Community Services Third Party
Resume:
MISTI
HONAKER
REIMBURSEMENT
MANAGER
********@************.***
Abingdon, va 24211
CONTACT
To obtain a position utilizing my
experience working closely in the
Healthcare field with Medicaid,
Medicaid MCO's, Medicare, and
Commercial Insurance Companies. I
am a self-starter, problem solver
regarding all medical complex
billing, payer problems, submission
errors, altering of electronic files to
submit clean claims.
I am looking for something new to
peak my interest and dive into. I am
at a place where I want new
challenges and new opportunities,
while utilizing all of my experience.
I love the work that I do. I am
confident I would be an asset to
your company if given the
opportunity.
CAREER OBJECTIVE
Reimbursement Manager
Highlands Community Services, Abingdon, VA
The purpose of this position is to work collaboratively as part of the Fiscal team at Highlands Community Services (HCS) in planning and providing required services and to aid in the Department/Agency's goals and objectives.
1. Manage agency-wide reimbursement and collections processes and activities through supervision of the Collections and Reimbursement Specialists and the Reimbursement Coordinator.
2. Responsible for agency wide registration/authorization processes for third party payors to include but not limited to submission of required forms, follow-up, entry into the HCS electronic consumer record and billing. 3. Review and edit all service entries for proper time, providers, codes, charges and insurance authorizations to ensure that services are billed correctly and submit electronic and paper claims to applicable third-party payers.
4. Interpret consumers' benefits and direct the coordination of benefits between consumers, third parties and HCS to include but not limited to changes in consumer benefit packages, assisting in determination of primary and secondary payers and entering eligibility into the HCS computer system.
5. Serve as HCS liaison with major third-party carriers to keep abreast of provider requirements and regulations, billing practices and fee changes to identify issues or concerns that affect reimbursement, including managed care, EAP and other contracts and provides recommendations for implementation of changes.
6. Prepare, process, and maintain HCS provider enrollment applications with third-party payers.
7. Oversee provider credentialing applications for all licensed staff and contractors.
8. Facilitate communications with insurance personnel, HCS staff and consumers to resolve questions on consumer accounts, third party payments, insurance requirements, documents, documentation of medical necessity and notes.
9. Complete the month end closing by reviewing credit balances in third party payor accounts, reconciling cash between the electronic consumer record and the financial software, creating journal entries and compiling month end reimbursement management reports.
10. Analyze month end Reimbursement reports, specifically the adjustment report and accounts receivable aging report, for outliers in reasons for adjustments, high unpaid balances by payor and large unpaid amounts over 90 days and facilitate corrections and re-bills.
11. Provide training to HCS's staff on appropriate CPT codes, insurance regulations, reimbursable diagnoses, and authorization procedures. 12. Assist the Department Director of Fiscal Services in evaluating possible new funding sources and/or expansion of existing funding sources, recommending policies and procedures for maximizing revenue and avoiding loss of income.
EXPERIENCE
December 2006 - Present
13. Monitor HCS data integrity and provide input into solutions for problem area and suggestions for increased efficiency in both job performance and effectiveness.
14. Accurately enter and document all required data and run required reports to review and correct any data entry errors. 15. Attend required HCS and/or Staff meetings.
16. Expand self-knowledge and education through appropriate training opportunities.
17. Implementation of 2 EMR systems.
18. Implementation of multiple MCO System set up.
19. Communicate with the Provider Representatives regarding in correct edit set up on the payer side. Claim reprocessing of incorrect payments. etc. Reimbursement Specialist
Wellmont Health Systems, Abingdon, VA
Post all insurance payments, retractions, etc.
Credentialing of Providers
Research claim denials, appeals, corrected claims etc. Billing of all claims Paper/electronic
Benefit Verification /Eligibility
Reimbursement Specialist
Russell County Clinic Services, Lebanon, va
Post all insurance payments, retractions, etc.
Credentialing of Providers
Research claim denials, appeals, corrected claims etc. Billing of all claims Paper/electronic
Benefit Verification /Eligibility
Claims Representative
Cigna Healthcre, Bristol, VA
Customer service in-bound call center
Assist Customers and Providers with benefits, eligibility, March 2004 - December 2006
August 2001 - March 2004
April 2000 - August 2001
High School Diploma
Abingdon High School, Abingdon, VA
EDUCATION
May 1993
SKILLS
• Past Due Account Management
• Account Discrepancies
• Health Information
• Effective Customer Communication
• Electronic Document Management System
• Payment Collection
• Insurance Requirements
• Electronic Health Records Systems
• Compliance Requirements
• Data Entry Software
• Healthcare Terminology
• Professional Development
• Reimbursement Management
• Diagnostic Codes
• Tracking Spreadsheets
• Federal Regulations
• Reading Comprehension
• Active Listening
• Customer Satisfaction
• Procedures Compliance
• Medical Billing and Coding
• Patient Account Reviews
• Complex Problem-Solving
• Accounts Payable and Accounts Receivable
• Staff Meetings
• Software Applications
• Standard Operating Procedures Understanding
• Financial Assistance
• Corrective Actions
• Computerized Maintenance Management Systems
• Revenue Cycle Management
• Electronic Patient Medical Record
References available upon request
REFERENCES
Contact this candidate