Azle, TX *****
Seeking employment with a well-established organization where I can contribute to its team’s success as well as demonstrate my own unique abilities. Interacts well with a diverse group of people and builds effective relationships. Good communicator, strategic thinker, hard-working, and exhibits solid interpersonal skills.
Christus Health, Irving, Tx 2013 to 2020
Audit and Compliance Coordinator
Responsible for performing patient chart audits. I ensure that all claims audited meet all government and third party mandated procedures for integrity and Compliance. Demonstrates a level of accountability to ensure issues impacting integrity and Compliance of organization and reported and make recommendations for improvement.
Sent insurance claims to insurance companies for processing. Contacted insurance companies, Medicare and Medicaid for status of claims. We also utilized the internet for claim status as well. I use SSI and TMHP for claim status and eligibility. Sent Appeal letters if/when needed. Reviewed accounts pending release of refunds. Created batches from lock boxes, helped post payments when needed. Made calls to patients for account balances, or ask them to contact their insurance company for various reasons. Worked accounts via a work queue and also run reports to work special projects. Ran reports and converted to Excel spreadsheets.
I created the complete process of the re-bill process. Responsible for performing re-bills and or adjustments of both government and non government claims as corrections and edits are done to the accounts.
I ensure that the re-bills or adjusted claim are reprocessed by insurance companies accordingly. All findings will be communicated to management with recommendations of counseling/coaching.
I serve as an advocate and information resource for external attorney, clinical case managers and Business Office Collectors in regards to patient account receivables. I support the overall success of Business operations by demonstrating flexibility, collaboration and cooperation in a team environment while maintaining a high level of production and service quality. I provide continuous input, reports and providers feedback for improvement in maximizing collections, reducing denials and improve upon process to prevent billing errors.
Cook’s Children’s Hospital, Bedford, TX 2006 to 2013
Medical Billing & Collections Specialist
Applied payments and adjustments to patient accounts, processed deposits and maintained accurate records of all cash received in accordance with company policy
Conducted patient follow-up and assisted with patient evaluation clinic programs
Coordinated communications with payers to ensure accurate billing practices, enhanced reimbursement opportunities, achieved cash collections targets and reduced A/R over 120 days to below targeted level
Ensured the privacy and security of protected health information per HIPPA requirements, reviewed clinician documentation to ensure patient charts were completed
Followed up on all opened accounts, maintaining thorough chronological financial records on each patient account
Compiled and coded A/P invoices per guidelines for approval and reported to corporate office for payment
Obtained accurate insurance information, verification and pre-authorization of accounts
Processed all billing daily, ensured claims were accurate, timely and fully documented
Provided counseling to patients advising them of their financial responsibility and obtained credit agreements for outstanding balances
Provided highest level of customer service to patients, fellow employees and referrals
Received, sorted and distributed mail appropriately and in a timely manner
Reported timely key statistics to marketing and corporate management for sales, revenue, cash and patient flow
Covered Admissions and Radiology for lunches and breaks when needed.
Contacted patients for balances due.
Created batches for lockbox monies.
American Care Source, Irving, TX, 2001-2006
Collections Resolution Specialist
Conducted recurring follow-up on all opened accounts, maintaining thorough chronological financial records on each patient account
Filed appeals and corrective documentation to resolve all claims denied by insurance companies
Performed quality assurance audits by verifying all accounts receiving payments; reconciled any necessary refunds, credit balances, or recoupment actions
Verified that all super bills were correctly marked by the physicians with the correct level of care prior to entering the charge into the billing system
Applied payments and adjustments to patient accounts, processed deposits and maintained accurate records of all cash received in a timely manner and in accordance with company policy
Health South Occupational Clinics, Arlington, TX 1997-2001
Managed staff of 28 employees in support of eight physicians operating within four clinics
Submitted monthly financial reports from each clinic to corporate management to update our Profit and Loss statements
Demonstrated outstanding sales traits - Spoke at job fairs and hosted seminars with company Marketing Reps for local businesses and industries to introduce ourselves and define our business methods and the services we offered
Human resources duties included interviewing, counseling, hiring and termination of employees, managed time cards, and conducted new-comers orientation
Performed QA and spot checks of patient accounts, disbursements, receipts and deposits
Ensured all staff members compiled and coded a/p invoices in accordance with company policy and guidelines and were verified for approval before billing insurance providers
Promoted keen fiscal practices by comparing the best prices with vendors, mandated an “As-Needed” policy on durable medical items, office supplies and employees work hours
Windows, Microsoft Office, Adobe, Meditech, Advantx, and Stolus Billing Systems, TMHP, SSI, Access, Internet Explorer, QuickBooks