Medical Billing Customer Service
Resume:
Seeking a great company where I can
utilize my skills and professionalism. I
have exceptional ability to understand
the healthcare industry and would like
to bridge that experience and
knowledge to develop professional
growth in the insurance industry.
Skills and Highlights:
Licensed All Lines. Adjuster
Experienced with both Self and fully
insured Benefit Plans
EDI Billing
Reimbursement Management
Critical Thinking
Medicare and Medicaid Processes
Medical Billing and Collections
Billing Codes
Customer Service
CPT Code Modifiers
Reviewing Patient Information
HIPAA Compliance
ICD-10 Coding
Claims Review
Tracking Spreadsheets
Insurance Claims
Medical Coding Knowledge
Microsoft Office Package
Medical Records Security
Verbal and Written Communication
Medical Billing Technology
Accounts Receivable Management
ICD-9
ICD-10
Training and Development
A/P and A/R Expertise
Homecare Homebase
Medical Billing Analyst 02/2020 to Current
Processing, monitoring, and collecting of Home Health/ Hospice Medicare, Medicaid and other commercial insurance claims in accordance with payor requirements
Verifying accuracy of billing data and revising any errors Identify contracting errors/billing errors. Identify discrepancies, such as denied claims, underpaid claims, or differences in reimbursement
Creating and distributing various financial reports as needed Timely resolution of all claims including appeals
Following up on accounts for billing and on overdue accounts for collections via phone calls, re-submissions and adjustments for billing errors
Communicated with insurance providers to resolve denied claims and resubmitted.
Analyzed complex Explanation of Benefits forms to verify correct billing of insurance carriers.
Prevented financial delinquencies by working closely with managers to resolve billing issues before becoming unmanageable.
Reviewed patient records, identified medical codes, and created invoices for billing purposes.
Verified insurance of patients to determine eligibility. Generated reports and analyzed trends to maximize
reimbursement and reduce claim denials.
Audited and corrected billing and posting documents for accuracy.
Pediatrix Medical Group
Appeal Analyst/ Neonatal Govt. Collector 01/2017 to 01/2020
Current responsibilities include conducting billing and Collecting on all commercial and Govt accounts greater than 90 days
Along with analyzing and managing accounts to provide feedback to management
Kelli Q
Shavers
*****.*******@*****.***
Plano, TX 75025
Summary
Skills
Experience
KS
Diagnostic Codes
Time Management
Client Inquiries
Workers' Compensation license
Insurance Collections
Payments Posting
Waystar
Emdeon
SMS
Reimbursements
Credentialing Data Coordination
Provider Enrollment Expertise
Strong Communication Skills
NextGen
MediSoft
Cerner
RealMed
All Scripts
Power Point
Excel
McKesson
GE Healthcare
E Clinical Works
Advanced MD
Xisin
BUSINESS APPLICATION SPECIALIST
PROGRAM- CERTIFICATE
Richland College
Dallas, TX
Business Administration, 08/1996
BACHELORS OF SCIENCE
UNIVERSITY OF PHOENIX
HEALTHCARE ADMINISTRATION
MEDICAL OFFICE PRACTITIONER
PROGRAM-CERTIFICATION
X-RAY
RICHLAND COLLEGE
TECHNICIAN PROGRAM- Registered with
the Texas Department of Health T.D.H.
Performance Masters
Fluent in Medical Terminology including
I identified trends, audit accounts and forward findings to the Director along with make credit balance adjustments and initiate refunds meeting departmental productivity standards Ensures that claims are processed accurately through review and audit functions to ensure timely payment
Responds to inquiries regarding claims with under payment or non-payment
Responds to inquiries, questions, and concerns from patients regarding the status of claims in a clear, concise, and courteous manner
Interfaces with external and internal customers to ensure optimal efficiency of service
Monitors aging of claims to ensure timely follow-up and payment.
Addison Group/ Pinnacle Partners
Reconciliation Specialist 09/2016 to 01/2017
Successfully reconciled outstanding deposits to balance financial records identifying issues attributing to account delinquency and communicate with management and billing department when necessary the collection and follow-ups Resolve all variances before final processing of claims. CCS Medical
Senior Revenue Appeals Analyst 07/2013 to 03/2016
Responsible for claims submission and claims resolution for insulin and non-insulin dependent patients in regards to Medicare patient accounts
Made corrections if needed, review audits, begins the refund processes
Collaborated daily with the teams on the productivity output along with the projected dollars
Successfully corrected accounts receivable issues
Collected and communicated with all clinical and IT departments for adding, deleting, changes and updates in the company database, including the CMS and AMA codes updates
Work with government and commercial payers and payer guidelines
Initiate contacts and negotiate appropriate resolution
(internal and external)
Receive and resolve inquiries and correspondence from third parties and patients
Researching accounts and refiling or appealing claims Submitting additional medical documentation and tracking account status by monitoring and analyzingassigned unresolved third party accounts
Conducted ongoing file reviews with the supervisor. Education and Training
Certifications
ICD9/ICD10 CPT coding-Certificate
Knowledge of Computers in Healthcare-
Certificate Medical Assisting and
Patient Care Management-Certificate
Radiography Training, Radiation Safety,
Radiological Equipment, Safety
Operation and Maintenance/Image
Production and Evaluation Microsoft
Office Package CPR & First Aid
Certified- American Heart Association
Licensed Workers compensation All
Lines Adjuster
Six Sigma Trained
Christus Healthcare
Senior Commercial Collector 08/2012 to 07/2013
Responsible for billing, collections and reimbursement services of Workers' Compensation claims to hospitals Ensured that all claims are billed and collected meet all government mandated procedures for integrity and
Compliance
Demonstrated a level of accountability to ensure data and codes are not changed on claims prior to submission if related to diagnosis, charge and other clinical type data Coordinated training classes and quality assurance for the revenue cycle department along with policy compliance with Federal (CMS) and State Regulations (HSCRC)
Ensures all Compliance errors are reported to the Director and maintain records and files of documentation supporting bill changes that are directed by Director and/or Integrity Officer
Used logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems.Communicated with claimants, providers and vendors regarding claim issues
Managed medical treatment and medical billing, authorized as appropriate based on the claims handling guidelines. Tenet Healthcare/ Conifer Health Solutions
Medical Billing/Sr. AR Specialist 10/2007 to 07/2012 Performed task as follows:
Successfully managed desk- and caseload of at least 55– 65 commercial claims in an efficient and professional manner Maintained accounts receivable/billing to ensure that all claims are billed properly and free from errors
Analyzed and produce data, reviewed trending issues for procedures and identified areas for improvement
Accurately checked and invoiced endorsements and attached insurance policies to the company database, reviewed premium rates, Audits accounts to ensure all demographic, insurance payer information and signatures are required and documented correctly
Collected on outstanding balances due from third party carriers in a timely fashion
Investigate claims thoroughly, including coverage, liability, denials, appeals and overpayment
Baylor Surgicare
Insurance Verification Trainer/Coordinator/Sr. Collector 11/2004 to 09/2007
Knowledge of Commercial insurance policies, applications, endorsements and insurance proposals .and performed the following task
Billing and collection of Workers' Compensation accounts Contact insurance companies to determine when payments will be made and if additional information is needed for processing payments and claims
Trained all new employees on Front Office procedures and job responsibilities, Reviewed monthly reports from the insured/ checked the rates and premiums, secure pre certifications and authorizations prior to surgeries Assisted patients in applying for financial assistance and or hardships
Receive and process invoices, code invoices and perform other account payable duties.
Contact this candidate