions.

Other day-to-day operation that will keep my workflow complete and accurate Receivable/Denials Specialist

St Elizabeth/Caritas Medical Group

April 2004-January 2006

• Provide Insurance’s Company with correct CPT, ICD9 Coding on claim issues.

• Process and Update Members Insurance info on to Meditech and Idx System.

• Update and process Members information and contracts pertaining to other third Party Insurances.

• Contact Providers and Billing Departments per claim issues.

• Process and updated corrected claims for resubmission to correct Insurance Company’s.

• Handed other trouble shooting Issues on Meditech, Meditrieve, and Idx Systems.

• Process Payment Posting daily and charge corrections. Third Party Billing Specialist

Tufts Health Plan

March 2001- April 2004 ( promotion)

• Provide Providers with Benefit information.

• Provide Members and Internal Departments with updated insurance issues.

• Update members’ information and contracts pertaining to other third party insurance issues.

• Contact Providers Billing Departments per claim issues.

• Adjudicated and adjusted claims for Medicare for A & B Insurance • Work on cleaning the AR for Medicaid, Medicare and Private Insurances. Provider Specialist (1999-2001)

• Provide Providers with Benefit information.

• Provide Members and Internal Departments with updated information on claims.

• Update Providers Credentialing information and Contracts.

• Contact Providers Billing Departments per claim issues.

• Adjudicate and adjust Claims/ for Medicare Part B Insurance. D&S Transportation

Driver/Owner September 1996 to Jan 1999

Transport school age children to Daycares and after School programs daily.

Contracted with the City of child services and private clients. Transported senior citizens to Appointments and shopping. Soft Ware Experience:

Medi-Tech Tahp Master

IDX Maces

Path links Athena

Unicare Care tracker

M Deon

EMR

Medicare-CMS

Mass health EMR People Soft

Centrix

Gateway

Education

Business Management

Roxbury Community College

September 2005- 2006

Medical Billing/ Administrative Course

Hickox Billing School

2000-2002

Boston, MA

1999 to 2000

Skills

Medical Billing Coding (10+ years), Customer Service Representative, Credential Rep (5 years) Hospice Outreach 2 Years, Suffolk County Campaign Manager 1 Year, and Transportation Business owner 5 years.

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