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Customer Service Medical

Location:
Woodridge, IL
Posted:
October 14, 2019

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Resume:

Veloria Bruce

**** ******** *** *** ***

Woodridge, Il 60517

708-***-****)

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

773-***-****

Access Community Health

Sharon Gier- coworker

222 N Canal St

Chicago, IL

312-***-****

Midwest Phy Center-Advocate Health Care Group

Pam Wilson-Burns-supervisor

9550 w 167th street

Orland Park, IL

708-***-****

Salary $32,00-$38,000



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