Resume

Sign in

Medical Billing

Location:
DeSoto, TX, 75115
Salary:
18
Posted:
October 10, 2019

Contact this candidate

Resume:

Loretta Johnson

Healthcare Industry

Portland, OR 97217

adaj8n@r.postjobfree.com

503-***-****

I have work with Contractor Agencies 13 years.

Willing to relocate: Anywhere

Authorized to work in the US for any employer

Work Experience

Home Health Care Aide

Private Duty In-Home Care - Portland, OR

February 2016 to July 2017

Assist with personal hygiene shower, dressing and meal preps. Assist with Feeding, Medication, Doctor appointment and bedtime. Cleaning rooms, laundry and preparing planning activities. Accounts Receivable Specialist

Providence Business Center - Portland, OR

October 2015 to January 2016

• Use EPIC software to research claim payment, billing EOB, send to billing/or follow up by documenting from insurance or Provider statements, send out medical records if requested.

• Resolve account issues including resubmitting claim if not on file

• Identify information needed to correctly process claim as expediently as possible

• Review accounts for accuracy through pre-assigned work ques to expedite payment and/or reverse denials for expedited payments

• Resolve/Research accounts receivable to secure constant cash flow

• Manage case load identifying appropriate follow up time lines

• Assist providers with claim history and patient regarding billing issues as needed Member Services

Kaiser Permanente

March 2015 to September 2015

• Use EPIC software to process and review medical claims, follow up on unpaid claims.

• Analyzes member not found claims information for accuracy

• Prepare detailed analysis of claims, activity and submit findings

• Process pre-certification claims for member's outpatient hospital services,

• Request Members Medical Records HIPPA Regulations and Rules Applied Member Services

A&I Benefit Plan Administrators, INC

October 2012 to August 2014

• Provide customer service to providers, members regarding insurance verification, deductible, co-pay, in/out network for medical benefits, verification for dental and vision benefits

• Worked directly with Medicare and Medicaid follow up reimbursements

• Epic system-Verify claim payment/denial status for member and provider

• Process pre-certification for outpatient hospital stay

• Process EDI, medical, HRA, RRA, and Flex claims

• Pending claim releasing, data information gathering Medical Records request if needed Membership Accounting Specialist

Regence Insurance Company - Portland, OR

December 2009 to December 2012

• Process medical premium and pharmacy claims

• Set up new accounts

• Epic Verify premium status, reinstatements, termination and if any plan change communicate by email, telephone and or by letter regarding member's payment Claims Auditor

Grassmueck Group LLP - Portland, OR

May 2010 to August 2010

• Audit Chapter 11 and 13 Bankruptcy claims

• Research to determine if claimant's has a valid claim

• Process, prepare and file a valid claim

• Send objection letter to claimant with determination whether claim was allowed or denied

• Follow up with claimant if missing information, to prepare claim, request medical records if needed

• Maintain a log of worked and completed claims

Medical Billing Specialist

Insurance Overload - Portland, OR

February 2009 to March 2009

• Epic system Follow up on medical claims for payment, pending and review claims if needed to be sent for rebill.

• Process insurance documents, maintain renewals, denials and default documents

• Review medical claims for eligibility verification

• Scan and Index medical claims

Customer Service Representative

William C Earhart Insurance - Portland, OR

September 2005 to April 2007

• Process dental and EDI medical claims

• Verify member eligibility for provider

• Verify claim status and payment for member and provider Senior Dental Claim Analyst

Standard Insurance Company - Portland, OR

July 1991 to January 2005

• Process dental claims, verify eligibility and benefits

• Provide excellent customer service to provider and member

• Train new employees on terminology, policy, products, provisions, groups, benefits and eligibility

• Process predetermination claims, reconcile claims, and adjustments

• Evaluated claim data to adjudicate dental claims

• Initiated and respond to requests for refunds or Medical records

Education

High School Diploma in Two years of full time College Washington High School-Portland

Marketing/Merchandise

Full time student 18 months

Skills

Medical Billing, DENTAL Billing, A/R, MEDICAL CLAIMS, Accounts Receivable, Medical Billing, Accounts Payable, MEDICAID, EDI, Medical Records, SKILLS • Accounts Receivable, Medicaid, Medicare, reimbursements • Medical and Dental Industry 15+ years • HCPCS, CMS 1500, ICD-10, ICD-9, HIPAA, UB04 • EPIC, Basy, Diamond, CM, and Facet claims system, HealthConnect • Medical claims, EDI claims, Flex claims, ARA, HRA claims processing • EOBS, copay, coinsurance, deductible • MS Suite, Excel, Word, Outlook, Data Entry • Consistently meet goals, deadlines, data and gather information . Additional Information

SKILLS

• Epic Healthcare Information Management-Accounts Receivable, Medicaid, Medicare, Medical Records

• Medical and Dental Industry 15+ years

• HCPCS, CMS 1500, ICD-10, ICD-9, HIPAA, UB04

• EPIC, Basy, Diamond, CM, and Facet claims system, HealthConnect, Maccess system

• Medical claims, EDI claims, Flex claims, ARA, HRA claims processing

• EOBS, copay, coinsurance, deductible

• MS Suite, Excel, Word, Outlook, Data Entry

• Pre Certification

• Medical Records



Contact this candidate