Claims Processor Loma Linda
Resume:
La Shawn Henry
Little Rock, AR 72207
Email address: *********@*******.***
OBJECTIVE: To obtain a position where my experience and collections background would allow me to assist any company to achieve their productivity goals while demonstrating it with great customer service, with this practice I believe their mission objectives can be met PROFESSIONAL PROFILE:
-Over 15 years of management experience
-Over 25 years in the Medical Field
- Over17 years as a Customer Service Rep (CSR)
- Over 10 years DME/Respiratory/ Incontinent Supplies/Food replacement
- Over 10 years of working in a hospital environment / Internal Medicine/ Pain Management
-Over 5 years working in a Long Term Care Facility
-Over 5 years in a Doctor Office setting / Billing and Collection
-Highly organized, dedicated with a positive attitude
-Exceptionally reliable, conscientious and thorough
-Thrive on challenging task
-Experienced in training new employees to proper company policies and procedures.
-Excellent verbal and written communication skills
-Computer skills; Word, Excel, Medisoft, Mesta Med, NextGen, EPIC, Brightree (DME) EDUCATION: San Bernardino Valley College
Business Management and Administration
Fairfax Adult Education
Medical Asst. / Ins. Billing and Collection / Medical Coding San Gorgonio High School
General Education
EXPERIENCE: Elite Medical Care
Aug 2019-Current Office Manger
- Serve as primary contact for providers act as a liaison between the providers and the health plan
-Conduct monthly face-to-face meetings with the provider account representatives documenting discussions, issues, attendees, action items, and research claims issues on-site, where possible, and route to the appropriate party for resolution
-Receive and effectively respond to external provider related issues
-Provide education on health plan’s innovative contracting strategies
-Answer patient question and concerns quickly and efficiently
- Manager with the daily operations of our office
- Managing a staff of 8 employees
-Worked denial/ appeals/ Billing & Collection, corrections /Auditing Claims before electronic submission / Workman Compensation accounts
-Training new and current employees on updated policies and procedures
-Close out daily cash for day end and month end
-Coding claims with CPT codes and ICD-10, HICP codes University Arkansas of Medical Science
June 2017-Aug 2019 Commercial Insurance Asst. Manager
-Answer patient question and concerns quickly and efficiently
-Assistance Manager with the daily operations of the Commercial Department
-Worked denial/ appeals/ Billing & Collection, corrections /Auditing Claims before electronic submission / Workman Compensation accounts
-Training new and current employees on updated policies and procedures
-Close out daily cash for day end and month end
-Coding claims with CPT codes and ICD-10, HICP codes JOB EXPERIENCES CONTINUES:
- Initiate data entry of provider-related demographic information changes and completion of change
- Educate providers regarding policies and procedures related to referrals and claims submission
- -Perform provider orientations and ongoing provider education MedEvolve Solution
Jan 2016- June 2017 RCM Supervisor
Little Rock, AR - Manage a team of employees
-Answer patient question and concerns quickly and efficiently
-Billing DME/Respiratory/ Incontinent Supplies/Food replacement
-Training new and current employees on updated policies and procedures
-Track weekly finance reports (Excel) on high dollar accounts
-Coding claims with CPT codes and ICD-10, HICP codes
- Posting of daily cash correspondence
-Collecting from all major payer high dollar accounts
-Bi-weekly payroll
-Worked denial/ appeals/ Billing & Collection /Auditing Claims before electronic submission for all insurance payors / obtain prior authorization for services being rendered Physiotherapy Corporation
Jan 2010-Nov 2015 Patient Service Manager
Kennesaw, Ga -Taking new and recurring intakes form referral source
-Answer patient question and concerns quickly and efficiently i.e. payments/EOB’s/Denials’
-Working denial / appeals/ Billing & Collection / Auditing Claims before electronic submission insurance payors/ obtain prior authorization for services being rendered
-Verification of all insurance benefits
-Training new and current employees on update policies and procedures
-Cash posting / Working EOB’s and daily correspondence
-Scheduling patient daily for appointments with Therapist Sleep Med Therapy
Certified Patient Account Rep
May 2007- Dec 2009 -Collecting from all major payer high dollar accounts Kennesaw, Ga -Insurance Verification
-Working daily correspondence
-Working all denials
-Answering patient questions and concerns i.e. payments/EOB’s/Denials Home Medical of America /San Bernardino Community Hospital Sr. A/R Supervisor
-Managed a business office staff of 25 employees
Jan 2000- Dec 2006 -Hiring and releasing employees San Bernardino, CA -Preparing employees annually reviews
-Training new and current employees
-Track weekly finance reports (Excel)
-Coding claims with CPT codes and ICD-9, HICP codes
-Insurance Verification
-Reviewing contract for processing
-Billing and Collecting for our Long Term Care Facility
-Billing and collection all high dollar accounts
-Helping patients with any question and concerns i.e. EOB’s quickly and efficiently Dec 1998- Jan 2000 Vitalink Pharmacy and Home Health Services (DME) San Bernardino, CA Reimbursement Supervisor
-Managed a staff of 20 employees
-Hiring and releasing employees
- Verifying insurance before referral was processed
-Billing and Collection on accounts
-Billed DME/Respiratory/ Incontinent Supplies/Food replacement
-Training new and current staff on all payers and policies and procedures
-Preparing weekly finance reports on our revenue
May 1996- Dec 1998 NMC Homecare Services
San Bernardino, CA Medi-cal / Medicaid Patient Account Rep.
-Billing and Collecting for Medi-cal IV
-Coding Medi-cal Claims
-Working Medi-cal Denials/ obtain prior authorization for services being rendered
-Answering patient questions and concerns
-Working daily correspondence
April 1991- May 1996 Loma Linda Univ. Medical Center San Bernardino, CA Billing Specialist/ Customer Sales Rep for DME / Resp
-Taking new and recurring intakes form referral source
-Answer patient question and concerns quickly and efficiently
-Coding all claims with the proper CPT and ICD-9 and HICP
-Prepare all medical claims for the billing dept.
-Making sure code were correct and tar’s where current
-Typing Tar’s/Par’s (authorization)
-Verifying insurance before referral was processed March 1986 - April 1991 Dr. Patricia Lee Family Practice San Bernardino, CA Office Manger
-Managed a staff of 15 employees
-Billing/Collecting all payors
-Working all denials
--Helping employees with any questions and concerns
-Working all renewal par’s
-Time cards
-Training new employees on billing and collections
-Helping patients with any question and concerns quickly and efficiently Feb 1984- March 1986 Caremark Homecare Services
San Bernardino, CA Medi-cal Biller/Collector Home Infusion
-Billing/Collecting medi-cal IV infusion claims
-Answering patient questions and concerns quickly and efficiently
-Working denials
-Checking eligibility
-Working all incoming mail
Job References From:
Sleep Med Therapy
Home Medical of America
Vitalink Pharmacy and Homecare Services
Loma Linda Univ. Medical Center
Contact this candidate