Richard L Jones
Highly skilled, knowledgeable, and proficient Hospital Medical Financial Eligibility Counselor / Medical Claims Biller, brings extensive, specialized experience working in medical billing, collections, patient accounts management, and customer care capacities throughout hospital and independent medical billing environments.
*PFS Group(Fresno,Ca), June 10, 2019 to November 7, 2019.
Medical Billing Insurance Specialist – Under the supervision of the Insurance Department Supervisor, I would ensure the efficient operation and effective reimbursement of third party account receivables by researching accounts, refiling or appealing various claims, submitting additional medical documentation and tracking account status by monitoring accounts of unresolved third party accounts. I would initiate contacts and negotiate appropriate resolutions (internal and external) as well as receive and resolve inquires.
Reason for leaving; Commute too far, personal reasons.
*”Unemployed, January 1 2019 thru June/9/2019”
*Amazon Fulfillment Center Fresno, Ca., June 2018.
Warehouse Fullfillment Associate. My responsibility was to complete customers’ orders on a professional /timely basis, using the best state of the art technical advancements from Amazon.
*Accountemps Temp(Visalia, Ca.) Feb 20, 2018 -> March 25, 2018
Medical Biller (job location: Adventist Health, Hanford, Ca.) My duties included hospital claims billing and insurance claims follow-up, at Adventist Health Billing Office, Hanford Ca.
*Navigant - Cymetrix,@Tulare Regional Medical, Tulare, Ca July 2011 - Oct., 2017).
Financial Patient Eligibility Counselor
I was responsible for screening patients on site for eligibility assistance programs either at bedside or in the ER, while working in conjunction on a daily basis with the Case Management Dept., doctors, nurses, and staff to ensure the highest quality of financial / program assistance offered.
Review the hospital census on a daily basis, to identify self-pay patients, whether from the United States or outside non-citizens from countries across the world.
Review patients that are in house or designated as self-pay for state, county and / or Federal assistance programs including starting / completing application processes.
Responsible for tracking of program assistance offered / accepted of past and present hospital patients, while keeping track of successful vs non-successful outcomes.
Maintained a positive working relationship with the hospital staff of “all” levels and departments.
Certified Covered Calif Representative, 2013-2014 while stationed at Tulare Regional. The jpb was part of my duties/responsibilities associated with the Financial Eligibility Counselor. Patients and clients who resided in Tulare and Kings counties would visit me to enroll them in Covered Calif.
*Tulare District Hospital, Tulare, Ca., (September 06, 2006 to July 11, 2011)
- Recognized for a proven ability to efficiently submit hospital medical claims to major and private insurance carriers including HMO/PPO, Blue Cross/Blue Shield, Healthnet and Medicaid/Medicare.
- Highly skilled with a demonstrated knowledge of medical terminology, ICD-9/CPT codes, No Fault, and Worker’s Compensation claims.
- Keenly recognized, investigated and resolved discrepancies leveraging extensive experience going through appropriate channels to facilitate medical claims review and appeal processes.
-Process in excess of 60 healthcare claims per day for ABC Administrators, a third-party administrator of health benefits, in areas of surgical, dental, mental health, and physical therapy cases.
-Respond to inquiries from providers on a broad scope of coverage issues pertaining to eligibility, coordination/explanation of benefits, and payment schedules
- Carefully research and review individual/group claims exercising a strong working knowledge of major medical plans and leading healthcare networks
- Proficiently utilize the RIMS program and collaborate with Claim Review Department to expedite the resolve of claim discrepancies and insufficient information.
- Acted as Professional Relations Representative for between the main office and three regional locations to ensure the timely and accurate processing of insurance claims.
- Trained and supervised personnel on accident insurance claim processing and approval procedures.
*Tulare Community Health Clinic, Tulare, Ca (April 2003-September 2006)
- Implemented an efficient follow-up system to expedite the recovery of 30-day outstanding payments from non-responsive insurance carriers.
- Reconciled outstanding balances and incidents of returned claim checks from Medicaid/Medicare.
- Gained a reputation for accuracy and timely responses to requests, most frequently requested associate by physician’s offices to locate and process charts.
*Hanford Community Medical, Hanford, CA (July 2002- April 2003)
- Processed computerized medical claims under private, No Fault, and Worker’s Compensation insurance plans.
- Followed up with insurance carriers and patients to expedite the recovery of payment obligations.
College of the Sequoias, Visalia, CA(August 1975-January 1978)
Associate of Arts Degree, Business Marketing, graduated 1/1978.
Cerner, AS 400,MS Word, Excel and PowerPoint; Patient Management System (PMS)
Nancy Korovillas(former Supervisor/patient Director @Tulare Regional Medical Center)#559-***-****
Gilbert Mora(former Supervisor-Tulare Regional Medical Center), #559-***-****
Susan Sigler(former Revenue Cycle, Regional Director – Navigant/Cymetrix)#559-***-****
Sandra Silva, #559-***-****