Data Entry Accounts Receivable

Mahoganycharisse McDaniels

***********@*****.***

Skills

• HCFA

• HIPPA Compliant

• Data Entry

• Health Insurance

• Customer Service

• CPT-4, HCPCS, ICD-9, ICD-10 Knowledge

• Facets 560 Prod

• Level 5 Inquires Experience

• Flexcare

• RainTree

• Access 365

• Salesforce

• Datanet

• CCA

• IDT

• Office ally

• QNXT

• MEIS

• Workforce

• EZ CAP

• DOFR (Division of Financial Responsibility)

• GFI FaxMaker

• Genesys Cloud

• CMS.GOV

• Encoder - Plus Win10 Pricers(ASC,DRG,APC)

• IDX {Edit Claims, Adjust Claims, Pending Claims}

• Epic Billing System

• Accounts receivable

Professional Experience

Claims Examiner, Managed Care Operations

Cedars-Sinai – Beverly Hills, CA {Temp Assignment} February 2024 to May 2024

• Review Account Payable report twice per week to ensure claims are paid correctly in conjunction with compliance.

• Processed UB04 and CMS1500 Claims

• Responsible for efficiency standards for number claims completed and for accuracy of entries

• Supports core values, policies, and procedures

• Obtains and adjudicates medical claims for processing; reviews scanned, EDI or manual documents pertinent data on claim for complete and accurate information.

• Analyze and adjust data, figure out appropriate codes, fees and ensure timely filing and contract rates are applied.

• Processed Claims in Epic System, Tapestry

• Work queue processed TAPAP TMIPA capitated, adjustments, Medi connect, non-contracted SR., referrals, Urgent care claims, COB, Continuity of care.

• Accounts receivable

Claims Auditor, ICMS Claims

Optum – El Segundo, CA {Temp Assignment} February 2023 to December 2023

• Review Account Payable report twice per week to ensure claims are paid correctly in conjunction with compliance.

• Research Providers checks that are returned due to bad addresses Stop/Pay/Reissues, Rejection of payment, Full back out/Replacements due to state checks or no response from provider.

• Posting of payment in IDX received by Providers/Vendors, and Health plans due to eligibility guarantee.

• Review and respond to CSR’s request daily regarding Provider and Patients issues in timely matter.

• NOC’s {Notice of Change of Address} request for providers updated W-9

• Monitor and maintain NOP’s notice of overpayments received from claim examiners/auditor’s spreadsheet

• Adheres to all company policies and procedures.

Resident Advisor

USHS – El Monte, CA September 2021 to February 2024

• Help Secure the premises and account for current residents at the beginning of each shift.

• At designated locations, regularly walk surrounding neighborhood to help maintain cordial relationships with neighbors.

• Ensure that union station policies and procedures are carried out correctly.

• Notify appropriate staff and law enforcement in situations that threaten the safety of staff, clients or the security and working conditions of the location.

• Assist client/guest in navigating and abiding by their Occupancy Agreement. Provide advocacy and assistance for client/guest during rules violation.

• Conduct wellness checks and document accordingly.

• Maintain a positive relationship with volunteers by providing support and supervision as needed.

• Provide appropriate crisis intervention to clients which can include support, problem-solving, meeting immediate needs, and/or ensuring client safety by calling for emergency services when needed.

Claims Examiner III

Connected Care Health – Newport Beach CA October 2020 to February 2023

• Follow up on of Medical Claims with the organization

• Review, adjudicate, and manually processed 80 claims or more daily

• Processed UB04 and CMS1500 Claims

• Processed claims for multiple IPA/Medical groups (Allcare,CVMG,APIPA,Alamitos,AAMG,JohnMur).

• Always communicates effectively with staff and management.

• Adheres to all company policies and procedures.

• Provide call backs to providers for Claim Status Inquiries

• Email Providers regarding their Claim status on payments/claim requests.

• Adheres to all company policies and procedures.

Care Coordinator

Martin Luther King Jr – Los Angeles, CA August 2020 to October 2022

• Provide Scheduling, organizing, and managing all aspects of patient’s healthcare maintenance and treatment.

• Help Patients complete paperwork, communicating with healthcare team about patients’ treatment plan and educating patients about resources and options for managing their health.

• Developing and coordinating health care programs

• Communicating between staff, patients, and family.

• Maintaining patient confidentiality and quality care.

• Provide transportation for participants as needed to essential appointments that support their wellbeing.

• Assist tenants in navigating and abiding by their lease obligations and house rules.

• Assist tenant in gaining, and maintaining financial, social, and medical services when needed.

• Assist tenants with their mental health needs such as making appointments for the provision of psychiatric or therapeutic services.

• Keep client records and information current and accurate and compliance standards.

• Provides linkage to mainstream resources, such as DPSS/Social Security Disability.

Healthcare Insurance Billing Representative

USCB INC – Los Angeles, CA July 2020 to October 2020

• Follow up on outstanding accounts in a professional and consistent manner.

• Successfully operates a PC, software/applications, telephone, fax, scanner, and copier.

• Accurately documents in the PC system the proper actions taken on each account.

• Performs accurate administrative or clerical duties in a timely fashion.

• Maintains compliance with FDCPA, FCRA, HIPAA plus local, state, and federal collection laws.

• Demonstrates attention to detail; achieves the determined production and quality expectations.

• Always communicates effectively with staff and USCB management.

• Performs special projects as assigned.

• Adheres to all company policies and procedures.

• Communicates effectively with staff and USCB management at all times.

• Follows instructions and maintains workflow standards.

Claims Recovery Specialist

CalOptima - Orange, CA December 2019 to May 2020

• Update Offset Accounts

• Process Refund Checks

• Recouped Share of Cost

• Provide status and eligibility verification.

• Send Recoupment Notices/Letters to Providers

• Review, Monitor, & analyze generated reports to determine recovery opportunities.

• Update and maintain accurate account of collections activity and incoming payments on claim files.

Reason for leaving: Temp assignment completed my 1100 hours.

Claims Processor

L.A Care Health Plan - Los Angeles, CA October 2017 to November 2019

• Provider Service Unit IV

• Process Provider Inquiries

• General inquiries on claim & appeal processing (Aetna, Healthnet, Molina, Anthem Blue Cross)

• Provide status and eligibility verification.

• Document all call interactions in system of record

• Process payments for LACC members

• Transportation Reservations/CCERTS

• Provide authorizations to Providers

• Provides support as needed to members of inbound calls as part of the larger role "one-stop shop"

service in the Customer Solution Center

• Assisted w/ Grievance & Appeals process overflow (Members dissatisfied with behavior or actions of their plan) Processed resolution letters and correspondence to providers & members. Escalated ongoing issues to management.

Reason for leaving: Looking for better career prospects, professional growth, and work opportunities.

CSC Representative

L.A Care Health Plan - Los Angeles, CA March 2017 to October 2017

• Processed Inbound & Outbound interactions involving members eligibility verification

• Processed general provider inquiries, claim status (pre-payment)

• Identify program and administration questions for all lines of business including direct member

• Request ID cards and PCP changes, triage of calls to appropriate departments

• Document all call interactions in system of record

Reason for leaving: Promotion.

Claims Processor

Beacon Health Options - Cypress, CA May 2015 to February 2017

• Processed 300 medical/Medicare claims daily

• Processed MHN, Aetna, Anthem Blue Cross UBH/HMO PPO Claims

• Data Entry Claims forms into Rain Tree & Flexcare system

• Assist in recovering and reconciling overpayments identified by external vendors

• Identify provider access problems on logs that are reviewed by Network Development Committee

• Confirm patient eligibility

• Review and process all claims per contract paid and or denied while achieving and maintaining

accuracy

• Research and Audit Accounts entered the MIS SYSTEM

• Analyze & manage complex or technically difficult claims by investigating & gathering information to

determine the Claim outcome to an appropriate & timely resolution.

• Follows-up on all claims suspended for review purposes or additional information requests until

claims are in the final stages.

Reason for leaving: Temporary assignment.

Claims Specialist

United Health Care - Cypress, CA July 2014 to May 2015

• Verify account holder, process payments, supply missing information

• Handling and researching issues over the phone

• Handle calls for Health Insurance

• Consistently meeting established productivity, schedule adherence, and quality standards

• Utilizing the computer database to verify and document information

• Processing Payments Via Internet & phone

Reason for leaving: Temporary Assignment

Mortgage Servicing Specialist

Wells Fargo - San Bernardino, CA April 2013 to July 2014

• Verify account holder, process payments, supply missing information

• Apply discounts to customer's account based on good standing

• Handle calls for Mortgage Accounts

• Data entry, sales, payoffs

• Heavy interaction with Title & Mortgage companies

• Processing GEM work orders, Escrow Analysis

Reason for leaving: Temporary Assignment

Lead Operations Monitor/Customer Support Representative

Access Services Inc - Los Angeles, CA September 2006 to August 2013

• Transportation order entry, verification/clarification, audit and investigation

• Apply discounts to customer accounts

• Handle calls from stranded passengers/uh Resolving passenger issues & determining eligibility

• Data entry, scheduling, recordkeeping, Monthly Company Reports

• Heavy interaction with service providers, dispatch and emergency providers

• Process police reports, no show suspension letters, handling TDD calls, Mail clerk

Reason for leaving: Company Relocated

Lead Medical Biller

US Health works - Van Nuys, CA August 2003 to August 2006

• Manage and process matching & mailing HICFA 1500 invoices

• Handle clean claims for insurance carriers

• Analyze account receivable through AS400 systems

• Process Claims.

Reason for leaving: Contract assignment.

Education:

Birmingham High School

●Cumulative GPA of 3.5/4.0

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