Service Representative Care
Resume:
Chakeila E. White
*********@*****.***
APPEALS SPECIALIST
Looking to secure a responsible career opportunity to fully utilize my training and skills, while making a significant contribution to the success of the company.
● EPIC systems
● Cerner system
● Allscripts
● Proficiency of Excel, Windows and
Outlook
● Problem solving
● Verbal and Written Communication
● Training
EXPERIENCE
Loyola University Medical Center, Westchester, IL 8/2019 - Present
Managed Care Appeals Specialist
Review charge information, claim forms and insurance correspondence when reviewing governmental and non-governmental denials to determine if coding, billing, claim follow-up, payment posting are accurate and supported by documentation before initiating appeals process.
● Monitors and follows up on appeals throughout entire process to ensure appeal has resulted in an overturned denial or has escalated through the proper channels.
● Review the Explanation of Benefits (EOBs) received from assigned carriers and take appropriate action according to company guidelines. Collect necessary information and prepare appeals to carriers when not in agreement with claim denials.
● Performs accurate and timely write-offs following identification of uncollectible accounts.
● Participates in regularly scheduled team meetings sharing denial trends specific to claim requirements to enhance front end claim edits to facilitate first pass resolution. Contributes ideas for work flows and best practices to maximize opportunities for performance, process and net revenue collections improvement. Performs other duties as assigned by management.
Shirley Ryan Abilitylab / RIC Hospital, Chicago, IL 07/2012 - 8/2019 Reimbursement Coordinator
Collected outstanding receivables from Commercial, Federal, State and third party Payors and Payor representatives such as TPA’s or fiscal intermediaries; identified potential uncollectible accounts and referral to management for further action; prepared and maintained collection related records.
● Process billing for all financial classes including Commercial, Federal, and State plans, as assigned, ensuring the confidentiality of patient billing information and HIPAA compliance. Liason for the team for pre-admission clinical and financial information. Educates team regarding patient financial benefits.
● Obtain and track claim status via online portals and via phone. Follow up on on claim appeals. Review of insurance Explanation of Benefits to facilitate account resolution.
● Identify, address, submit or process adjustments, over payments and outstanding balances. Allocate co-insurance and deductible appropriately within the Cerner systems.
● Updates to the accounts receivable system with appropriate documentation reflecting current billing and/or collection status. Responds to correspondence and calls forwarded from the customer service unit.
● May provide assistance and support regarding charity care guidelines to Lab physicians and hospital operational leadership. May meet with patients and families as needed regarding financial assistance/ charity care program
● Maintain volume and productivity information and report to management. Performs other duties as assigned by management.
Resurrection Health Care,Chicago, IL 04/2003 - 07/2012 Managed Care – WSMC, 10/07 - 7/12
Claims Representative, Managed Care – WSMC, 02/06 - 10/07 Loaded and maintained the Mysis Health plan Benefit Table to ensure claims were being adjudicated per the contract rates. Reconciled referred claims, making sure the tables are set up correctly. Check eCare system for eligibility on members, plan numbers and Co-pays etc. Trained new employees.
● Responsible for training new hires and temporary employees to ensure thorough understanding of claim procedures. Participate in professional activities to keep abreast of trends/changes, regulations, and legislation in the claims field.
● Responsible for handling the various claim reports submitted to us by the Health plans in a timely manner. Meet all deadlines for submission of responses. Attend meetings, participates on committees and completes assigned tasks within deadlines.
● Ensure fee schedule updates are entered/maintained in Mysis and troubleshoot all system related issues. Handle special projects within the department. Perform other duties as directed/required.
● Was in the process of helping to build electronic claims paying system LuminX, loading contracts, CPT codes, ICD 9 codes and eligibility.
● Customer Service Representative, answer phones, respond to customer or client inquiry regarding claim status or eligibility.
Contact this candidate