Accounts Receivable Medical Billing
Resume:
***********@*****.***
SKILLS SUMMARY:
• 10 + years Experience with Worker’s Compensations, Leave of Absence Case Management, Medical Billing, Accounts Receivable, File Audits and Customer communication.
• Proven ability to aggressively analyze, investigate, calculate, post and manage billing accounts in relation to All Lines of Insurance claims to secure company revenue.
• Experience in processing Short Term Disability and Worker’s Compensation claims which required outreach to providers and claimants and extensive medical review for payment determinations.
• Understanding of primary code classifications: ICD-10, CPT and HCPCS
• Knowledge of unfair debt collection practices and insurance guidelines.
• Strong interpersonal and communication skills as well as the ability to maintain professionalism under pressure.
• Proficient in Microsoft Office products and various medical billing systems ERA including NAVINET, EPIC, MEDITECH.
•Able to adapt and quickly learn new policies, systems and procedures.
• Review Explanation of Benefits for proper reimbursement.
EDUCATION
09/2011-05/2013
COLLIN COUNTY COMMUNITY COLLEGE
CERTIFICATIONS
Texas All-Lines Adjuster License #2394462
CE HOURS COMPLETED 07/2022
EXPERIENCE
REVENUE CYCLE ASSOCIATE - STEWART HEALTH CARE
04/2023 – 09/2023
RICHARDSON, TX
•Resolve outstanding and/or denied claims based on third party claim processing rules within established timelines
•The Revenue Cycle Associate reports to the central business office supervisor.
•Meets goals and objectives in assigned area
•Complies daily with departmental policies and procedures
•Performs collection activity to ensure proper resolution and reimbursement on claims
•Reviews Hospital census daily to confirm NICU accounts that newborns have been added to parents policy, any auto coverage has been documented, working with front end staff to make sure all safeguards have been completed to preserve payment on high dollar NICU accounts
•Provides thorough, courteous, and professional assistance to coworkers and patients
•Ensures that all claims are billed and collected and meet all government mandated policies for Integrity and Compliance
AUTO/PROPERTY ADJUSTER and CLAIMS CSR - RENFROE ADJUSTER STAFFING (CLIENT- STATE FARM INSURANCE)
12/2019 - 11/2022
WORK FROM HOME
• Handled inbound/outbound calls from insured.
• Prepare and submit claims electronically
• Entered/updated insure’s billing information, demographic and claims information.
• Provided claims status.
• Reviewed and analyzed opened unresolved claims and took appropriate steps and resources to resolve.
CLAIMS SPECIALIST - DONOVAN & WATKINS STAFFING (CLIENT - STEWART HEALTH CARE)
09/2019 – 12/2019
RICHARDSON, TX
• Conducted detailed review of Explanation of Benefit forms. Maintain accounts receivable records to ensure aging is up to date, credits and refunds researched and applied, uncollectible amounts are accounted for, and miscellaneous differences are cleared.
• Collaborating with patients or customers, third party institutions and other team members to resolve billing inconsistencies and errors
• Initiate reports weekly/monthly to maintain accuracy.
• Posted customer payments by recording cash, checks, and credit card transactions.
• Contact Medicare, Medicaid, Commercial carriers for claim status and payment details.
• Prepare and submit claims electronically to the clearinghouse.
• Perform claim corrections and follow up activities to ensure timely reimbursement
WC ADJUSTER and CLAIMS SPECIALIST - MEDICAL PRACTICE SOLUTIONS
11/2017 – 06/2019
RICHARDSON, TX
• Managed Medical, Workers Compensation and Injury claims.
• Entered information necessary for insurance claims such as patient, insurance ID, diagnosis and treatment codes and modifiers, and provider information. Insured claim information is complete and accurate.
• Follows up with insurance company on unpaid or rejected claims. Resolves issue and re-submits claims.
• Conducted detailed review of Explanation of Benefit forms. Maintain accounts receivable records to ensure aging is up to date, credits and refunds researched and applied, uncollectible amounts are accounted for, and miscellaneous differences are cleared.
• Resolves collections by examining customer payment plans, payment history, credit line; coordinating contact with collections department.
• Posting payments to patient’s accounts and processing statements.
• Completes re-bill request as necessary to facilitate timely and proper claims reimbursements.
• Corresponds with Medicare, Medicaid, and Commercial payor for resolution on unpaid accounts.
• Assist in streamlining and improving the accounts receivable process identifying areas of performance improvement
A/R BILLING SPECIALIST - US RENAL CARE
12/2015 – 11/2017
PLANO, TX
• Conducted detailed review of Explanation of Benefit forms. Maintain accounts receivable records to ensure aging is up to date, credits and refunds researched and applied, uncollectible amounts are accounted for, and miscellaneous differences are cleared.
• Reviewed and analyzed opened unresolved claims and took appropriate steps and resources to resolve.
• Communicate via email and phone with customers and insurance companies in regards to billing and collections.
• Aggressively follow up on denied and rejected claims.
• Processed daily reports for patient billing and A/R payment details.
• Reconcile the accounts receivable ledger to ensure that all payments are accounted for and properly posted.
• Monitoring and maintaining assigned accounts
• Submitting and reviewing of authorizations.
A/R SPECIALIST - MMB STRATEGY
01/2015 - 05/2015
PLANO, TX
• Reviewed Laboratory Claim payment details.
• Collect and manage account reviews
• Prepare and submit claims electronically to insurance companies.
WC ADJUSTER and CLAIMS SPECIALIST - MEDI-LYNX
12/2013 – 01/2015
PLANO, TX
• Managed Workers Compensation and Injury claims.
• Processed all insurance correspondence and performed research to ensure that claims are paid timely.
• Conducted detailed review of EOB’s, ERA’s, ETA’s, ACH’s.
• Research and respond to all patient inquiries via phone, email and mail
• Updated patient demographic information and initiate account adjustments as needed
• Follow up with insurance companies on appeals to resolve unpaid and denied claims.
• Resubmitting of claims in timely manner for proper reimbursement.
• Complete all assigned projects in a timely manner.
WC ADJUSTER and STD/LOA/FMLA CLAIMS MANAGER - CIGNA
07/2010 – 10/2013
PLANO, TX
• Managed Workers Compensation, Short Term Disability and Long Term Disability claims in addition to FMLA/MLOA leaves that run concurrently.
• Performed full scale absence claim management including initiating claims, phone contact to employees and healthcare providers, Investigate and analyze information and documentation received, and made pay determination based on the relevant information.
• Calculate and schedule payments. Update and entered state and Workers Compensation off-sets.
• Performed research regarding payment issues and partner with payroll as needed.
• Accurately determine eligibility for and entitlement to disability benefits and informed claimants by phone regarding determination or additional information needed
• Served as benefits liaison between Account Managers, HR and Vendors.
• Partner with the clinical team on complex or escalated cases.
• Developed plans to address disability obstacles and plans with claimants’ attending physicians, nurses, pharmacist and employers.
• Monitor long term claims and partnered with the Long term disability department regarding claim transition as needed.
• Partner with the Accommodations team regarding rehabilitation plans and on-going medical treatment for employees. Coordinate with vocational rehabilitation counselor utilizing the American Disability Act language.
Only companies/businesses seriously employing should respond.
TANEA CLARK
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