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Medical Billing Claims Specialist

Location:
Conley, GA
Salary:
43,000
Posted:
October 20, 2021

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Resume:

Edna Webb

Business Office /Medical Administrator

Atlanta, GA 30305

ado3t8@r.postjobfree.com

1-770-***-****

Results oriented professional contractor with expertise in driving financial health and business

development.

Exceptional people skills with strengths in ensuring high customer satisfaction and consistent revenue

growth.

Possesses proven ability to succeed, excellent leadership skills and superb communication and

interpersonal abilities.

Authorized to work in the US for any employer

Work Experience

Loan Processor

Robert Half - Atlanta, GA

February 2021 to Present

• Preparing and submitting loan files to banks and mortgage lenders for approval .

• Ensure all documents in signatures are in order prior to submission for loans

• Interviewing assessing and researching loan applicants while authorizing approvals or denying

applications .

• Assisting clients going through hardship by determining ratios and metrics to set up payment plans.

• Act as a liaison between customer and financial institutions who assist qualified applicants.

Remote Banking Fraud Specialist

Iconma/Contractor Call Center - Kennesaw, GA

January 2020 to October 2020

• Reviews verifies and/ or identifies customer transactions to detect/ prevent financial crime activity.

troubleshoot investigate and resolve fraud issues for credit cards and atm debit card clients. Information

security

• Gathers info from client to submit fraud claims or billing dispute.and issue refunds credits. close

and reissue debit and atm cards due to suspicious activity or charges client didn't make or dont

recognize. Verify signature cards on business accounts. customer service inbound and outbound calling.

Authenticate all accounts.

• Use a variety of sources for information to include online systems and tools such as model, flash boss

synergy and solution center, Reissue lost stolen damaged or cards not received. Add blocks to prevent

charges due to fraud, Read disclosures to client after claim or billing dispute has been created.

• Remove restrictions from cards once charges are made valid and have been identified by the client,

• Monitors moderate to complex account activity which requires research that involves multiple

transactions.

Property Claims Specialist

Manpower/Contractor/ Call Center - Marietta, GA

July 2019 to September 2019

• Effectively handles conclusion of all assigned claims with little to no direction and oversight. Adheres

to high standards of professional conduct consistent with the delivery of superior. service

• determined property policy coverages and applies best claims practices to conclude assigned cases

in accordance with company guidelines.

• Submits severe incident reports, reinsurance reports and other information to claims management

as needed.

• Partners with SIU and subrogation to identify fraud and subrogation opportunities .Assist or prepare

files for suit trial or subrogation( Property MD Casualty)

• Initiates and conducts follow ups via proficient use of the claims systems and other related business

systems.

Medical Billing Specialist

Robert Half/Contractor/Call Center - Sandy Springs, GA

December 2018 to March 2019

• Submitted medical claims to insurance companies and payers such as Medicare and Medicaid .Refunds

Hippa Guidelines and Regulations EMR Heidis

• Collects delinquent accounts by establishing payment arrangements with patients: monitoring

payments, following up with patients when payments lapses occur. (ECW and EPIC system) answer email

request .reviewed proof of payments.

• Utilizes collection agencies and small claims court to collect accounts by evaluating number of

statements and payment history on accounts. Assisted patients in six markets, Working with AR reps

to ensure accuracy

• Maintain bad-debt cost report by tracking billings: monitoring collections compiling information.

• Taking credit card payments. Trouble shooting accounts to resolve billing issues. Posted payments

and from adjustments and overpayments submitted refunds

Hugh Spalding, Unit Secretary

Pro Staff - Atlanta, GA

February 2017 to May 2018

• Assisted house supervisor with patient transfers to psychiatric facilities. Prepares and maintain paper

and computerized medical records, census and admission logs.(EPIC system)(Responder5) intake and

information security Heidis service tickets for repairs on in office equipment.

• Assisted entire medical staff with administrative needs to include faxing coping dictations, baby

wellness appointments, transcribed and entered doctors' orders, prepared staff assignments in tele

tracking system

• Served as primary contact for emergency awareness for staff and patients, initiated group huddles,

monitored door entrance by camera and lock button, by adhering to HIPA rules and regulations.

Pro Staff -Marcus Autism Center Research Behavioral Health Data Entry Specialist Atlanta Georgia

8/2016/12/2016

• Verifies entered data by reviewing, correcting, deleting, or reentering data; combines data from

multiple systems protecting patient information by adhering to HIPA rules and regulations.

• Purge files to eliminate duplication of data. DEX, CERNER, EPIC) Heidis

• Follows data entry requirements and procedures, SAP data extracting adheres to center operations by

following all additional policies and procedures, SAP data extracting.

• Monitored feeding and potty sessions. Collaborating results from customer call backs to physicians

and psychiatrists

Aflac Cancer and Blood Disorders Center Registration Coordinator

Pro Staff - Atlanta, GA

April 2016 to June 2016

• Scheduled and set appointments when needed reported cancellations and referrals from

faxes .prioritized fast track and deep section patients. EPIC system, EMR) intake and information security

• Conferred with nurses and physicians to resolve discrepancies, verified all insurance coverages. Service

tickets for repairs on in office equipment.

• Obtained demographic, diagnostic, and epidemiologic treatment and survival patient information from

inpatient and outpatient reports medical records and electronic data bases,

• processed cash check and credit card payments. Pre Authorization of insurances

Sales/ Claims Representative

Medworx LLC/Call Center - Jackson, MS

November 2014 to November 2015

• Collections computerized adjustments, researched accounts, uploaded documents, sold pain creams

and prosthetics.

• Data entry obtained and posted credit card payments through QS-1 system. Adhered to HPPA

guidelines and regulations copied and uploaded important documents to be further processed. Inbound

and outbound calls.

• Assigned mandatory continuing education courses, networked at events to drive business

development.

• Conferenced with different insurance companies and doctors' offices for eligibility and cancellation

purposes to insure proper healthcare coverage. Assisted with prior authorizations when insurance

rejected claims.

Education

Certified Professional Coder in Medical Billing and Coding

Everest College - Hampton, VA

August 2009 to May 2010

Associate in Business Computer Programming

BCTI - Tacoma, WA

February 1997 to February 1999

Skills

• Reporting and analysis

• data entry

• customer service

• order entry

• project management

• medical registration

• and insurance precertification and Preauthorization.

Familiarity With: Microsoft Excel

• Microsoft Outlook

• Microsoft Word

• CPT-4/ICD-9/ICD-10 codes

• Epic

• Cerner

• Insurance Verification

• Medical Coding

• Medical Scheduling

• eClinicalWorks

• Medical Records

• Medical Billing

• EMR Systems

• HIPAA

• Business Development

• Medical Terminology

• Clerical Experience

• Medical Office Experience

• QuickBooks

• Microsoft Powerpoint

• Auditing

• Time management

• Sales

• Microsoft Excel

• Word processing

• English

• Data collection

• Typing

• Multi-line phone systems

• Public relations

• SharePoint

• Sales support

• Recruiting

• Salesforce

• Adobe Acrobat

• Training & development

• Documentation review

• Customer support

• Accounting

• Video editing

• Medical collection

• Payroll

• Front desk

• Accounting software

• Multi-line phone systems

• Fair Housing regulations

• Retail sales

• Loan processing

• Banking

• Multi-line phone systems

Certifications and Licenses

CNA

AHIMA

Certified Coding Specialist

RHIT



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