Customer Service Third Party
Resume:
Vanessa Hammett
**** *** * * ****** Road Manning, SC 29102 803-***-****
OBJECTIVE
To secure a challenging position that will maximize my strong claims processing background, customer service experience, and organizational skills, while advancing the agenda of an established organization.
PROFESSIONAL WORK EXPERIENCE
January 2016 -Current PFS Quality Denial Analyst/ Government Team Leader
Monitors quality of service and make suggestions for improvement.
Audits patient accounts for accuracy and addresses any issues that need clarification or indicate a need for retraining.
Process denial at the account level.
Accurately document denials findings at department and account level per procedure.
Assists with improvements initiatives based on denial information.
Assists in working each account to resolve denials as needed.
Responsible to provide information to the PFS department Supervisors and Managers regarding Quality Audits.
Responsible for electronic billing to all third party payers, follow up and cash posting.
Proficient in both verbal and written communication and should possess extensive knowledge in third party billing and reimbursement.
Documenting accounts and communication skill with management level for reporting issues and concerns with problem accounts.
Assists with cash posting and customer service as needed.
Knowledge and understanding of coding guidelines for ICD-9, ICD-10 and CPT codes.
Regularly reviews aging appeals and problem cases.
April 2013-Present Non Government Biller – Palmetto Health
Prepare and file appropriate primary or secondary billing for Third party payer claims and patient statements. Edit and correct failed claims and rejections. Monitor claims for appropriate billing. Communicate problems with billing to supervisor/team leader. Monitor and bill patient accounts based on all regulatory requirements.
Perform follow-up duties with third party payers and/or patients for immediate payment. Provide duplicate billings, coordination of benefits and medical records to expedite payment of third party payer claims.
Research accounts daily for credit balances and forward to the appropriate department to process the refunds. Respond to correspondence.
Document all billing notes and patient telephone calls.
Work and prepare reports necessary to maintain acceptable levels of account receivables.
Post adjustments to accounts as necessary. Transfer charges to secondary insurance for billing. Comment on patient account - all deductibles, co-pays and denial information. Receive and answer patient telephone and written inquiries regarding charges and/or billing discrepancies for third party payers. Prepare accounts for bad debt write-off. Work and prepare reports for bad debt write-off and end of day balancing.
Prepare accounts for bad debt write-off and end of day balancing.
April 2011-Jan 2013 Patient Account Clerk – Columbia Eye Clinic
Process daily posting of all charge batches to include scanned, electronic, surgery, optical, and all manual entries. Posted all monies collected associated with the charge ticket.
Provided accurate posting of all monies from all sources to include insurance payments, patient payments., adjustment codes, and denials.
Completed all batches accurately and in a timely manner to include the review and completion of all associated reports.
Provided daily updates and close of the Misys Tiger and NextGen billing systems
Download and Upload medical claims for filing using the NextGen and Navicure claim filing systems.
Assist with the preparation for month-end balancing and close as needed.
Responsible for the daily transmission of all insurance claims, review and correction of rejected claims, and tracking reports.
Responsible for the weekly submission of patient bills and collection notices.
Responsible for reporting payments to the collection agency.
Assist with projects, audits, or special reports as needed.
Jan 2008–Oct 2010 Claims/Customer Service Representative – Antares Staffing West (division of Medical Mutual of Ohio)
Process 100+ claims per day while taking multiple phone calls from both policyholders and providers of service.
Interpret and apply medical claims coding, including: ICD-9, CPT, HCPCS and other codes found on standard claim forms.
Provide EDI support, reset passwords, and resolve database issues.
Navigate a windows-based processing system for claims, letter generation, call logs and client information.
Follow Standard Operating Procedures for departmental workflows and specific processing guidelines, including coordination of benefits with Medicare policies.
Provide resolution to a variety of issues including claims and health benefits.
Consistently meet or exceed the departmental goals; actual performance results shown below:
o2010 Average Claims Processing Procedural Accuracy = 98.5%
o2010 Average Claims Processing Financial Accuracy = 99.5 %
o2010 Average Customer Service Quality Score = 99.5 %
Oct 2007–2008 Support Services Coordinator – Carolina Care Plan (division of Medical Mutual of Ohio)
Processed New and Renewing Groups information in an Access database.
Prepared Pre and Post Enrollment material for Agents, Group Benefit Administrators, and members.
Generated and distributed various membership reports, fulfilled electronic and telephonic requests for supplies and materials.
Verified insurance policies.
Printed policies and mail them to customers.
May 2006–2007 New Group Coordinator – Carolina Care Plan (division of Medical Mutual of Ohio)
Screened new group applications and prepared documents for medical underwriting review.
Communicated underwriting decisions, including approval rates, declines and withdrawals.
Completed group installation forms to ensure accuracy and to effectively deliver the products and services.
Calculated participation, eligibility criteria, and rating review.
Feb 2002–2006 Member Distribution Clerk – Carolina Care Plan (division of Medical Mutual of Ohio)
Prepared new and renewing group benefit packages for mailing.
Data entered information for patients’ medical ID card.
Certifications
New Horizons Technical School – Columbia, SC
Completed Study: Microsoft Office Suite, Excel, and Lotus
Midlands Technical School- Columbia SC
Completed Study: CEUS Courses, Working with difficult People, Public Speaking, and Team Work
Certificate- Healthcare Foundations: Healthcare Basics
Certificate- Healthcare Foundations: Hospital Terminology
Medicare Fraud Abuse: Prevention, Detection, and Reporting
Bachelor’s Degree- Healthcare Management- Walden University
Certificate -Revenue Cycle Foundation: Denials, Appeals, and Collections
Certificate- Revenue Cycle Foundation: Billing and Reimbursement
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