Medical Billing Customer Service

Rose Holloman

San Bernardino, CA 909-***-****(cell) *******@*****.***

Objective

Seeking a career position that will offer a challenge and an opportunity

for advancement in the Medical and/or Business Administrative Management fields.

Education

DIPLOMA SEPT. 2003 BRYMAN COLLEGE

·Major: Medical Administrative Management

Skills & Abilities

·Microsoft Word, Excel, Access, Power Point, Outlook, Publisher, Typing 40+wpm, Data Entry, Word Processing, Medisoft, and 10 Key by touch, Medical Terminology, Coding, and Medical Billing. Non- Bilingual.

Experience

NEW PATIENT COORDINATOR INLAND BEHAVIORAL & HEALTH SERVICES, INC. OCT. 2019 TO FEB. 2020

This was a temporary position only - Completed

Schedule patient appointments and make reminder calls. Greet patients and direct them to examination rooms. Maintain patient medical records up to date. Obtain insurance information from patients, process patient billings, and collect payments. Collect and maintain patient health, demographic, insurance and financial information.

Respects patients by recognizing their rights; maintaining confidentiality. Maintains quality service by establishing and enforcing organization standards. Maintains patient care database by entering new information as it becomes available; verifying findings and reports; backing up data.

PATIENT ACCOUNT REPRESENTATIVE PACIFIC MEDICAL MANAGEMENT OCT. 2017 TO AUG. 2019

Responsibilities: Contacting patients who are delinquent in payments by mail, email and telephone. Additionally, we may contact insurance companies regarding claim status, verify eligibility, update account information, process credit card payments, mailing statements, posting and adjusting payments and all other basic administrative tasks on each account.

Paper authorizations, updating pending information for patients requiring DME/Orthotics intake face sheets, hard DME (i.e., hospital beds), Default Queue, Data on calls, clear out incomplete faxed denials, UM emails, urgent authorizations, standing referrals, benefits, UM Tech Queue for billing and collections.

P/T OFFICE CLERK/ASSOCIATE GOODWILL INDUSTRIES MAY. 2016 TO OCT. 2017

Responsibilities: Worked in the office and on the floor. Insures expeditious and accurate data entry and reporting. Maintain good customer service with our customers and maintain daily cash draws for overages and shortages.

CLAIMS DATA ENTRY PROCESSOR INLAND EMPIRE HEALTH PLAN NOV. 2014 TO MAR. 2016

Temporary Assignment with Medical Professional Staffing – Completed

Responsibilities: Worked in claims operations distinguishing appropriate rendering providers by NPI, Place of Service and ICD9 & 10 codes. Correcting and entering missing provider claims information. Identified non-contracted providers in facilities and sent provider requests to configuration team to research contracts. Verified and corrected member eligibility and ID number on claims. Also sent back non eligible and misdirected claims to facilities. Worked incomplete error reports.

Responsible for providing expertise on general claims support to teams in reviewing, researching, investigating, negotiating, processing and adjusting claims for all DME medical private insurance; HMO/PPO and workers compensation sub-contractors, and Medicare payers.

Responsible for Medical billing through E-claims for professional and facility claims. Provide claim negotiation for lien settlements, workers comp/subcontractors. Authorized the analyze appropriate payment or refers claims to investigators for further review. Conduct data entry, review, and identifying trends and providing reports as necessary for APAR. Managed patient data using an EMR to read and write a patient’s record, send and receive orders, reports, and lab results.

ENROLLMENT VERIFICATION COORD. PRIMECARE MEDICAL INC. OCT. 2008 TO OCT. 2014

Review results of database updates from various electronic sources and take corrective actions if needed. Take corrective actions determined by review of system exception reports. Interfaces with other departments to obtain necessary information required for resolution of claims. Responsible for tracking claims within the system for previously submitted claims, medical records request, tracers, and missing claim information. Complete screening of claims for provider information and multiple member information such as Eligibility, not in system (NIS), and belonging to another IPA

Determine coverage, complete eligibility verification and identify discrepancies. Paper authorizations, pending information, face sheets, hard DME(i.e. hospital beds), Default Queue, Data on call, clear out incomplete faxed denials, UM emails, urgent authorizations(EIOD’s), standing referrals, benefits, Um Tech Queue responsible for operational activity associated with assigned Health Plans enrollment, capitation reconciliation.

PATIENT REGISTRATION SPECIALIST BEAVER MEDICAL GROUP AUG. 2007 TO SEPT. 2008

Pre-registered and registered services for outpatient. Explained procedures, policies, and financial responsibility to patients. Greeted patients, provided information about department and answered phones. Interviewed more than 65 patients daily to process registration forms, insurance, and information required.

PROFESSIONAL PROFILE:

Specializing in Managed HealthCare

CUSTOMER SERVICE

CALL CENTER

10KEY BY TOUCH

BILLING/COLLECTIONS

E-CLAIMS

MICROSOFT OFFICE

WORD/ACCESS/EXCEL/POWER POINT/EMAIL

HCPCS/CPT ICD-9-10 CODING

MILLIMAN.ADVANCE DIRECTIVE

NCQA/HEDIS /ACO

MEDICARE/MEDI-CAL

HMO/PPO/EPO/POS

EHS/EPIC.MEDITECH/DIAMOND/FACETS/IDX

RIGHTFAX/TOUCHWORKS.ALLSCRIPTS

ELIGIBILITY/AUTHORIZATIONS INTAKE

CCMS/SNP/TOC/CPS/CCS

UTILIZATION MANGEMENT

CWQI/ QC CONSULT

GRIEVANCE & APPEALS

DME/ORTHOTHICS

HIPPA/PHI ACCREDIATIONS

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