Referral Specialist Registration

Leslie Moorman

***** ********* **** **

Hendersonville, Tn 37075

***- ***-**** **********@*****.***

PathGroup Labs

Patient Account Representative, Brentwood, Tn (July 2018- current)

Responsible for the review and follow-up of outstanding accounts and adhering to productivity guidelines as established by the Patient Account supervisor.

Contact patients and insurance companies for collection of outstanding claims

Resolve outstanding accounts, following established policy/procedures in resolving, i.e. account write off, placement with collection agency, payment plan scheduling, and appeals with insurance companies etc.

Analyze and review reports to identify reimbursement problems with insurance companies.

Compose letters to insurance companies/patients to resolve reimbursement problems.

Contact insurance companies to resolve contract issues regarding rates of payment.

Review Bad Address reports/returned statements and utilizes resources to locate correct information.

XTEND Healthcare, Hendersonville, Tn

Insurance SpecialistII ( Apri 2017- June2018 )

Possess excellent reading and writing skills.

Strong Computer skills.

Ability to communicate successfully with patients, hospital or Xtend Employees.

Is able to work individually and as part of a team.

Possess ability to concentrate for long periods of time.

Proficient in numeracy skills.

Pays close attention to detail.

Must possess excellent grammar and spelling skills.

Proficient in knowledge and use of email and internet.

Possess above average knowledge of administrative procedures.

Prism system

EPIC

Comdata, Brentwood, Tn

Account Specialist ( Oct-2016- April 2017 )

Processing trucking invoices with Fedex, ODL Freight, UPS, etc

Refunding payments

MEDASSETS, Nashville, TN

Patient Account Representative (February 2016-Oct 2016)

· refunding the payments for commercial and government insurances.

· Apply credits to accounts

· Apply adjustments to any accounts that are needed.

DAVITA INC, Brentwood, TN

Various Roles (Sept 2007-Oct 2015)

Regional Registration Specialist (November 2011 – October 2015)

· Initiate and/or maintain ongoing communication with facilities to ensure timely and accurate receipt of each patient's insurance coverage information

· Enter insurance information into billing system

· Verify patient insurance with payers including eligibility and benefits related to outpatient kidney dialysis

· Update Patient Registration and associated systems accurately and as required

· Coordinate and partner with Patient Referral Coordinators (PRC) to obtain documentation for successful patient registration

· Partner with facility and Insurance Management Team to resolve incomplete registrations

· Review registration denials received to determine root cause

· Resolve patient account errors that cause registration denials

· Help identify process changes to prevent failed registrations

· Determine Coordination of Benefits as required; maintain current patient account information at all times

· Follow-up as necessary to ensure insurance changes are verified and line of coverage is reset

· Submit internal requests, including but not limited to RCUs, SMARTFORMS, PCS Inquiries, SPA Requests, etc., to ensure accurate and timely claims submission to the correct payer

· Complete all ancillary reports and assigned projects within established timeframes

· Support Patient Account Representatives and other ROPS teammates as needed

· Maintain confidentiality of all company and patient information in accordance with HIPAA regulations and DaVita policies

· Other duties and responsibilities as assigned including but not limited to:

· Work overtime with little or no notice as needed

· Attend team meetings, phone conferences, and training as needed

· Know, understand, and follow teammate guidelines, employment policies, and department or company procedures

· Consistent, regular, punctual attendance as scheduled is an essential responsibility of this position

Patient Account Representative (June 2008- November 2011)

· Medical Billing/ Collections, Customer services

· Medicare Billing (Medicare DDE)

· Followed up on claims, work denials, submitted reconsideration of payment for non-payment or short-paid claims.

· Cash posting, EOB's, UBO4's

A/R Clerk (September 2007 – June 2008)

· Coordinate and print claims for PAR’s, distribute the appropriate to BAR PAR’s and mail claims as well.

· Make the necessary adjustments for Triage, Run reports for management

VANDERBILT UNIVERSITY MEDICAL CENTER, Nashville, TN

Various Roles (April 2005-Sept 2007)

Account Reimbursement Specialist (May 2007 – September 2007)

· Coordinate the billing process between Vanderbilt and the Payer. Timely and aggressive billing, collect monies from state and federal agencies, manage care and commercial insurance companies and third party organizations.

· Research and audit accounts to verify charges, coding, and procedures. Interact with the Departments to verify charges and obtain charge correction documentation. Monitor and audit accounts and process adjustments to accounts as necessary.

Registration/Referral Specialist (April 2005 – May 2007)

· Verify patient insurance eligibility with payers.

· Obtain and update patient registration (demographic and insurance) information. Obtain referrals and insurance authorizations/ pre-certifications prior to patient's date of service; accurately document and assign referrals and authorizations in EPIC

Provider enrollment

Physician Credentialing

EDUCATION

AMERICAN INTERCONTINENTAL UNIVERSITY

Bachelor of Arts, 2007

AMERICAN INTERCONTINENTAL UNIVERSITY

Associate of Arts, 2006

NATIONAL COLLEGE OF BUSINESS & TECHNOLOGY

Diploma, 2004

MAPLEWOOD HIGH SCHOOL

Diploma, 1989

ADDITIONAL INFORMATION

Technical Expertise: Microsoft Word, Excel, PowerPoint, Outlook; Medicare DDE, Emdeon, Navinet

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