Customer Service Medical
Resume:
Veloria Bruce
Woodridge, Il 60517
adak9h@r.postjobfree.com
SUMMARY:
Dynamic Medical Claims Professional with more than 20 years of experience in medical.
Excellent leadership skills and grasp of claims submissions, appeals, denial and billing
SKILLS: Medical & Dental adjustments written correspondence medical/dental terminology
customer service/interpersonal skills medical/dental claim adjudication
SOFTWARE:
Microsoft Word and Excel Lotus 1-2-3 WordPerfect Paragon, OneSource Allscripts IDX, Soarian,Citrix LLS,
Siemens, Enhance,EDM, Connex,Epic, Nebo/Ecare,Aeos, Meditech-PCI-MSC, Citrix
ASOBGYN, Rims AS600, AS400 based programs, flowcast
EXPERIENCE:
CSI/Nationwide Insurance 08/2017-Present
815 Commerce Drive
Oak Brook, IL 61350
Claims Specialist/Team Lead
Review and address provider and member first level of appeals.
Assist the team of 9 with daily billing activities.
Oversee relationship and team building.
Conduct weekly team meeting for any new trends or issues.
Train and develop all claims analysts and review specialists.
Identify root cause related to member and provider customer service complaints.
document all account information in the hospital database.
Follow up on accounts concerning payments and make the necessary calls.
Contact the payers concerning all claim status.
Northwest Community Hospital 08/2016-04/2017
800 W Central Road
Arlington Heights, IL 60005
Patient Account Specialist
Collect on unpaid, denied or appealed claims for Northwest Community Hospital
Research accounts specifics to complete necessarily follow up actions
Contact insurance payers via telephone on aged/delayed claims for resolution
Maintain complete and accurate follow up actions in Aeos and Epic
Obtain necessary patient records required as attachments to claims
Submit electronic and/or hand copy claims with any attachments as per the contract,
Timely filing
Document all account activity in the hospital system notes and the database
Prepare request for account balance adjustments in accordance with client
Rev MD Partners 03/2015-07/2016
111 Pasquarelli Dr
Westmont, IL 60559
A/R Specialist
Collect on unpaid, denied or appealed claims for Ingalls Memorial Hospital
Post Insurance payments
Contact insurance payers via telephone on aged/delayed claims for resolution
Maintain complete and accurate follow up actions in Siemens, Enhance, Sorian and EDM
Obtain necessary patient records required as attachments to claims
Submit electronic and/or hand copy claims with any attachments as per the contract,
Timely filing
Document all account activity in the hospital system notes and the database
Prepare request for account balance adjustments in accordance with client
Access Community Health Network 03-2012-01/2015
222 N Canal
Chicago, IL
Billing Analyst – Revenue Cycle
Verified all CPT and ICD9 codes with the diagnosis
Posted/entered office and hospital charges
Merged Duplicate patient accounts in Epic
Completed encounter registration following the defined guidelines and policies
Validated coverage via real time eligibility or other defined mechanisms
Verified all PPO, HMO, Medicare/Medicaid and AARP
Billed Medicare, Medicaid and Commercial Insurance
Maintained daily workflow, unbilled report and productivity
Initiated corrections and resolved discrepancies
Submitted charges in a timely manner
Balanced batch totals to the daily total, post and print batch
Midwest Physician Group 2004-2011
Orland Park, IL
Patient Representative
Verified all PPO, HMO, Medicare and AARP
Billed Medicare, Medicaid and Commercial Insurance
Prepared daily cash summary sheets
Verify and process charges for lab, radiology and physician claims for payment
Business and Personal References.
Nationwide CSI Insurance
Pia Colon
adak9h@r.postjobfree.com
Access Community Health
Desiree Ball- supervisor/manager
222 N Canal St
Chicago, IL
Access Community Health
Sharon Gier- coworker
222 N Canal St
Chicago, IL
Midwest Phy Center-Advocate Health Care Group
Pam Wilson-Burns-supervisor
9550 w 167th street
Orland Park, IL
Salary $32,00-$38,000
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