Pamela S. Allen

206-***-**** or ad3ey8@r.postjobfree.com

SUMMARY OF SKILLS:

• 30+ years medical administrative and customer service, working in medical office and finance.

• Experience, training and education in providing superior clerical Administrative Support to large teams of Administrative Professionals including front desk coordination, medical billing, patient care coordination, and medical office management

• Educated/trained/Experienced in ARMA, FCDA, Public Records Management, Public Records Act, FOIA,ROI, Medical Terminology, Medical Billing/Coding ICD-9, CPT Codes, EMR/Medical Records Management, MS Office Suite 2010

• Supervisorial experience of 9 staff members including 3 interns for small medical billing firm.

• Preparation of Business documents and correspondence, generating reports

• Typing: 65 WPM, 10,000 KPH Outlook Calendar, Appointments, Meeting Coordination

Experience working with claims processing all bill types, using EPIC, MCESSION, Change Health Care Endion, and Experion to electronically submit claims for clean processing. Experience performing claims corrections and resubmission. Experience working with corrected claims, reconsiderations, and appeals.

•MEDICAL SOFTWARE: EPIC//MCKESSON//PROTOUCH//IBM VIEWS//GROUPWISE//IDX RAD EXPERION CLAIMS PROCESSING/FACETS/MS MEDICAL 360 AND ALL OHP PORTALS/AVAILITY/LINK

•CHANGE HEALTHCARE ENDION CLAIMS PROCESSING

•GENERAL SOFTWARE: MS OFFICE SUITE//INTERNET EXPLORER

OUTLOOK ETC.

EDUCATION:

South Seattle Community College Medical Business Information Technology 2013

(SCCC Dean’s List Academic Achievement)

Seattle University AA Communications 1993

Multiple years of Experience in Patient Registration, Insurance Verification, Authorization, Patient Care Coordination,, Medical Records, Clams, Patient Account Review, Patient Scheduling for all Specialties, Front Desk Coordination, Remote Work

Most Applicable Experience

Employment

Tricare Healthcare Alliance

VA Community Care Network

Claims

Current

Use of knowledge and training in CPT and ICD10 codes to review for claim resubmission and preprocessing.

Worked with authorizations, referrals, cpt codes and diagnosis codes to assist providers with authorizations for medical care under this insurance plan.

Experience providing excellent customer services to providers regarding claim information for claims processing thru PGBA and WPS Inc payor. Processing of corrected claims for reconsideration, payor reprocessing and payment. Working with both CMS 1500 claims and UB04 facility claims for all types of inpatient and out patient services. Review and process for electronic claims thru Experion and Endion Change Health Care for reprocessing and explanation of payment to providers. Use of knowledge pf EOP, PRA, CPT codes, ICD9 and 10 codes, referrals and authorizations to interpret and process claims.

Taking inbound calls to explain to providers problems, with claims, (denial and rejection reasons reviewed thru Endion and CHA) and the need for the correction, reconsideration, and resubmission process to adjudicate for plan coverage and payment. Experience working with provider contracts and credentialing for contractual claim payment review and working with plan and CMS fee schedules to determine plan provider payment, plan coverage and benefits, to include coordination of benefits and plan payments. Including interpreting RA, EOB’s, EOP’s, to assess payment to provider regarding the claim’s submission process. Current experience working with patient referrals, and authorizations .

PACIFIC MEDICAL CENTER

USFHP Enrollment Coordinator

Patient Account Specialist

Patient Access Rep (coverage, referrals, claims: rejections, denials, processing..

Patient Access Coordinator Referrals and Authorizations

Seattle WA 98144 06

Use of knowledge and training in CPT and ICD10 codes to review for claim resubmission and preprocessing. 01/2017 09/30/2021

Worked with authorizations and referrals, cpt codes, diagnosis codes for approval for medical treatment for patients under all types of insurance.

Patient Access Specialist—perform account review for denial and follow up, reading and interpreting of EOB’s, remittances, to determine insurance payments and denials, provider write offs, contractual allowances, etc. Use of interpretation and knowledge of CPT codes and ICD-10 codes to determine payments and to submit appeals, performance of customer services regarding incoming patient calls regarding bills; performance of determination of patient responsibility. Under Enrollment coordinator—use of DEERS, and CENTRICITY to enroll TRICARE Prime military members and family members into the USFHP TRICARE Prime health insurance plan. Creation of invoices and bills for plan participant payment of enrollment fees, and premiums. Taking of payment over the phone, processing of payments in the Paya payment system; posting of monthly, quarterly and annual payments. Dis-enrollment of plan members and collection and adjustment of amounts owing at time of disenrollment. Patient access referral coordinator-process of referrals for patients, worked with all major health plans, review of eligibility, coverage and benefits, and high-volume technical customer service to assist patients with referrals, appointment access to providers and scheduling patient appointments. Experience working with provider contracts for credentialing review, pay fee schedules, contractual allowances, and payment regarding patient health care plans, benefits and coverage to involve coordination of benefits, for medical claims processing. Appointment scheduling and communication to clinical staff. Account review for claims processing of corrected claims. Verifying correct TID, NPI, Taxonomy codes, referral codes, working with coders for correct code submission to produce and submit a clean claim to Experion and Endion (Change HC) claims processing software electronically. current experience working with patient referrals, and authorizations for many various Medical Insurance Plans, including commercial, EHIP, Medicare, Medicaid, Tricare West, Tricare Prime, HMO, PPO, and EPOm plans. Worked with PIP and Accident Claims for MVA, L&I for personal,medical and 3rd party medical coverage. Reviewed PIP Auto and HOME policy coverage, limitations, and coverage.

The Polyclinic

06/01/2016 to 03/01/2017

PFS Patient Account Rep, claims review authorizations and referrals

Use of EPIC Mysis Excel and MS Office Suite

Worked with authorizations and referrals, cpt codes, diagnosis codes for approval for medical treatment for patients under all types of insurance.

To manage patients accounts and follow up on insurance payments and billing.

Use of Excel to work patient accounts with extensive and detailed information, to maintain database, and produce reports. Use of MS Office for insurance correspondence and for communications purposes. Provided customer service to coworkers, clinics, management and patients. Worked with claims processing using Change Health Care to review for Medicare processing and payment for primary Medicare and 2ndary Medicare Plans. Experience working with provider contracts for credentialing review, pay fee schedules, contractual allowances, and payment regarding patient health care plans, benefits and coverage to involve coordination of benefits, for medical claims processing.

Worked with Endion for electronic claim submission and processing. Current experience working with patient referrals, and authorizations for many various Medical Insurance Plans, including commercial, EHIP, Medicare, Medicaid, Tricare West, Tricare Prime, HMO, PPO, and EPO; to obtain authorization for providers services for patients from plans for all types of service to include primary care, specialty, diagnostic, procedures. Worked with 3rd party entities, such as Availity, AIM, Core Care, Evercore and Optum to obtain authorizations from plans, care coverage and benefits. Use of knowledge and training in CPT and ICD10 codes to review for claim resubmission and preprocessing. . Worked with PIP and Accident Claims for MVA, L&I for personal,medical and 3rd party medical coverage. Reviewed PIP Auto and HOME policy coverage, limitations, and coverage.

Core Medical Consulting

Claims and medical consulting small business, Bremerton WA 06/2009—06/2014

Use of knowledge and training in CPT and ICD10 codes to review for claim resubmission and preprocessing.

Claims review, patient accounts, referrals and authorizations

Worked with authorizations and referrals, cpt codes, diagnosis codes for approval for medical treatment for patients under all types of insurance.

(Worked for business off and on as needed on a full time and part time basis as business was in flux)

Medical Office Manager and Administrative Assistant /Patient Accounts/Patient Care Coordination: for business owner. Supervisor of 9 staff including 3 interns. Performed front office coordination, medical billing, referral coordination, records management, insurance pre-authorization and patient care coordination. Performed account maintenance, adjustments, and report management. Performed insurance follow up including assistance with payment rejections and appeals. Performed medical claim processing for corrected claims. Performed clam correction and resubmission to Endion. Worked with supply venders. Use of knowledge of CPT, ICD-9 and HCPCS codes, medical terminology, physiology, and anatomy. Use of MediSoft, Medatech, MS Office Suite, DSHS data base, Provider One FAXsys System, and Access applications. Performed customer service, patient care coordination, and administrative support. Experience working with provider contracts for credentialing review, pay fee schedules, contractual allowances, and payment regarding patient health care plans, benefits and coverage to involve coordination of benefits, for medical claims processing. Use of web based data systems and VPN's to run office from home. Use of MS Office (Excel and Access) to compile, interpret, translate corresponding data from data bases to reports and back again for medical statistical and business purposes. Use of advanced Excel. Performed claims processing and corrections to claims submitted electronically to claims scrubber either in Endion or CHC. Current experience working with patient referrals, and authorizations for many various Medical Insurance Plans, including commercial, EHIP, Medicare, Medicaid, Tricare West, Tricare Prime, HMO, PPO, and EPO; to obtain authorization for providers services for patients from plans for all types of service to include primary care, specialty, diagnostic, procedures. Worked with 3rd party entities, such as Availity, AIM, Core Care, Evercore and Optum to obtain authorizations from plans, care coverage and benefits. . Worked with PIP and Accident Claims for MVA, L&I for personal,medical and 3rd party medical coverage. Reviewed PIP Auto and HOME policy coverage, limitations, and coverage.

UW Medicine Temp Services

Assignments at UWMC/HMC/NWHMC/SCCA/UWP

Patient Financial Counseling Admitting/Patient Accounts

Referrals, authorizations for all types of insurance

Worked with authorizations and referrals, cpt codes, diagnosis codes for approval for medical treatment for patients under all types of insurance.

UWMC now UW Medicine, Seattle WA 11/19 Worked with authorizations and referrals, cpt codes, diagnosis codes for approval for medical treatment for patients under all types of insurance. 95-12/2003

Seattle, WA (06/2013—09/2015)

Patient Financial Services Counselor and PFS Specialist II

Reviewed claims for correction and electronic resubmission to Endion and Change HC. Corrected for CMS 1500 and UB04 forms. Reviewed and corrected for incomplete referral number, NPI numbers, TID Numbers Taxonomy numbers, units of service, CPT codes, incorrect and incomplete patient information. Use of knowledge and training in CPT and ICD10 codes to review for claim resubmission and preprocessing.

Performed insurance clearance for all different types of insurance. Assisted patients and families with obtaining healthcare thru ACA, and with obtaining insurance authorization for medical procedures, appointments, and provider services. Use of online and proprietary data bases, use of proprietary medical software, use of MS Office Suite etc. Knowledge of medical insurance programs, and resources available in King County, City of Seattle, State of WA and the Federal Government, to help patients obtain services and pay medical bills. Performed large volume customer service over the phone and sometimes in person: using professional and courteous skills. Worked closely with the Geriatric Psych Inpatient Unit on pre admissions for patients. Verified health insurance coverage, obtained insurance authorization, performed data entry for large statistical reports regarding care and demographic information. Worked with billing and medical information. **Customer service in small call/contact center** Provided excellent, consistent, professional customer service to large diverse population of patients. Performed insurance verification and follow up, medical billing, management of both hospital and professional fees accounts. Use of EPIC and other proprietary software programs of a daily basis. Use of different data base programs on a daily basis. Worked with electronic medical records. Data entry performed, reports generated. Use of MS Office Ste on a daily basis. Experience working with provider contracts for credentialing review, pay fee schedules, contractual allowances, and payment regarding patient health care plans, benefits and coverage to involve coordination of benefits, for medical claims processing. Financial Services Clearance Counselor: performed data entry, customer service, worked with CPT codes, referrals to obtain authorization and financial clearance for procedures. Current experience working with patient referrals, and authorizations for many various Medical Insurance Plans, including commercial, EHIP, Medicare, Medicaid, Tricare West, Tricare Prime, HMO, PPO, and EPO; to obtain authorization for providers services for patients from plans for all types of service to include primary care, specialty, diagnostic, procedures. Worked with 3rd party entities, such as Availity, AIM, Core Care, Evercore and Optum to obtain authorizations from plans, care coverage and benefits. . Worked with PIP and Accident Claims for MVA, L&I for personal,medical and 3rd party medical coverage. Reviewed PIP Auto and HOME policy coverage, limitations, and coverage.

I am an applicant for the Progressive Medical Claims Adjuster Examiner Trainee Position in Lynnwood WA remote to start.

I have 33 years of medical claims experience performing claims processing, cash applications, claims review, patient account review, denials, appeals, grievances, insurance eligibility, coverage review, provider contractual allowance, patient responsibility review (patient deductibles, coverage, benefits, co-pays, co-insurance), coordination of benefits; working on both the medical provider side and insurance plan side.

I have worked with all types of medical insurance from commercial, Medicare (all areas), Medicaid all areas, Tricare all plans, L&I, accident claims, MVA PIP claims and private pay. I have extended knowledge of and training in, working with patient medical records, CPT codes, Diagnosis Codes, medical conditions, medical terminology, medical treatment evaluation, and physiology, in both clinical out patient and inpatient areas.

I applied for the Medical Claims Adjuster/Examiner trainee position in Lynnwood WA, remote to start. I was required to take an online test that has nothing to do with this work. I am not applying for a CSR Call Center Rep. This test included a CSR Call Center exercise that included shipping. This is an area that I have never worked in before. The training for this part of the test was only about 3 minutes. I feel that this test was unfair and discriminatory toward my skills, age, job experience, and disability. This test was not geared to what I am applying for. Because of this incorrect testing I was taking out of consideration for this position, unfairly. I have over 33 years of experience in and training in critical thinking, and in the evaluation and processing of complex medical information.

I have more than enough proven experience, skills, and training to be an excellent and effective Medical Claims Examiner, as I know how to process and interpret medical claims for MVA and Accident PIP claims for payment and denial. I have worked with all types of claims on the provider’s side for many years.

For example, I used to review claims for payment under patients who were covered under MVA Personal Injury Protection, and commercial insurance. I also worked with claims regarding patients who were covered under an open L&I claim and commercial insurance. Often these claims were incorrectly billed as the provider saw the patient for the MVA injury covered under PIP and for diabetes covered under commercial insurance at the same visit. These services were billed on the same claim incorrectly and submitted to the PIP MVA insurance for payment and then denied. It would be my job to fix these claims by correctly evaluating what condition was covered under the PIP MVA insurance and or L&I claim, and which condition was covered under patient’s private or commercial insurance. It was also my job to follow up with MVA PIP insurance claim managers to see how much the pip coverage was for and when and if it had exhausted. It was my job to also manage and follow up for 3rd party MVA accident PIP coverage, for when patients were not covered under their own PIP MVA coverage thru their own policy, and covered under another person’s MVA PIP coverage because patient was a bystander or person in the car when the driver had the accident. I also worked on medical claims involving general accident or home owners’ insurance.

Also when I applied for this same position back in 2018 and got an interview I did not have to take this type of test.

I feel that I have been unfairly reviewed for this position and would like to be reconsidered based on applicable testing, my experience, training and skills. I am willing to take a test that gauges my skills and knowledge applicable to this position.

So, as I cannot speak with anyone about this in HR at Progressive, I have decided to apply again.

Thanks for your re-consideration.

Pam Allen

Medical Claims Adjuster Examiner Trainee

Lynnwood WA.

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