Lorna Palmer

Phone: 469-***-****

Email: admywj@r.postjobfree.com

Objective: To acquire a challenging, and committed position utilizing my professional skills and capability developed through my experience and education, with the opportunity for professional growth based on my knowledge and performance in achieving long term employment while representing a company in a professional and creative manner in improving quality service, production and increasing revenue. Qualifications: Knowledgeable in government program guidelines, HCPCS, ICD, CPT, Revenue Codes, DRG, payment methodologies, managed care operations for both hospital and physicians front office processes. Possess strong analytical and problem solving skills with the ability perform time management skills.

PROFESSIONAL EXPERIENCE

Health Partners Management Services 2/2018-10/2020 Plano, TX 75093

Claims Collector

● Manages aging of A/R through follow up with payers on LTACH and SNF billing for reimbursement per network contracts or Medicare DRG reimbursement guidelines ensuring that prompt and proper payment of claims

● Submit late charges and interim bills, reconsideration, appeals for underpayments to payers or facilities

● Research and determine proper action per denial of claims

● Payers: Tricare, VA’S, Champus, Workers compensation, LOA’s, Hospice Reny Company 6/2017-12/2017

Negotiator

Plano, TX 75093

● Negotiated medical bills for Workers Compensation, Texas non-subscribers, occupational accident, Maritime, and liability claims

● Provided compensation reimbursement and pricing recommendations per fee schedule and/or state reimbursement guidelines

● Submission of contractual information to providers as part of negotiation and reimbursement per network discounts, and agreements

Teladoc P.A. 7/2015-5/2017

Claims Analysis/Collector/Billing

Lewisville, TX 75057

● Responsible for all aspects of follow up and collections including making telephone calls, accessing payer websites, identify issues or trending and provide suggestions for resolution. Accuracy of claim data. Noting all patient accounts accurately and thoroughly.

● Verify claims adjudication utilizing appropriate resources and applications via electronic submission. Perform appropriate billing functions, including manual re-bills as well as electronic submission to payers and edit claims to meet and satisfy billing compliance guidelines for electronic submission for rejections/errors/denials.

● Appeals and Denials: reviewing EOB to facilitate adjudication of payment per reimbursement policies. Working rejected and denied claims reflecting incorrect payer, multiple denial code(s) reconsiderations, appeals and or eligibility auditing.

Dallas Medical Center (Prime HealthCare) 10/2013-5/2015 Dallas, TX 75267

Collector Biller/Revenue Cycle Specialist

● Review all EOBs denial and payments for the maximum reimbursement per Texas fee schedule/Network Contract

● Review any all PLN-11 (disputes), BRC, and CCH that has been filed with TDI/DWC.

● Submit request for reconsideration (appeals) for all underpaid claims to insurance carriers/payers

● Followed up on unpaid claims, review EOB's for accuracy, process/rework and followup on any denied claims

● Identify and correct billing errors, process refunds and make necessary insurance adjustments

● Collaborate with various financial and clinical departments to compile data and analyze data for all necessary disputes with payers

● Communicate effectively with managers and directors of applicable rules, regulations, policies, laws and guidelines that impact/affect any collections efforts in meeting internal goals

● Researched and determined action needed to initiate resolution of unpaid accounts/claims

● Maintained accounts to a zero balance and worked all aging reports with no timely filing issues Progressive Rehabilitation in Dallas of Ergonomics 8/2007-10/2013 Dallas, TX

Collector/Biller

● Performing analysis of patient records and determined legitimacy of treatment

● Verifying that records for patients include all information required for billing/referral purposes

● Obtaining and documenting current insurance and coverage benefits/contracts: heavy billing and follow up on medical government claims

● Handling billing and collections, denials and appeals, and checking claims status

● Consulting with claim processors at insurance companies/TPA regarding disputes/denied claims and follow up on unpaid bills not processed within claim period

● Oral and written communication with insurance adjusters, auditors TWCC representatives, attorneys, regarding all aspects of reimbursement for services

● Examine payment denials against insurance company contracts/policy provision

● Maintain communication with managers, and other departments concerning issues affecting collections, peer reviews, authorization, RME, denials

Texas Health Resources, CBO 10/2002-8/2007

Dallas, TX

Workers Comp. Collections Specialist

● Communicate with insurance companies to obtain claim status, verifying insurance benefits and coverage regarding issues and resolutions

● Refilling claims after insurance carrier paid incorrectly, making sure claims were paid by the work comp guidelines reimbursement

● Handling medical disputes, adjusting claims to show correct balances

● Appeal claims; analyze EOB’S for payment issues on delinquent claims

● Investigate and respond to EOB’s, correspondence, problems, questions or request in a timely manner to ensure resolution and customer service to facilitate payment and demonstrates above level problem solving skills and decision-making abilities

● Working collections for the self-pay accountants off the Ontario Dialer System Job Related Skills:

● Proficient in medical terminology, CPT and ICD-9 codes for billing purposes and appealing payment decisions, EMR

Knowledgeable of government payers’ regulations and reimbursement, subscribers and non-subscribers

● Multi-tasker and fast learner, ability to work in a past paced, deadline driven environment

● Displays appropriate interpersonal and analytical skills

● Team player, dedicated worker

References Available Upon Request