Customer Service Medical Billing

Kathy Caravas

Kennesaw, Georgia, ***** 908-***-**** *******@***.***

Medical Billing and Coding

Strong customer service, leadership, and follow-through skills

Excels in meeting the needs of the various cultures and social sectors

Knowledgeable of third-part billing and insurance protocol

Recognizes and understand timely filing and processing of claims

Knowledgeable of the handling of denials

Critical thinking and problem solving

Professionalism and strong worth ethic

Teamwork and collaboration

Education

DeVry University, Online

Medical Billing and Health Information Coding Certificate

Key Coursework: Current Procedural Terminology Coding II with Lab, Legal and Regulatory Issues in Health Information, Coding Practicum, Certified Coding Specialist Certification Review

- Medical Terminology – Foundations of terms used to describe the human body and its conditions terminology for medical procedures, along with the names of commonly prescribed medications

- Human anatomy & Physiology - -Human body systems, structures, and functions.

- Health Services & Information Systems – The use of electronic medical records

- Pathopharmacology – Scientific study of the effects of drugs & chemicals on living organisms

- Health Insurance & Reimbursement

- International Classification of Diseases Coding II with Lab

- Inpatient & Outpatient guidelines

- HIPAA & Patient confidentiality laws

Nassau Technology January 1996 – October 1996

Medical Assistant

- Gained theoretical and practical knowledge of the vital operations required to maintain the functions of a medical office including clinical and administrative aspects

- Venipuncture and EKG

Court Reporting Institute March 1998 – September 1998

Medical Transcription

Work Experience

Wellstar Kennestone Hospital August 2021 – Present

Marietta, GA

Clerical Imaging Medical Imaging Clerk

- Communicating Emergent reports to physicians and nurses

- Management of the issuance of CD record of images to the medical providers or patient

- Assisting in the communications of the medical providers and radiologists

- Uploading medical images to PACS & EPIC

- Obtaining missing images or clinical information from radiology departments in other hospitals

Mark Yampaglia Law PC October 2007 – May 2008

Rutherford, NJ Settlement Negotiator/Claims Analyst

Due to my extensive experience in processing of claims and understanding the laws and bylaws to process a claim for payment, I was able to negotiate payment for the providers from the insurance company and apply attorney fees.

- Maintained organized files of provider claims to be processed

- Kept track of claims pending to maintain timely processing or reprocessing

- Followed up on pending payments

- Maintained spreadsheet of total amount of money recouped for the providers

- Maintained total amount of attorney fees collected on spreadsheet

Ameripath Dermpathology Diagnostics of Florida November 2006 – August 2007

Pompano Beach, FL Project Coordinator/Payor Analyst

- Analyze payments received from payors/insurance companies to confirm appropriate reimbursement

- Coordinated & monitored projects assigned by management

- Assisted in collection efforts from insurance companies & third-party administrators

- Filtered accounts billed to patient according to their plan benefit design

- Reviewed & confirmed contractual agreements between providers & insurance companies

- Appealed claims with supporting documentation for the reprocessing of claims

- Reviewed delinquent accounts to determine final resolution

- Monitored collection projects among staff to assure proper handling of accounts

Magnacare – Third Party Administrator March 2006 – October 2006

Westbury NY Claims Analyst/Customer Service

- Analyze & apply medical policy, contractual provisions, operational & adjudication procedures

- Advocate for patients concerning enrollment, eligibility, contractual benefits, and/or claim issues

- Reviewed & resolved denied claims and adjudication inquiries

- Assist resolving claim issues from incoming calls from patients and providers

Healthcare Partners, IPA June 2004 – February 2006

Garden City NY Customer Service Team Lead

- Accountable for quality assurance to members & providers

- Audited all documentation by representatives

- Monitored & reviewed employees’ work for accuracy and professionalism

- Educated employees of new protocols and procedures

- Maintained compliance/requirements according to company’s policy/procedures

- Evaluated incoming patient/provider calls to assure resolution to an issue

Healthcare Partners, IPA February 2001 – May 2004

Garden City, NY Senior Customer Service Representative

- Resolution to claim denials, eligibility issues, authorizations, and related inquiries from providers, members, and health plan representatives

- Input referrals in the computer system EZ CAP from information supplied by the providers and specialists

- Verification of CPT codes and ICD-9 codes & appropriate use

- Requested & gathered clinical information for the processing of a claim or authorization for a procedure

- Trained new employees & maintained training classes on claim resolution, proper phone etiquette

- Review calls for thoroughness and compassion for the caller’s needs

- Quality assurance for claims to be processed with the appropriate coding and timely filing guidelines

Language: Greek

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