Resume

Sign in

Appeals Case Manager

Location:
Florissant, MO
Salary:
$87,934
Posted:
May 15, 2020

Contact this candidate

Resume:

Kertonnia Petty-Miliken

P.O. BOX *****

St. Louis, Mo. 63141

adc8vb@r.postjobfree.com

636-***-****

SUMMARY:

9+ Years extensive experience in the healthcare industries in A/R Portfolio, Medical Billing, Collections, EMR, Appeals, Denials, Client information and Administrative Management.

Supervised collections for delinquent accounts, follow up, appeals, denials, posting and credit resolution.

Oversaw day-to-day operations of business office; billing/collections, account payables, receivables as well as team management

Knowledgeable of CPT codes, ICD-10, managed care contracts, insurance/insurance plan requirements and government regulatory guidelines.

EDUCATION:

Masters of Business Administration 2015

Bachelors of Science Health Administration. 2013

Lindenwood University, Saint Charles, MO

SKILLS:

As400 (3 years)

Accounts Receivable (10+ years)

Accounts Payable (8 years)

Epic (3 years)

40 WPM

Collections (10+ years)

Medical billing (10+ years),

Office Manager (8 years),

PowerPoint (6 years),

Excel (6 years)

Sage 50

Accounts Receivable Project Manager (5 years)

CERTIFICATIONS/LICENSES:

HIPAA November 2019 to November 2020

Compliance of health information privacy.

HIPAA April 2018 to April 2019

Compliance of health information privacy.

HIPAA. October 2017 to December 2017

Compliance of health information privacy.

PROFESSIONAL EXPERIENCE:

BeaconHill Services November 2019 – December 2020

Eversana

Responsibilities:

Case Manager

Over saw territory accounts for specialty physician practices, worked with field managers to capture revenue.

Compose and draft letters, review correspondence, initiate and or track appeals, prior authorizations and predeterminations.

Calculated cost shares, out of pocket responsibilities, and researched account.

Identified low paid claims, clarified discrepancies.

Provided personalized support over the phone and online portal.

Collaborated with health care providers with issues related to enrollments, payments, reimbursements, denials, precertification and appeals.

Completed benefit verification and prior authorizations.

Responded to inquiries from healthcare providers and business partners, followed up on requests in a timely, courteous and professionally.

Assisted healthcare providers with denials, appeal and precertification submissions.

Completed benefit verifications and reported results to healthcare providers and client reimbursement teams.

Subject matter expert for healthcare providers for medical claim denials, appeals and precertifications.

Point of contact for healthcare providers to obtain completed patient eligibility

AlliedGlobal Services September 2019 – November 2019

St. Louis University GI Department

Responsibilities:

Medical Secretary

Responsible for the execution of excellent customer service to all staff, students and guest.

Oversee departmental offices, answered telephones, scheduled appointments, light bookkeeping.

Transcribed medical documents such as, journal publications as well as prepping for same.

Scheduled procedures, travel arrangements, maintained 6 physicians, 2 nurse practitioners, 5 nurse and 3 fellows’ calendars.

Maintained meetings, conference arrangements, responsible for reimbursement expense reports.

Renewed physicians' licenses and credentialing and maintained patient files.

Served as lias between patient, physicians, vendors and staff.

Allied Global Services, St. Louis, MO August 2019 to September 2019

Washington University ParkTrans

Responsibilities:

Administrative /Account Specialist

Responsible for the execution of excellent customer service to all staff, students and guest.

Oversaw departmental offices, answered telephones, scheduled appointments, light bookkeeping.

Worked with customers to understand specific reasons for delinquency on accounts and preventable measures to prohibit future delinquencies.

Ability to evaluate situations, prioritize requests and responsibilities, and adapt as needed.

RobertHalf International, St. Louis, Mo March 2019 to August 2019

BJC Homecare Services

Responsibilities:

Integrity Specialist HIM

• Analyzed accounts discrepancies, identified variances, lias physicians/HIM/Nursing.

Responsible for entering data of accounts.

Supervised billing transactions, the import and export of ancillary billing items and updates.

Analyzed Home Health, SNF, MCD, MCR, commercial, follow-up, collections, denials, appeals for hospital/ physicians.

RobertHalf, Consulting Division, Maryville, IL October 2018 to November 2018

Responsibilities:

Consultant/Analyst Conversion Project

• Analyzed reimbursement discrepancies, identified variances; researched contract terms; performed analysis of

Discrepancies.

• Recommended policies and procedures for greater efficiency.

Reduced average days in A/R from 79 % to 48 % in a 6-month period.

Increased net collections from 65% to 80% by following up on accounts.

Reconciled, processed medical accounts, lias for administrator, physicians, hospitals and various staff members.

Calculated billing adjustments/completed adjustment forms as well as researched accounts.

Identified overpayments, clarified discrepancies: such as payment received by more than one payer, retroactive payments, double billing/payments, and inaccurate postings.

Allied Global Services, St. Louis, MO

Washington University

Department of Inclusion & Diversity May 2018 to July 2018

Olin Business School January 2018 to April 2018

School of Occupational Therapy October 2017 to November 2017

Responsibilities:

Administrative Assistant I/II

Provided administrative support to the department of Occupational Therapy Program, Olin Graduate Business Office, Department of Inclusion and Diversity and Alumni and Development Research as well as various other departments.

Responsible for the execution of excellent customer service to all staff, students and guest.

Oversaw departmental offices, answered telephones, scheduled appointments, light bookkeeping.

Researched possible philanthropist, giving capacities and net worth.

Calendar Management-assisted staff in maintaining appointments with walk-in students, reminder notices, meetings etc.

Maintained data base of the Doctorial Students.

Identified problem areas, consulted serious systems downtime.

Recommended policies and procedures for greater efficiency.

Provided supervision to department, students and student workers.

Healthcare Scouts December 2016 to May 2017

Conifer Health

Responsibilities:

Appeals Writer/Specialist

Experience in Accounts Receivable portfolio management of past-due receivables with a genuine and authentic emphasis on customer service excellence.

8+ years of combined accounting, accounts receivable, collections and/or billing experience.

Reviewed discrepancies for underpayments, denials, wrote appeals and followed process to completion.

Worked with customers to understand specific reasons for delinquency on accounts and preventable measures to prohibit future delinquencies.

Responsible for verifying credentials of the physicians and doctors and then submitting it to appeals department.

Obtaining credentials from the physicians and Nurse Practitioners to get it submitted to appeals department.

Responsible for maintaining database for the products coming in from the outsourcing company.

Life Care Center of Florissant January 2016 to April 2016

Responsibilities:

Business Office Manager

Managed day-to-day operations of business office such as billing/collections, account payables, receivables as well as team management.

Responsible for entering payments to the account.

Implemented and interpret programs, goals, objectives, policies, as well as procedures of the business office.

Supervised GL ledgers, daily receipts, collection of delinquent accounts.

Hired, trained, mentored, terminated, supervised and managed performance of the front desk/ billing department associates.

Brown Mackie College March 2015 to January 2016

Responsibilities:

Adjunct Instructor

Diagnostic Coding/Medical Administrative Practices

Provided competency-based education which aligns with the EDMC model of curricula as well as supporting the EDMC style of system delivery.

Designed and delivered class instruction through the development of instructional plans to meet course competencies, the development of activities which support lesson objectives, and online.

Delivered learning-centered instructions by establishing a classroom environment conducive to learning and student involvement as well as effectively planning and preparing for classes and student success. (Coding/medical billing/collections).

Wayne Perry Associates August 2014 to July 2015

Independent Contractor-Finance

Responsibilities:

Spec, Customer Ops AR Mgmt /Custom Solutions

Reduced average days in A/R from 79 % to 48 % in a 6 month period.

Increased net collections from 65% to 80% by following up on accounts.

Reconciled, processed medical accounts, lias for administrator, physicians, hospitals and various staff members.

Calculated billing adjustments/completed adjustment forms as well as researched accounts.

Identified overpayments, clarified discrepancies: such as payment received by more than one payer, retroactive payments, double billing/payments, and inaccurate postings.

8+ years of combined accounting, accounts receivable, collections and/or billing experience.

Office Team, A/R, St. Louis, Mo March 2014 to July 2014

Contractor Finance Accounting April 2012 to January 2014

Responsibilities:

West DME Supply

Stockel

Magellan

Knowledgeable of CPT codes, ICD-10, managed care contracts, insurance plan requirements and government regulatory guidelines.

Researched billing/payment inquiries from customers.

Responsible for maintaining data entry for benefits and transfer it or update it to their system.

Identified and took appropriate action to rectify escalated issues.

Reduced clearinghouse denials from 39% rate to 15% in a 4-month period with follow-up.

Supervised billing transactions, the import and export of ancillary billing items and the updates.

Home Health, SNF, MCD, MCR, commercial, follow-up, collections, denials, appeals for hospital/ physicians.

Reviewed A/R balances to ensure timely and accurate payments are received by 25%.

Reduced A/R critical errors 38% improving insurance claims submissions and quality control by 23% over 4 months.

Determined operational objectives by studying business functions; gathering information; evaluating output requirements and formats.

Account receivables project manager, reviewed aging reports, invoice reports to ensure collections aging and bad debt/write off goals were met.

Reviewed data entry for the production spreadsheet and updating main spreadsheet.

Processed payment discrepancies, identifies variances; researched contract terms; performs analysis of discrepancies.

Missouri College March 2010 to January 2011

Responsibilities:

Adjunct Instructor/Healthcare Administration

Provided competency-based education which aligns with the EDMC model of curricula as well as supporting the EDMC style of system delivery.

Created curriculum, selected text books, created exams. Designed and delivered class instruction through the development of instructional plans to meet course competencies, the development of activities which support lesson objectives, and online.

Delivered learning-centered instructions by establishing a classroom environment conducive to learning and student involvement as well as effectively planning and preparing for classes and student success. (ethics/coding/medical billing/collections).

St. Johns Mercy, St. Louis, MO October 2010 to March 2011

Responsibilities:

Contractor-A/R Project Manager

Account receivables project manager, reviewed aging reports, invoice reports to ensure collections aging and bad debt/write off goals were met.

Analyzed reimbursement discrepancies, identified variances; researched contract terms; performed analysis of discrepancies.

Knowledgeable of CPT codes, ICD-10, managed care contracts, insurance plan requirements and government regulatory guidelines.

Researched billing/payment inquiries from customers.

Responsible for maintaining data entry for benefits and transfer or update to their system.

Identified discrepancies, took appropriate action to rectify escalated issues.

Reduced clearinghouse denials from 39% rate to 15% in 4 month period with follow-up.

Supervised billing transactions, the import and export of ancillary billing items and the updates.

Home Health, SNF, MCD, MCR, commercial, follow-up, collections, denials, appeals for hospital/ physicians.

Reviewed A/R balances to ensure timely and accurate payments are received by 25%.

Reduced A/R critical errors 38% improving insurance claims submissions and quality control by 23% over 4 months.

Determined operational objectives by studying business functions; gathering information; evaluating output requirements and formats.

Account receivables project manager, reviewed aging reports, invoice reports to ensure collections aging and bad debt/write off goals were met.

Reviewed data entry for production spreadsheet and updating main spreadsheet.

Processed payment discrepancies, identifies variances; contract terms; performs analysis of discrepancies.



Contact this candidate