Medical Billing Customer Service

Barbara E. Donaldson

**** ******** ***** ***** ***** Rouge, LA 70816

Cell: 504-***-**** Email: *************@*****.***

Skilled professional with administrative experience in a medical setting. Knowledgeable of medical terminology, medical billing, medical Coding (ICD-10 & CPT Coding) and payroll.

Work Experience:

Coordinator Front End

TJMaxx (2000 to present both full and part time)

Dallas, TX, Houston, TX, New Orleans, LA, Denham Springs, LA

Responsibilities: Assist with customer service issues (complaints, returns, adjustments, etc.), support cashier, open and close registers, and assist with any departmental requirements. Performed other duties as assigned or requested.

Financial Reviewer II

Kelsey-Seybold Clinics (June 2014 to February 2023)

Houston, TX

Responsibilities: Resolved billing issues by contacting patients and their insurance carriers regarding outstanding balances, worked denied or rejected claims, appealed claims, explained patient’s responsibility, advised of possible payment / payment arrangements, followed-up on bad debts with collection agencies collecting on outstanding balances, informed uninsured patient of self-pay discount and possible payment plan or payment arrangements, opened and closed cashiers at the begin and end of workday, reported on surveys results monthly, and participated in end of month closeout ensuring all accounts balanced and accurately documented. Performed other duties as assigned or requested.

Patient Account Representative

Cymetrix (October 2008 to May 2014)

Lewisville, TX

Responsibilities: Processed medical claims maintaining accountability and control of accounts to assure that reimbursement received with no financial loss due to errors which included communicating with patients and insurance companies by making telephone calls, using websites, mail/emails, and faxing documentation to support appeals and denied claims for payment consideration in a timely manner.

Patient Relation Rep

Sarasota Memorial HealthCare System (February 2007 to October 2008)

Sarasota, FL

Responsibilities: Accurately entered patients' demographics into database, obtained correct prescription for services rendered, filed insurance claims, verified eligibility, managed denials, posted payments, maintained database and created reports. Also, scanned patient data into electronic medical records, communicated with patients, physicians and insurance companies to obtain necessary information and correct CPT/ICD9 codes using modifiers as needed. Performed other duties as assigned or requested.

Accessioner / Data/Order Entry Operator

Labcorp (August 1995 to March 2008)

New Orleans, LA, Baton Rouge, LA, Dallas, TX and Sarasota, FL

Responsibilities: Processed specimens for storage and transportation (Cyto, Histo, Micro and Chem), split specimen, converted orders into test codes, performed medical billing, tracked and provided reporting of specimens.

Information Analyst / Intake Coordinator / Administrative Assistant

Physicians Hospital (May 2000 to February 2002)

New Orleans, LA

Responsibilities: Provided computer support (training new techniques and new systems) throughout the facility, worked as a liaison with caseworkers, hospitals, doctor offices, EMS, families and other facilities for admissions, transfers, and discharges. Assisted with human resources and payroll functions. Also supported the Director of Nursing with all clerical needs and support. Performed other duties as assigned or requested.

Data Control Coordinator/ Medical Secretary / Data Entry Operator

East Jefferson Hospital (January 1990 to April 2000)

Metairie, LA

Responsibilities: Collected quality assurance data on physicians for credentialing purposes, maintained physicians’ files, prepared reports, minutes, and coordinated monthly meeting. Performed other duties as assigned or requested.

Skills:

Typing (50 - 55wpm)

Medical Terminology

Medical Billing and Medical Coding (ICD-9 & CPT Coding)

Financial management (Payroll, Account Payable/Receivable)

Insurance Verification (Medicare, Medicaid, Private)

Patient Registration (Admission, Transfer, Discharge)

Data Entry (Alpha/Numerical)

Human Resources (Credentialing, Policies & Procedures)

Meeting and Minutes Preparation

PC Proficient (Word, Excel, Publisher, Outlook, Internet, Access, Email, PowerPoint)

General Office Procedures (Computing, Phone, Fax, Scanner, Copier, etc.)

Education/Training:

Certified in Medical Insurance, Coding and Billing and Secretarial Sciences

Experience with Microsoft Suite (Word, PowerPoint, Excel, Outlook)

20+ years of Facility Claims Adjudication experience in a HMO,PPO, or TPA environment

20+ years of experience as Claims Payment Analyst

Demonstrated ability to process complex professional and facility claims

Special Skills:

Demonstrated understanding of DRG pricing methods, Outpatient Prospective Payment System Mechanics, Outliers and Case Rate Payment Mechanics

Knowledge of CMS rules and regulations. Skillful in medical terminology, CPT and ICD9 Coding and billing. Demonstrate strong working knowledge of Payor Contracts, Utilization Review procedures (specific to authorizations)

Knowledge of contracts, fee schedules and reimbursement methods

Ability to understand and/or interpret regulatory guidelines (i.e. CMS, HIPAA, etc.)

Strong knowledge of claims service and claim processes, able to absorb new material quickly.

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