Medi-Cal Data Entry
Resume:
ERMA M. MAGINN
Whittier, Ca. *****
********@*****.***
PROFESSIONAL SUMMARY
Seeking a Professional and Team Driven Environment. To provide excellent customer service skills, with
a positive and team player attitude. Work Independently. Analytical thinking. Attention to Detail
SKILLS
MS Word, MS Excel, MS Outlook, MS PowerPoint
Google Voice
Send Pro Certified Mail application
Pitney Bowes Mailing System
10 Key-by-Touch, 50 WPM Typing
Supervisory Training
Implemented HIPPA In-Service Hospital Wide
Knowledgeable of UB-04 and CMS 1500 Claim forms
WORK EXPERIENCE
Cash Posting/Daily Reconciliation/Data Entry 01/29/2024 – 04/26/2024
HMO, Commercial, Managed Care Biller Follow-Up
Lead Medi-Cal Biller/Follow-Up
Beverly Estate – Montebello, California
Research and enter accurate data of insurance payments, post to patients/GL and all health plans, IPA/medical groups.
Post all ACH payments, manual checks, self-pay payments, and adjustments daily.
Post all non-EDI payments, zero-pay EOBs, contractual allowances, deductibles, denial codes, and copayments.
Post insurance payments, and Prop 56 payments on payment log
Pull EOBs from payer websites and other applications as needed.
Post all credit card payments and chargebacks daily.
Post/Deposit check payments directly via online banking
Research unidentified payments to determine appropriate resolution.
Update and maintain all logs and spreadsheets used for reconciliation daily.
Journal Summary and Batch Lists comparison.
Retrieve 835 ERA payment reports for Medicare, Medi-Cal, and Other Insurances w/One Source application.
Process self-pay cash payments.
Post all Medicare, Medi-Cal payments.
Audit and Enter data with accuracy on patient demographics as well as health plans, IPA/medical groups.
Identify proper Healthplans, Medical group or Capitated facilities for reimbursement.
Enter and Update accounts to with accurate billing data or billing process
Verify claim for billable codes such modifiers, HCPCS, NDC numbers
Validate correct authorization numbers for Outpatient billable codes as well as Inpatient Stays
Process hardcopy or electronic billing
Review paid or underpayments for adjustments, denial or appealing for additional reimbursement
Provide invoices on implants or medical records
Process ATB, priority 365 days and high dollars
Follow-Up w/appropriate payers for claim status, claim discrepancies, resubmission of claims
Understand of Medi-Cal billing Compliance, code edits for proper reimbursement
Follow Medi-Cal Policy and Regulations, review Medi-Cal updates on website
Process and obtain Treatment Authorization Process (TAR)
Knowledgeable of Hospital Presumptive, Every Women Counts, Family Pact, GHPP/CCS,
Medi-Cal Secondary Billing to Medicare Part A&B, Commercial, HMO/PPO and Managed Care plans
Collection Process Review for accurate Reimbursement, Contractual, Refunds if necessary
Eligibility Review for Commercial/HMO/PPO/Managed Care health plans
HCPCS coding, ICD9 and ICD10
Review and Process APR DRG calculations
Review and Process HMS projects
Organ Donor Billing
Cash Posting/Daily Reconciliation/Data Entry 09/06/2023 - 01/26/2024
HMO, Commercial, Managed Care Biller Follow-Up
Lead Medi-Cal Biller/Follow-Up
Beverly Hospital – Montebello, California
Research and enter accurate data of insurance payments, post to patients/GL and all health plans, IPA/medical groups
Post all ACH payments, manual checks, self-pay payments, and adjustments daily.
Post all non-EDI payments, zero-pay EOBs, contractual allowances, deductibles, denial codes, and copayments.
Post insurance payments, and Prop 56 payments on payment log
Pull EOBs from payer websites and other applications as needed.
Post all credit card payments and chargebacks daily.
Post/Deposit check payments directly via online banking
Research unidentified payments to determine appropriate resolution.
Update and maintain all logs and spreadsheets used for reconciliation daily.
Journal Summary and Batch Lists comparison.
Retrieve 835 ERA payment reports for Medicare, Medi-Cal, and Other Insurances w/One Source application.
Process self-pay cash payments.
Post all Medicare, Medi-Cal payments.
Audit/Enter current patient demographics
Identify proper Healthplans, Medical group or Capitated facilities for reimbursement
Enter and Update accounts to with accurate billing data or billing process
Verify claim for billable codes such modifiers, HCPCS, NDC numbers
Validate correct authorization numbers for Outpatient billable codes as well as Inpatient Stays
Process hardcopy or electronic billing.
Review paid or underpayments for adjustments, denial or appealing for additional reimbursement.
Provide invoices on implants or medical records.
Process ATB, priority 365 days and high dollars
Follow-Up w/appropriate payers for claim status, claim discrepancies, resubmission of claims
Understand of Medi-Cal billing Compliance, code edits for proper reimbursement
Follow Medi-Cal Policy and Regulations, review Medi-Cal updates on website.
Process and obtain Treatment Authorization Process (TAR)
Knowledgeable of Hospital Presumptive, Every Women Counts, Family Pact, GHPP/CCS,
Medi-Cal Secondary Billing to Medicare Part A&B, Commercial, HMO/PPO and Managed Care plans
Collection Process Review for accurate Reimbursement, Contractual, Refunds if necessary
Eligibility Review for Commercial/HMO/PPO/Managed Care health plans
HCPCS coding, ICD9 and ICD10
Review and Process APR DRG calculations.
Review and Process HMS projects.
Organ Donor Billing
HMO, Commercial, Managed Care Biller Follow Up 11/2021 – 09/2023
Lead Medi-Cal PSR Biller/Follow-Up
Beverly Hospital – Montebello, California
Audit/Enter current patient demographics
Identify proper Health plans, medical groups, and Capitated facilities
Enter/Update accounts with current eligibility and insurance data
Verify claim for billable codes with modifiers, HCPCS, NDC numbers
Validate correct authorization numbers for Outpatient billable codes as well as Inpatient Stays
Process hardcopy or electronic billing.
Review paid/underpayments for accuracy and any adjustments, denials and appeal for additional reimbursement based on contracts
Provide invoices on implants or medical records
Priority ATB process from the oldest with high dollar balances
Claim status on unreceived claims and corrected claims
Knowledgeable of Medi-Cal billing Rules and Regulations, code edits for proper reimbursement
Review Medi-Cal updates on website.
Process and obtain Treatment Authorization Process (TAR)
Knowledgeable of Hospital Presumptive, Every Women Counts, Family Pact, GHPP/CCS,
Medi-Cal Secondary Billing to Medicare Part A&B, Commercial, HMO/PPO and Managed Care plans
Collection Process Review for accurate Reimbursement, Contractual, Refunds if necessary
Eligibility Review for Commercial/HMO/PPO/Managed Care health plans
HCPCS coding, ICD9 and ICD10
Review and Process APR DRG calculations.
Review and Process HMS projects.
Organ Donor Billing
Lead Medi-Cal PSR Biller/Follow-Up 10/2005 - 01/26/2024
Beverly Hospital – Montebello, California
Follow Medi-Cal Policy and Regulations, review Medi-Cal updates on website.
Process and obtain Treatment Authorization Process (TAR)
Knowledgeable of Hospital Presumptive, Every Women Counts, Family Pact, GHPP/CCS,
Medi-Cal Secondary Billing to Medicare Part A&B, Commercial, HMO/PPO and Managed Care plans
Collection Process Review for accurate Reimbursement, Contractual, Refunds if necessary
Enter/Update current eligibility for all health plans
HCPCS coding, ICD9 and ICD10
Review and Process APR DRG calculations.
Review and Process HMS projects.
Organ Donor Billing
Audit/Enter current patient demographics
Enter/Update accounts with current eligibility and insurance data
Verify claim for billable codes with modifiers, HCPCS, NDC numbers
Validate correct authorization numbers for Outpatient billable codes as well as Inpatient Stays
Process hardcopy or electronic billing.
Review paid/underpayments for accuracy and any adjustments, denials and appeal for additional reimbursement based on contracts
Provide invoices on implants or medical records
Priority ATB process from the oldest with high dollar balances
Claim status on unreceived claims and corrected claims
Knowledgeable of Medi-Cal billing Compliance, code edits for proper reimbursement
Patient Accounting Secretary 09/1995 to 10/2005
Beverly Hospital – Montebello, California
Greet clients, vendors, and department personnel.
Heavy Calls and directing to personnel
Organizing and distributing messages
Organizing/Maintaining documents, contract filing system
Assist Supervisors/Staff with department projects and tasks.
Process time sensitive correspondence, memos, and requests.
Maintain Monthly Variance Reports
Generate A/R Reports/ Review Daily/Monthly Billing Reports
Medi-Cal Denial Reports
Inpatient/Outpatient Productivity Reports
Update/Maintain all Policy and Procedure Manuals
Maintain all Personnel Files, Employee Status Changes, supervising staff, and new employees.
Prepare Employment Evaluations, Staff Competencies
Maintaining/Order office supplies and service calls on Office Equipment
Scheduling meetings and conferences
Material Preparation for Staff Meetings, minutes.
Car rentals/Airfare/Hotel Accommodations with Itinerary
Process Director Expense reports monthly.
Assist Director/Office Manager with Schedules
Commercial Insurance Biller / Credit & Collections 02/1992 – 09/1995
Beverly Hospital – Montebello, California
Audit daily accounts for insurance data accuracy.
Prepare and send clean claims to various insurance companies via Electronically or Hardcopy
Review/Follow-Up ATB reports Inpatient/ER/Observations/Surgery Daycare
Contact Health plans/IPA for delinquent or underpayments based on contracts.
Establish patient payment plans, evaluate patient financial statements.
Transfer accounts to Collection Agency assignment.
Maintains Confidentiality and adheres to all HIPPA guidelines/regulations.
FACILITIES WORKED:
City of Hope Medical Center, Duarte, Ca
Presbyterian Intercommunity Hospital, Whittier, Ca
St. Mary's Hospital, Long Beach, Ca
St. Joseph's Hospital, Orange, Ca
Anaheim Hill Medical, Anaheim Hills, Ca
Contact this candidate