Billing Specialist Claims
Resume:
LaFrances Rainbolt
Dallas, Texas 75243
***************@*****.***
OBJECTIVE:
To obtain a position with an organization that will utilize my skill set to benefit mutual growth and success.
EDUCATION:
University of Phoenix Dallas, Texas Bachelor of Science Business Administration, State of Texas State Adjusters License
SOFTWARE:
Health Trust, Availity, TAPS, Health Logic, Master Data Base, Navinet, On base, Next Gen, Navicure Simple LTC, Superior, Amerigroup, United Healthcare, Molina, Cigna, Health Logic
Point Care Click (PCC), Advantx, Zirmed (Waystar), Scan Chart, TMHP, Palmetto GBA, WPS, Cahaba GBA, Quick-Books, AS400, Excel, PowerPoint, Cisco Phone Systems, Microsoft Word, Vision, HTPN Reporting Service, HBOC
SKILLS:
Quality Assurance, Special Projects Skip tracing via Internet. Accurint Collections
Experience, Organizational Skills Oral/ Written Skills, Researching Skills, General Accounting, Multi-Tasking Abilities Multiple Deadlines, Attention to Detail Client Relations, Time Management, Documentation skills, Analytical Skills, Highly Trainable Leadership Abilities, Reconciliation Experience, Problem Solving, Structured Finance
EXPERIENCE:
Mednax pediatrix Medical Group (Collection Administrator II) Richardson, Texas 05/01/2019-5/05/2020
Ensures that claims are processed accurately through review and audit functions to ensure timely payment. Responds to inquiries regarding aging of claims with under payment or non-payment. Responds to inquiries, questions, and concerns from patients Monitors to ensure timely follow-up and payment Ensures follow-up and reimbursement appeals of unpaid and inappropriately paid claims.Maintains individual productivity of 32 accounts and performance standards. Assists in evaluation of reports,Recommends new approaches, policies, and procedures Analyzes common errors to support quality assurance. Ensures corrected claims are sent out and monitored for payment. Appeals follow-up, maintains a working knowledge and understanding of CPT and ICD-10 codes. Communicates collection problems to supervisor and makes recommendations for changes.
Senior Care Center-Billing/Collections Specialist Dallas, Texas 02/18-11/18
Responsible for gathering all of the medical and billing information by reviewing patient information checking for completeness. Ensuring all payments by verifying accuracy of Medicaid coding. Billed Medicaid carriers input the billing information into the database, initiating electronic transmissions. Resolves disputed claims by gathering, verifying and providing additional information, following up on claims. Resolves any and all discrepancies by examining and evaluating data, selecting corrective steps. Adjusted patient bills by reviewing remittance advice, consulting with the Medicaid office. Prepared weekly reports of Medicaid billing by summarizing billings, adjustments, and revenues received.
N-thrive - Credit Operations Specialist Plano, Texas 7/17- 11/17Responsible for analyzing all credit balances before a refund or adjudication is considered and/or processed. Analyzed patient accounts for posting errors before considering refund or adjudication and search pay credit balances Monitor and report to management any trends that have been identified, understands insurance and contractual adjustments detail oriented and the ability to think independently.
United Surgical Partners International- Collections/Billing Specialist Dallas, Texas 10/2016-6/2017
Manage the Medicare and Medicaid claims for 7 facilities. Daily duties include monitoring aging reports to ensure that the claims are sent in a timely manner. Monitor payments for accuracy. Correct and rebill claims via paper or electronically. Request adjustments as needed. Appeal claims Review Medicare/Medicaid remits to identify recoupments. Handle correspondence for the facilities I handle. Answer incoming calls from patients. Communicate with facilities ensuring patient payments taken over the phone are processed and receipts are sent to patients.
Intrepid USA Home Healthcare - Collections/Billing Specialist Dallas, Texas 10/2015-09/2016
Handle all of the Medicaid/Medicare collections and billing for several branches within the organization. Worked online using TMHP website to review client accounts. Appealed claims online as well as on paper. Corrected claims, handle recoupments, refunds and all adjustments. Called Medicaid if there were any discrepancies with the claims. Worked aging reports to make sure claims are appealed before past timely filing. Responsible for million dollar A/R. Responsible for billing claims using Zirmed clearinghouse. Analyze claims before billing to assure ICD9 and ICD10 and all information is correct to avoid any rejections. Ensure that all collection criteria are satisfied in a timely manner in order to forward delinquent accounts to the proper collection avenue. Responsible for providing monthly aging and analysis reports for accounts receivable to the Senior Director as well as the other departments. Prepare and mail the monthly accounts receivable past due billing statements. Handle incoming as well as outgoing phone calls to TMHP. Demonstrated ability to communicate and interact effectively at all levels of the organization.
Epic Health Services - Credit/Accounts Receivables Analyst Dallas, Texas 03/2013-08/2015
Maintaining and updating internal control documentation as is required. Maintain a list of key contacts. Prepare and organize documentation necessary to collect payment. Interface with inside and outside auditors to share information and coordinate periodic reviews. Handled accounting transactions in support of the receivables process, and maintaining account reconciliations. Review weekly aging reports and address accounts 45+ days past due. Follow-up to ensure all actions are completed. Continue to monitor to improve A/R processes. Professionally handled all incoming calls from customers including returning the calls and expediting requests in a timely manner. Consulted with the various team members as well as the Sales and Manufacturing departments. All receivables were handled to meet metrics or exceed the established goals. Identify causes for nonpayment and communicate problems for corrective action to be taken.
Ace Cash Express Regional - Collections Manager Irving, Texas 01/08 - 02/13
Managed a team of 35 center collectors. Handled team evaluations, disciplinary actions, monitoring, side by side evaluations, Handled returned dishonored items Research with potential fraud or misrepresentation at origination. Communicate with potentially fraudulent customers via phone. I processed payments over the phone. Perform fraud prevention activities involving Kite Detection, Deposit Verification, Check Fraud and Identity Theft. Perform daily review of exception and risk reports. Assist in maintaining staff and management with risk recommendations and remedies. Provide and communicate management reports as required. I was responsible for evaluating current processes and policies and recommending improvements. Take action based on transaction characteristics as appropriate and necessary. Maintain thorough and current knowledge of all federal, state, and local regulations as well as internal policies and procedures and credit worthy products and services. Reviewed new accounts for fraud risk indicators and compliance. Assist in managing a Suspicious Activity reporting program. I collected on commercial, payroll or personal checks Perform Negotiated payment arrangements to assure check was paid within a timely manner. Skip traced via the internet, handled incoming and outgoing calls. Handled escalated calls to ensure resolution was met in a timely manner.
References Furnished Upon Requests
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