Service Rep Patient

SUMMARY:

Seasoned Patient Service Rep/Billing Coder with 27 years of experience in healthcare administration, including Medicare/Medicaid claims auditing and provider claim services. Proficient in insurance verification, payment posting, and patient scheduling, ensuring accuracy and compliance. Seeking to leverage expertise in high-volume claim handling and patient support to contribute to a dynamic healthcare team.

WORK EXPERIENCE:

AmerihealthCaritas:

Operation Quality Auditor Oct 2016 - Present

• Conduct comprehensive audits on claim processing and payment adjustments to ensure accuracy and adherence to technical standards, identifying and reporting on errors and system or operational inefficiencies. • Perform a variety of audit types, including live, performance guarantee, and random audits, to maintain quality performance standards across Medicare/Medicaid claims. • Deliver training to associates and a trainer on Medicare/Medicaid guidelines, enhancing team knowledge and compliance with regulatory requirements.

Personal Caregiver:

(Patient is deceased on 4/29/2024) Direct Care Worker (DCW) Feb 2020 - Apr 2024

• Delivered compassionate care and assistance with daily living activities, including personal hygiene and dressing, ensuring client dignity and comfort. • Managed household tasks such as shopping, laundry, and general housekeeping to maintain a clean and safe living environment. • Assisted with mobility, aiding in safe transfers and navigation both ambulatory and via wheelchair, enhancing client independence and well-being.

. AmerihealthCaritas:

Provider Claim Service Representative Jun 2013 - Oct 2016

• Resolved payment discrepancies by guiding providers through correct coding practices, resulting in enhanced accuracy and reduced claims rejections. • Assisted providers with website navigation and registration processes, ensuring efficient access to necessary information and member services. • Delivered first-call resolution by equipping providers with pertinent resources and conducting thorough follow-ups for comprehensive issue closure.

Albert Einstein Medical Center:

Billing Representative/Patient Scheduler Mar 2008 - May 2013

• Managed the accurate posting of payments from patients and insurance carriers, ensuring adherence to contractual agreements and organizational policies. • Coordinated patient appointments, adhering to the established protocols of the oncology department. • Conducted patient registration and insurance verification processes while maintaining a courteous demeanor, securing necessary authorizations and patient signatures for hospital documentation.

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Hahnemann Hospital:

Verification of Insurance Benefits (Part-Time) Jul 2005 - Mar 2008

•Conducted thorough verification of patient insurance benefits, ensuring active coverage and up-to-date payments, while effectively meeting deductible and out-of-pocket requirements. • Managed patient communications through inbound and outbound calls, providing assistance and clarification regarding insurance verification processes.

Independence Blue Cross:

Business Analyst Mar 2003 - Feb 2008

• Conducted comprehensive analyses of business processes and documented user requirements, ensuring alignment with evolving business objectives. • Applied continuous improvement methodologies to assess and prioritize enhancements, effectively streamlining operational procedures.

Claim Examiner Sep 1996 - Feb 2003

• Accurately processed a high volume of insurance claims, ensuring thorough verification of charges and maintaining balance upon billing completion. • Managed payment postings, charge entries, and effectively handled resubmission procedures for rejected claims, contributing to efficient claims resolution. • Conducted detailed research on credit and refund requests, eligibility verification, and benefits review, while also coordinating third-party billing involving Medicare, Medicaid, and subrogation claims.

EDUCATION

Overbrook High School Diploma Jun 1980

SKILLS Excel

• Microwork • Power Point • Outlook • Spreadsheets • Skype • Word Processing • Email • Epic Web Portal Facet • Performer X Navinet • Integrate Agent Desktop (IAD Phone) • Verint • Jivaa • Cotiviti Claim Inquiry Tool • Macess.

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