Sandra L. Tweed

**** *. ******** *** #**

West Allis, WI 53227

Phone # 414-***-****

adib6o@r.postjobfree.com

Professional Summary:

I have worked in Healthcare for most of my career from being a Claims Examiner, to a Claims Adjuster to follow-up AR rep.

I am looking for a remote @ home claims or data entry work

Wheaton Franciscan Medical Group

Title: Payor Service Representative II (Physician Billing and Follow-up) November 5th, 2007-2016

Bought out by Ascension Health 2017, then Ascension bought R1 RCM in 2018. Same position/title.

11/02/2020 R1 RCM remote at home F/U position via Michigan.

●Billing and follow-up of Contracted and Commercial insurances.

●Ensuring accuracy of payments from our contracted payers.

●Extensive telephone use in contacting insurances for claim status and daily follow-up. Website investigations, eligibility checks, PC based applications and Internet daily. (Program used is McKesson Empowering Healthcare Program) Epic healthcare system for 5 years, R1 Hub along with Epic

●Resubmissions, Appeals, Adjustments, write off requests, Overpayments, Recoups, Timely filing, and further follow-up with the insurance carriers for resolution.

●Posted cash to claims, (provider discount) disallows deductibles, co-payments, and co-insurance. I write remarks, add remark codes for future follow-up.

●Follow-up with coding specialists daily through PC based applications and e-mail for status checks for appeals.

●Add modifiers, different CPT codes, & Diagnosis at Coders request. I have basic knowledge of CPT-4 & ICD-9-10 codes.

●Paper/Electronic remits, correspondence, and letters.

●Trained numerous new people for help with my carrier which is (UHC) United HealthCare/United medical Resources (UMR).

●Volunteer for Racine All Saints Hospital Billing Clinic, which are appointment/walk-in patient based questions and answers

National Government Services (Blue Cross Blue Shield) Sept. 7th, 2005 to November 1st, 2007

Claims Examiner II/Adjuster for Michigan, California, & Wisconsin

●Reviewed adjustments to determine if they are complete by comparing the original submitted claim.

●Returned the incomplete adjustments to the sender.

●If the request was complete, I bypass the adjustment.

●Determine if the adjustments are complete.

●Reviewed all inpatient/outpatient claims.

●All of the Claims Examiners duties (below) also.

Claims Examiner I March 7th, 2005 to Sept, 7th, 2005

●Worked claim reason codes

●Determined if claims should be moved and where they should be moved to

●Determined if the claims should be sent to another department

●Determined if claims should be placed on system hold

●Determined if a file problem exists and requests corrections

●Determined if file problem is (MSP) Medicare Secondary Payer related.

●Send request for assistance and waited for response

●Reviewed claim when corrections were completed and released claim

●Resolves subsequent reason code edits.

●Manually released claims to system when edits are completed

●Complete referral sheets, and determines if claim should be returned to provider, rejected or overridden

●Returned claims to provider with remarks and determines if utilization problem exists and corrected it.

●Worked some paper but mostly electronic claims on the (FISS) Fiscal Intermediary Shared government System

Medicare Customer Service Support Clerk (I worked Beneficiary/Provider side every other day) April 2002 – March 2005

●Screened, sorted, batched, and logged incoming mail into the government program FISS, access, and excel daily

●Maintained control of correspondence inventory from receipt to finalization

●Completed weekly and monthly inventory physical counts

●Created and maintained department files and purged when necessary

●Photocopied, faxed, and numerous other clerical duties as assigned

●Trained 5 temporary employees for my position, to help me.

●Ordered all department supplies and maintain care of the fax, copier, and printers on Beneficiary and provider sides.

EDUCATION

I have attended MATC College for:

●Keyboarding, WordPerfect, Windows 95, Excel 97 Pt. I & II, Microsoft Word 2000 Pt I & II, Information & records management, Administrative Office Procedures, Business English Essentials, Office Technologies Course. I also received a certificate for 7 hours of completion from the MRA- Institute of Management Inc. in the program, “Success Skills for Administrative Professionals” on 07/29/2004. GED-1984,

●I completed Microsoft Outlook 2003 part I & II in May of 2008 at Elm brook Hospital through Wheaton Franciscan HealthCare learning Link Program.

●I completed Microsoft Excel 2003 part I & II in July of 2008 through Wheaton Franciscan HealthCare learning Link Program

VOLUNTEER OPPORTUNITIES

●I always volunteer to do overtime on projects as assigned during the week and Saturdays when asked.

●I volunteer for the Cancer Run at the Milwaukee County Zoo every year.

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