ER registration medically billing patient financial representative
Resume:
Nicole Thomas
Stockton, CA *****
***************@*****.***
To obtain a rewarding and challenging career in the Medical Insurance Billing field. Willing to relocate: Anywhere
Authorized to work in the US for any employer
Work Experience
Patient Access Representative I Float Radiology, Emergency Room Department, Out Patient Lab(Part-time)
Stanford Health Care - Livermore, CA
December 2023 to Present
My responsible is to Greets patients and begins the registration process. for completing patient admissions/registration functions. Identifies patients' insurance coverage or existing financial resources to pay for medical care and services. Handles routine customer service inquiries and concerns. Processes necessary admission/registration paperwork and obtains necessary documents for billing and compliance requirements.
Maintains professional communication with various PAS staff, clinical staff, physicians, guests, and patients regarding the admitting/registration services . Communicating through telephone, correspondence, email, or in person contact.
Meets weekly individual productivity and key performance indicators and standards while following planned priorities as set by the department leadership team. Secure handling and accurate recording of payments collected at the point of service of delivery. Handling routine/ Simple patient escalations and perform service service recovery,at level Il assist complex patient admitting/ registration services escalations. Providing excellent customer service to all individuals with whom the employee has contact with. Clinical Quality Analyst
Wollborg Michelson / Blue Shield of California - Los Angeles, CA September 2023 to December 2023
• Responsible for outreach to members to resolve barriers to care, provide education on missing gaps in care, and assist in scheduling appointments.
• Document in member interactions in BSC systems and outreach tracking spreadsheets.
• Follow-up with members if needed and remind members of upcoming appointments.
• Responsible for outreach to providers to secure medical records from services completed for BSC members.
• Send communications via fax and email to provider offices and conduct timely follow-up until providers, hospitals, and vendors have complied.
• Document medical record retrieval activities in systems if applicable and ensure documentation is complete and detailed.
• Respond to and resolves various customer inquiries via telephone and responds to provider, hospital, and medical record vendor queries accurately and consistently.
• Coordinates with other departments if required to ensure timely and appropriate responses.
• Engages in provider follow-up to ensure medical records are received within required deadline.
• Expedites and resolves complex issues and escalates medical record retrieval issues as needed.
• May assist in scheduling and coordinating team activities.
• Additional administrative duties as needed
Government Follow Up Collection Representative
The CSI Companies/ John Muir Medical Center - Concord, CA May 2022 to November 2022
1. Responsible Collaborate and communicate with internal and external partners. Research and analyze accounts receivable and outstanding balance. Identify, recommend, support, and monitor collections accounts Negotiate and approve payment plans and balances.Receive,process, and oversee customer payment.Manage and resolve customer disputes and grievances. Check insurance payments for accuracy and compliance with contracts Reviewed resolved outstanding balances Medicare,Medicare Managed Care Plans Medi_cal Hmo's,Review process appeals on denied claims.Notifies supervisor of problems arising from erroneous codes, missing information, error/edit messages, or any data payment entry procedures or patient inquiries not covered by specific guidelines and procedures. Maintains patient confidentiality; complies with HIPAA and compliance guidelines established by the HCP.Providing excellent communication, time management, and organizational skills. ER Admissions Representative/Registrar Per Diem
Valley Health System Hospital - Las Vegas, NV
June 2019 to July 2021
Responsible for incoming patients of his/her representative and records information required for admissions. Performs responsibilities consistent with hospital safety policies, Obtain patient or representative signatures on all applicable consents and/or admitting forms, witnesses all signatures and scans into document Imaging. Obtain authorization for insurances when required, scanning notification into document imaging and documenting information into imaging. speak and demonstrate process for unidentified naming convention for patients who are unable to communicate with no identification, Process physicians paper orders in accordance with admitting procedures emphasis placed on verifying all applicable data is secured on order before processing. Required to collect all applicable copay/ deductible, coinsurances or deposits upon pre-registration or time service. Actively reviews and work HDX,MSP and Consent logs. Ensures electronic order is placed prior to activating direct admit accounts Helps out in other areas when needed throughout department. Knowledgeable in completing Cerner task list accurately.Demonstrates ability by performing assignments independently without close supervision.Giving Excellent Customer Service at all time. Patient Account Representative
UNLV School of Medicine - Las Vegas, NV
December 2019 to April 2021
Review and interpreting insurance explanation of benefits (EOB) documents Check insurance payments for accuracy and compliance with contracts Independently evaluate and interpret explanation of payments for patient accounts Accurately post and record information regarding collection receipts Process and file correspondence, collection receipts, and reports Process a minimum of 220 invoices per day
Research and correct account balances in conjunction with accounts receivable department Follow up with the insurance company on unpaid or rejected claims as well as denied claims. Resolve issue and re-submit claims
Respond to inquiries from insurance companies, patients and providers Look up ICD diagnosis and CPT treatment codes from various resources, As well as manage review claims in Medicare DDE Data Bas, Medicaid, Medical
Provide excellent communication, time management, and organizational skills Responsible to follow-up with correspondence and telephone inquiries from third party payers and patients
Reviews follow-up reports and takes appropriate action to achieve prompt resolution of open accounts Notifies supervisor of problems arising from erroneous codes, missing information, error/edit messages, or any data payment entry procedures or patient inquiries not covered by specific guidelines and procedures.
Reviews assigned insurance claims for accuracy and information Demonstrate ability to be flexible, work collaboratively with internal and external departments, as applicable to accomplish the requirements of the department Demonstrated service and success in teamwork and consistent high productivity and quality Maintains patient confidentiality; complies with HIPAA and compliance guidelines established by the HCP. Collection Specialist
West Dermatology - Henderson, NV
October 2018 to June 2019
Review the monthly AR Aging report and work through all open balances. Identify appropriate plan of action for remediation of balance, including but not limited to: rebilling corrected claims; obtaining corrected insurance information; preparing and filing appeals, obtaining medical records.
Reviews all denials identified through NextGen tasking and related reporting Identify appropriate plan of action for remediation of denial, including but not limited to: rebilling corrected claims; preparing and filing appeals
Research claim denials via Navicure, payer websites, web portals, and phone calls to the payers. Research patient insurance eligibility via Phreesia, payer websites and portals Contact patients as necessary to update insurance or demographic information as needed for corrected claim billings.
Monitor and identify trends that may be specific to a payer, service or provider, and communicate such trends to RCM Leadership.
Communicate with payers to identify the root cause of unpaid claims. Partner with other team members and departments to resolve issues leading to unprocessed claims, denied claims, or missing payments.
Request adjustments for denied balances that are deemed uncollectible due to inability to support an appeal or appeal options being exhausted.
Work tasks for requests to submit corrected claims, ensuring that corrected claims are appropriately submitted with narratives, forms, or other payer requirements. Review patient balances remaining open after 3 statements, fully validate the balances, and prepare them for submission to external collections agency. Assists with special projects upon request
Performs other duties as required by management.Review the monthly AR Aging report and work through all open balances.
Identify appropriate plan of action for remediation of balance, including but not limited to: rebilling corrected claims; obtaining corrected insurance information; preparing and filing appeals, obtaining medical records.
Reviews all denials identified through NextGen tasking and related reporting Identify appropriate plan of action for remediation of denial, including but not limited to: rebilling corrected claims; preparing and filing appeals
Research claim denials via Navicure, payer websites, web portals, and phone calls to the payers. Research patient insurance eligibility via Phreesia, payer websites and portals Contact patients as necessary to update insurance or demographic information as needed for corrected claim billings.
Monitor and identify trends that may be specific to a payer, service or provider, and communicate such trends to RCM Leadership.
Communicate with payers to identify the root cause of unpaid claims. Partner with other team members and departments to resolve issues leading to unprocessed claims, denied claims, or missing payments.
Request adjustments for denied balances that are deemed uncollectible due to inability to support an appeal or appeal options being exhausted.
Work tasks for requests to submit corrected claims, ensuring that corrected claims are appropriately submitted with narratives, forms, or other payer requirements. Review patient balances remaining open after 3 statements, fully validate the balances, and prepare them for submission to external collections agency. Assists with special projects upon request
Performs other duties as required by management.
Education
None
Western Career College - San Leandro, CA
October 1999 to October 2000
High school diploma or GED
Skills
• BILLING (3 years)
• CLAIMS (3 years)
• MEDICARE (3 years)
• COMPENSATION (Less than 1 year)
• EPIC (Less than 1 year)
• Primary Care
• Home Health
• Medical Billing
• Medicaid
• EMR Systems
• Hospital Experience
• Cerner
• Medical Records
• McKesson
• Managed Care
• ICD-10
• CPT Coding
• Benefits administration
• ICD-9
• HCPCS
• Customer support
• Medical collection
• Analysis skills
• Medical office experience
• Medical coding
• ICD coding
• Data entry
• Document management
• Microsoft Office
• Front desk
• Medical receptionist
• Continuous improvement
• Insurance Verification
• HIPAA
• Workers' Compensation
• Medical Terminology
• Communication skills
• Customer service
• Computer skills
• Microsoft Outlook
• EDI
• Microsoft Excel
• Microsoft Word
• Customer service
• Accounts receivable
• Analysis skills
• Accounting
• Typing
• Cash handling
• Accounts payable
• Windows
• Clerical experience
• HIPAA
• Epic
• Data collection
• Medical terminology
• Revenue cycle management
• Medical records
• Office management
• Front desk
• Hospital experience
• DRG
• Root cause analysis
• Financial services
• EDI
• Research
• EMR systems
• VPN
• Account reconciliation
• ICD-10
• ICD-9
• NetSuite
• Contracts
• Salesforce
• Sales
• Clinic
• Medical imaging
• Athenahealth
• AdvancedMD
• Banking
• Medical coding
• Home & community care
• Outpatient
• Live chat
• Google Docs
• Computer literacy
• Citrix
• Google Suite
• Quality assurance
Certifications and Licenses
Medical Billing Certification
BLS Certification
Driver's License
Additional Information
SKILLS:
Data Entry • Insurance Billing • Workers Compensation • TAR Authorizations • Medical Terminology
• ICD-10/CPT Coding • Payroll • Medical Records • Insurance Authorization • IDX • TRAC • Stock Amp Transcription • Windows 10 • Account Payable • Vital Signs • Appointment Scheduling • Claims Processing • Pharmacology • UB-92 • 1500 Claims • Medicare • Medi-cal • Workers Compensation Billing • Prime Clinical • Epic • Mckesson • Home Health & Hospice Billing, MS4, Nextgen
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