Customer Service Medical Collections
Resume:
Ellamae Anderson CBCS
**** **** *** **** *** *** Randallstown, MD 21133
Phone: 443-***-**** E-mail: ***************@*****.***
PROFESSIONAL SKILLS SUMMARY:
●Medical Claims Processing
●Third Party Billing
●Medicare Insurance Billing
●Payments Posting
●Medical Administrative
●Accounts Receivable
●Medical Collections
●Insurance Verification
●Charge Entries
●Accounts Reconciliation
●Worker’s Compensation Claims Processing
●CPT Coding
●PowerPoint
●IDX- (Johns Hopkins University Software)
●Microsoft Excel
●AS400
●ICD-10 Coding
●Commercial Insurance Billing
●Tricare Insurance Billing
●Medical Claims Follow-Up
●Epic (Johns Hopkins University Software)
●Microsoft Word
●Keane Software
●Vision Share/CMS) Microsoft
●CARES- (MD State Software) MMIS- (MD State Software)
●EPR
●Microsoft Excel
●Medical Collections
●Data entry
●Availity Claims Verification (Johns Hopkins University)
●MABS- (MD State Software)
●SHARE- (MD State Software)
●SVES- (MD State Software)
●EVS
●PARIS- (MD State Software)
●Medicaid Billing
●Access
●Cerner Billing Software
●Medical Billing
●Electronic Health Record
●GE Centricity (Johns Hopkins University Software)
●CPR-Medical Billing/Collection Software
●Zimax Verification Software
●Waystar Billing Software
●Patients Authorizations Process
●Anatomy & Physiology
PROFESSIONAL EXPERIENCE:
Nation’s Home Infusion & Nation’s Healthcare LLC
Medical Reimbursement Specialist/Medical Collections Representative 02/2022-02/2023
●Processed aged receivable accounts, by utilizing the A/R reports and other supporting documentation to complete the billing process.
●Reviewed and assessed adjudicated claims for timely process in order to received proper payment for outstanding balances
●Researched, corrected and resubmitted unpaid claims for processing to complete the billing process.
●Submitted adjustment form, charge correction forms, and payment request daily as necessary when needed.
●Verified and validity for account balances by researching, reviewing and ensuring accuracy of charges.
●Performed payments posting and payment adjustments to ensure account balances are correctly applied to the patient account.
●Reviewed and interpret Explanation of Benefits (EOB) for denials and underpayment of codes
●Researched and resolved denials and underpayments with insurance carriers.
●Communicate with insurance companies, healthcare providers, and patients regarding billing inquiries or disputes.
●Confirmed insurance eligibility to insurance carriers for policies referrals and authorization is needed for claim adjudication.
●Resolved account discrepancies and prepared adjustments and refunds for approvals as necessary.
●Submitted carrier appeals and documentations for reconsideration request in a timely manner.
●Identified and submitted the required insurance refund request to the specialist according to policy and procedure.
●Met productivity goals/benchmarks as set and communicated Department leadership
●Served as a customer service representative for patient inquiries and phone calls.
●Follow up and collect on unpaid and denied claims to resolve any billing discrepancies.
●Maintained and updated confidentiality for patient information to protect and secure vital information.
●Performed collaboratively with other departments and coworkers as needed to complete the billing process.
●Attended quarterly monthly meetings with respective payers for new policies and regulations.
●Verified claims status for dates of services from the insurance carriers’ websites.
●Negotiates with clients’ repayment terms on past due accounts
●Makes decisions, documented on referring accounts for collection or writing off.
●Confirmed credit balances and gathers necessary documentations for processing refunds.
●Prepared delinquent accounts to transfer to self-pay when no active insurance was available for dates that were rendered.
Life Bridge Healthcare/PDI 02/2019-09/2019 & 05/2018-07/2018
-
Recovery Specialist I (Temp)
(Medicaid & Medicare Department)
●Analyzed accounts using EMT software to ensure that all outstanding account balances are resolved in a timely manner.
● Maintained the highest levels of accuracy and patient confidentiality by applying HIPPA regulations and rules.
●Quickly identified and resolved medical billing issues and insurance discrepancies in order to complete the billing process.
● Retrieved and submitted EOB along with secondary insurance or tertiary insurance for the outstanding balance.
● Developed and maintained an automated Excel spreadsheet for billing purposes.
●Followed up on denial and rejected claims to resolve accounts and maximize reimbursement for billing purposes.
●Escalated problem accounts to supervisor to be reviewed for special attention to resolve billing issues.
●Determined why the claims were denied or underpaid and requested claims adjudication corrections.
●Provided supporting documentation or referred payers to reimbursement agreements for resolution of non-payment.
●Prepared monthly billing reports by summarizing billing productivity based on financial class to complete the billing process.
●Escalated significant problem accounts for further action based upon factors such as unsuccessful collection efforts or age of accounts.
●Submitted and documented W-9 forms to the various insurance companies for correct billing address information.
●Identify key issues and take appropriate follow-up actions to resolve billing matters and ensure proper payments.
●Follow up and document all third-party insurance and self-pay accounts in order to complete the billing process.
●Prepared, reviewed, and transmitted claims using billing software, including electronic and paper claim processing.
● Using A/R follow-up systems and reports to identify unpaid claims for collection/appeal.
●Gathers and verifies all information required to produce a clean claim including special billing procedures that may be defined by a payer or contract.
●Review and update patient registration information (demographic and insurance) as needed.
●Resolved claim edits as needed to apply appropriate discounts and courtesies based on department policy.
●Prepared delinquent accounts for transfer to self-pay collection unit according to the follow-up matrix.
●Printed and submitted claim forms and statements according to the follow-up matrix to complete the billing process..
●Retrieves supporting documents (medical reports, authorizations, etc.) as needed and submits to third-party payers.
●Appeals rejected the claim with documentation in order to complete the billing process.
●Confirmed credit balances and gathered necessary documentation for processing refunds.
●Identifies insurance issues of primary vs. secondary insurance, coordination of benefits eligibility and any other issue causing non-payment of claims.
●Contact the payors or patient as appropriate for corrective action to resolve the issue and receive payment of claims.
●Monitor invoice activity until the problem is resolved.
●Process daily mail, edits reports, file or pull EOB batches.
●Identifies and escalates non-standard appeals to a higher-level specialist.
●Performed claims processing in order to receive outstanding payments from an Excel spreadsheet.
●Adjudicated 1500 claims daily into the computer database to complete the billing process.
●Identified and billed secondary or tertiary insurance timely per operational standards and company policies and regulations.
●Verified insurance eligibility and updated both in GE Centricity and Cerner computerized software system to complete the billing process.
●Confirmed and verified the patients’ account balances to make sure the correct third-party payer is properly addressed.
Maryland Department of Health and Mental Hygiene 11/2017-01/2018
Medicaid Eligibility Department
Eligibility Determination Specialist (Temp)
●Provided Medicaid eligibility determination services for the Medicaid population under the services and direction of the Department of Health Mental Hygiene Division.
●Received and processed documents, and applications from Medicaid members in order to complete the Medicaid process.
●Prepared monthly billing reports by summarizing billing productivity based on financial class to complete the billing process.
●Reviewed, determined, and updated demographic information in the computer system in order to complete the Medicaid process for eligibility.
● Requested verifications, citizenships, and identities from Medicaid members and dependents for Medicaid process and determination.
●Interacted with the supervisor, case management, and other departmental teams to complete the Medicaid Eligibility application process for yearly coverage.
●Utilized the various Maryland State Medicaid software in order to complete the application process for medical coverage.
●Determined eligibility for Medicaid coverage by investigating searches for incomplete documents and incomplete application data.
●Provided and submitted insurance enrollment information to ensure cases were completed in a timely fashion.
●Maintained effective working relationships with management to ensure anomalies were brought to resolution and completion.
●Developed and maintained an automated Excel spreadsheet for demographic and billing information.
●Adjudicated 50-100 applications daily into the computer database to complete the billing process.
●Prepared, reviewed, and transmitted claims using billing software, including electronic and paper claim processing.
Johns Hopkins Medicine Clinical Associates: Physicians Billing Department 12/2015-09/2016
Insurance Resolution Specialist (Temp)
●Resolved insurance errors while maintaining productivity and quality standards in a professional manner.
●Accurately and comprehensively documents activities and results in the billing system and applies the correct error classification code.
●Updated patient registrations that are made on account level and have an impact on all claims regardless of the location where the claim is generated.
●Accuracy and subject matter expertise are critical to preserving the integrity of the revenue cycle across JHM as patient records are updated.
●Developed and maintained automated Excel spreadsheets and computerized systems, for reconciling documents.
●Submitted patient's confidential information to complete medical coverages for the patient and dependent to complete the billing process.
●Retrieved and submitted Explanation of Benefits (E.O.B) documentation in order to complete the billing process.
●Performed follow-up and collections on outstanding claims balance for dates of services that was rendered.
●Adjudicated and submitted 50-100 claims daily into the computer database to complete the billing process.
●Used relevant functions of GE and software patient-centric computer systems proficiently.
●Developed and maintained an automated Excel spreadsheet for demographic and billing information.
●Verified, eligibility and benefits verification for treatments, hospitalizations, and procedures.
●Reviewed patient bills for accuracy and completeness and obtain any missing information.
●Processed, scanned and documented correspondences to complete the billing process.
●Prepared, reviewed, and transmitted claims using billing software, including electronic and paper claim processing.
Maryland Health Connection Inc. 11/2014 – 6/2015
Customer Service Representative (Temp)
● Developed and maintained an automated Excel spreadsheet for demographic and billing information.
●Accurately resolve simple and complex billing issues with the ability to understand and follow Maryland State insurance policies, procedures, and work rules.
●Performed and educated using customer services skills to enhance knowledge to members and the public.
●Identified key issues and took appropriate follow-up action to resolve billing issues and ensure proper payment is received for dates of services.
●Obtained relevant information to respond to difficult patients and addressed inquiries to resolve complex issues.
●Appropriately utilize various websites to verify customers eligibility and resolve customers’ accounts.
●Proficiency in the process of documentation on customers accounts and follow-up on accounts to resolve issues.
● Answer calls daily from customers and providers seeking assistance with navigating the Medicaid system and tracking the disposition of the calls using a customer relationship management (CRM) system based on unit policies and procedures.
●Received 50-150 inbound calls per day from clients regarding services provided by the faculties.
●Utilized the various Maryland State software in order to complete the application process for medical coverage.
●Maintains a regulatory/compliance environment by following organizational policies and procedures to ensure compliance with state, local, and federal standards and regulations.
●Interacted with customers to provided and process information in response to concerns, requests, and inquiries about services
Healthcare Access Maryland Inc. 11/2005 – 11/2013
Clerical Support Representative
●Processed 50-100 MD Medical Assistance applications daily into the computer database.
●Researched and reviewed medical eligibility policies and regulations to verify that the information is accurate.
●Applied the appropriate procedures to establish eligibility information in the MD State database (Cares/MMIS).
●Conducted and organized Healthcare events to educate the public about the various services and programs.
●Prepared monthly billing reports by summarizing billing productivity based on financial class to complete the billing process.
●Performed insurance verification on patients’ information for dates of services and knowledge of the Affordable Care Act program.
●Expert knowledge of the policies and procedures related to the determination of eligibility for the State Medicaid Program.
●Provided customer services to various agencies regarding issues related to Medical Assistance eligibility.
●Resolved discrepancies that prevent recipients from receiving Medical Assistance benefits in a timely fashion.
●Transmitted and submitted patient's confidential information to insurance carries complete medical coverages for the patient and dependents
●Investigated and researched denied cases on Excel Daily Log sheet report for Medical Assistance completion.
●Provided a monthly statistical report to the Eligibility Director and Supervisors for the monthly update.
●Utilized technical skills to navigate and updated data to establish eligibility to obtain missing verifications.
●Updated and maintained Excel monthly log sheet for department informational data and coverages.
●Interment policies, procedures, and regulations using the Cares and MMIS software when interacting with my customers that were applying for Medical Assistance benefits.
●Using MS Word software when formatting and composing letters to clients about their medical coverage
●Educated and informed the public about nutrition and healthy choices to maintain a healthy lifestyle
● Directed and referred potential applicants to the various programs that are offered in the state of Maryland and the surrounding counties.
EDUCATION:
Northwestern Sr. High School 1979 Diploma/GED
Community College of Baltimore County 2023 Certificate Awarded Microsoft Word Program- Advanced & Intermediate
Community College of Baltimore County 2023 Certificate Awarded Excel Program- Advanced & Intermediate
Baltimore Community College of Baltimore 2017 Certificate Awarded-Medical Terminology
Brightwood College 2016 Certificate Awarded- Medical Billing & Coding
Centers for Medicare & Medicaid Services 2016 Certificate Awarded- ICD 10 Coding
Centers for Medicare & Medicaid Services 2016 Certificates Awarded- Medicare Billing A &
Medicare Billing B
Healthcare Access Maryland Inc. 2012 Certificate HIPPA Training
Essex Community College 1997 Certificate Awarded Advanced Medical Billing
John Hopkins University 2003 Certificate Awarded EPR Training
Honors & Awards
Healthcare Access MD 2008 Letter of Appreciation Awarded Governor Martin O’Malley
John Hopkins Hospital 2001 Certificate of Appreciation Awarded Patients Accounting Dept.
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