EXPERIENCE

UPMC

Sr Authorization Specialist Pittsburgh,Pa March 2018- Currently

To perform authorization activites of inpatient /outpatient and Emergency department patients, denial management /all revenues

Reviews and interprets medical record documentation for patient history, diagnosis, and previous treatment plans to pre-authorize insurance plan determined procedures to avoid financial penalties to patient, provider and facility

Ensures accurate coding of the diagnosis, procedure, and services being rendered using ICD-9-CM, CPT, and HCPCS Level II, reimbursement controls,medical terminology, pathology, 22-modifiers, sox coding,

Works collaboratively with internal and external contacts specifically, Physician Services and Hospital Division, across UPMC as well as payors to enhance customer satisfaction and process compliance, ensuring the seamless coordination of work and to avoid a negative financial impact

Resolves basic authorization edits to ensure timely claim filing and elimination of payor rejections and or denials, submitting appeal

Utilizes payor-specific approved criteria or state laws and regulations to determine medical necessity or the clinical appropriateness for inpatient admissions, outpatient facility, office services, durable medical equipment, and drugs in terms of type, frequency, extent, site and duration, and considered effective for the patient's illness, injury, or disease

UPMC

Pittsburgh, PA December 2016- March2018

Account Representative Sr.

ensure the prompt and correct payment to the hospital of all monies owed to the provider by insurers and patients, payer experience, sox coding, 22 modifier, staying update with new policies/procedures, utilizing software applications, other resources to complete the task

claims are submitted thru Epic, MC400 accurately and timely manner, communicates with insurance companies, patients, and physicians regarding payment issues, reimbursement controllable loss, contractuals,establishes reasonable payment arrangements

assign appropriate status codes, surgical coding, human anatomy, physiology, medical terminology medical records, decentral edit

Third Party Billing and Collection Guidelines

Medco

Pharmacy Tech

Pittsburgh, Pa July 2016-August 2016

Provide exceptional customer service to all patients and members, direct reimbursement, medical records,

Under direct supervision of the registered pharmacist, fill prescription orders, makes them ava liable for verification by the pharmacist .

Once verified by the pharmacist, dispenses the descriptions, receive and store incoming supplies, process wholesaler medication order, stock perform various clerical duties related to the dept, compliances with all federal and state requirement .

United Healthcare Pittsburgh, PA

Provider Data Specialist February 2012 to August 2016

Maintains current provider data and database, reporting and extracting data for various reports and analyses,sox coding,icd 9, 10 coding,human anatomy, pathology,medical terminology,

E/M surgical cpt codes,sox coding,disease processes

Manages communication processes with other departments regarding database improvement in a timely manner, payer reimbursement, controllable losses, contractual adjustments, medical records

Submit appeals according to guidelines

Develops and maintains standards for database integrity and quality assurance while conducting audits and providing feedback to reduce errors and improve processes and performance

UPMC Pittsburgh, PA

Provider Advocate January 2011 to February 2012

Provided information regarding claim status, provider payments, appeals and member eligibility thru Mc400, other source like review medical records and solving and assisting with resolutions

Addressed customer service inquiries in a timely and accurate manner, medical terminology, human anatomy, pharmacolgy

Built customer loyalty by placing follow-up calls for providers who reported product issues

Assist with adjustments in accordance with company policies and procedures.

Golden Living Center Pittsburgh, PA

Medical Insurance Biller April 2006 to January 2011

Working claims and denials or submitting appeals to ensure maximum reimbursement for services provided, medical records, medical terminology, human anatomy,icd 9 the principles of the treatment,

Perform posting charges and completion of claims to payers in a timely fashion

Checking eligibility and benefits verification for treatments, hospitalizations, and procedures.

Called insurance companies regarding any discrepancy in payments if necessary

Canterbury office / Outpatient service/

Medical Assistant

Managing office telephone systems, including answering calls and returning messages

Scheduling patient appointments and maintaining communication to confirm future appointments

Documenting patients' medical information, including medical history and health insurance information

Performing data entry tasks to document patient records within facility databases and maintaining patient files

Coordinating daily office activities, greeting patients and checking patients in and out for their appointments

H&R Block Pittsburgh, PA

Receptionist, Tax Preparer August 2003 to Current

Responsible for greeting clients and assisting authorized personnel with locating information

Responsible for filling and responding to customer inquiries

Prepare tax returns for individuals, companies,or organizations under the guidance of a certified public accountant

Building a relationship with my clients that serve diverse,grow stronger every year, provide accurate tax return

Knowledgeable in tax laws and regulations explain complex issues

Prepare financial statements and other reports, meet deadlines

EDUCATION

Carlow University Jan 2015-Current

Bachelor of Science in Management in Health Service

Community College of Allegheny County May 2002

Associate of Science in Physical Therapy Assistant

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