Medical Billing Payment Poster
Resume:
Rachelle Jean Malicdem
Human Services
Las Vegas, NV 89146
*****************@*****.***
Willing to relocate: Anywhere
Authorized to work in the US for any employer Work Experience
Medicaid Specialist
Marquis Plaza Regency - Las Vegas, NV August 2018 to February 2021
Facilitate the successful approval of an individual’s Medicaid application. Knowledge of the federal, state and county eligibility guidelines for Medicaid long-term care benefits. Detailed attention to project management as well as providing the best possible experience for the client. Resolves financial problems identified by the patient and addresses them in a timely manner. Reviews daily census for all uninsured patients and/or those who have poor insurance coverage to determine intervention needed. Meets with all uninsured patients within 24 hours of admissions by completing a thorough financial assessment to ensure we have screened those patients for county, state and federal programs. Gathers required financial information by phone or by direct interview in a professional manner, demonstration regard for dignity of all patients and family members. Maintains up-to-date knowledge regarding medical insurance’s coverage policies.
Family Services Specialist I
State of NV - Las Vegas, NV April 2018 to June 2018
Assist families in achieving self-sufficiency; determine eligibility for a variety of public assistance and health related programs; and/or provide coordinated employment and training services including assessment, vocational guidance, support services, and education to clients; and/or provide child support enforcement services.
Follow-up Claims Specialist
Efficient Optimized Billing - Costa Mesa, CA July 2017 to April 2018
● Handled all claims for Addiction facility for Los Angeles location
● Posting payments, adjustments, denials and rejections for manual insurance checks by the deadline ● Read and analyze EOBs.
● Research accounts in credit balance status to refund or adjust accounts.
● End of month spreadsheet reports
● Verify that payment amounts and batch totals are correct before posting batches.
● Work Accounts Receivable reports to identify slow processing payers, reasons for denial and opportunities for rebilling or appealing to ensure claim payment.
● Responsible for collections from all insurance companies for assigned facilities.
Medical Payment Poster/Contractor
St Joseph Heritage Healthcare December 2016 to June 2017
Posts payments based on explanation of benefits (EOBs) from insurance companies and government agencies in an accurate and timely manner
● Posts patient payments in an accurate and timely manner to the appropriate line item charge
● Posts adjustments in an accurate and timely manner
● Performs batching and reconciliation work flows
● Researches and resolves "unapplied and/or unidentified" payments to ensure monies are properly distributed
● Processes zero pay EOBs & refers them to appropriate resources for follow-up and resolution ● Performs other duties as assigned by management
Claims Follow Up Specialist/Contractor
MedCore Revenue Services INC August 2016 to December 2016
Posting payments, billing, coding, and insurance verification. ● Claims follow up
● Filing appeals, collections, and account audits.
● Send statements for outstanding balances.
● Answer billing correspondence and telephone calls regarding applicable accounts.
● Knowledge of all insurance types including HMO, PPO, and Private insurance, Medicare, ● Secondaries, Medi-Cal and Cal Optima.
Medical Billing & Collections Specialist
Planned Parenthood of OSBC - Orange, CA April 2013 to August 2016
Posting payments, adjustments, denials and rejections for manual insurance checks, patient
checks and Medicaid electronic remittance to the correct client, patient, line item, by the deadline
● Read and analyze EOBs.
● Research accounts in credit balance status to refund or adjust accounts.
● End of month spreadsheet reports
● Verify that payment amounts and batch totals are correct before posting batches.
● Managed patient payment plans, processed payments & posted to patient's account.
● Work Accounts Receivable reports to identify slow processing payers, reasons for denial and opportunities for rebilling or appealing to ensure claim payment.
● Responsible for collections from all insurance companies for assigned clinics.
● Process Family PACT and Medi-Cal claims.
● Knowledge of all insurance types including HMO, PPO, and Private insurance, Medi-Cal, F Pact,
and various insurances including Cal Optima and Monarch.
Patient Service Admin
Nvision Eye Center 2011 to 2012
Check-in/check-out duties
● Collecting payments
● Updating patient demographics
● Answering front desk calls and appointment preparations
Cross-trained in multiple administrative support duties
Las Vegas Radiology 2009 to 2011
Patient VIP Services 2009-2011
● Recording timely and accurate patient demographics, insurance information, patient charges ● Collections
● Scheduling VIP patient appointments
● Cross-trained in multiple administrative support duties.
Education
Family Studies Counseling Certificate in Family Studies
Cypress College - Cypress, CA
January 2017 to May 2017
Human Services Generalist
Cypress College - Cypress, CA
2012 to 2016
Cimarron Memorial High School - Las Vegas, NV
Associate's degree
Skills
• adjustments (3 years) • Claims (3 years)
• collections (5 years) • credit (5 years)
• payments (6 years)
• ICD-10
• Child & Family Counseling • ICD-9
• Medical Collection
• CPT Coding
• Medical Records
• Tagalog
• Medical Billing
• Accounts Receivable
• Documentation review
• Addiction counseling
• Phone etiquette
• Insurance Verification
• EMR Systems
• Hospital Experience
• Mental Health Counseling
• HIPAA
• Microsoft Office
• Microsoft Excel
• Medical office experience
• Microsoft Word
• Customer service
• Patient monitoring
• Vital signs
• Patient observation
• Behavioral health
• Crisis intervention
• Individual / group counseling • Group therapy
• Google Docs
• Utilization management
Certifications and Licenses
Human Services Generalist
Present
Family Studies Counseling
Present
Driver's License
Additional Information
Key Skills:
● Medical Terminology, ICD-9, ICD-10
● Computer skills including MSWord and Excel
● Typing 80-85 Wpm
● Experienced with several EMR Systems
● Bilingual in Tagalog
● Excellent Phone Skills
● Excellent Interpersonal Skills
● HIPAA Compliance
● Charge Entry & Payment Entry
● Insurance Claim Submission
● Excellent time management and people skills
● Strong knowledge of claims, denials, appeals and collection procedures ● Expert at claims follow up, appeals, collections, and account audits.
● Post charges, payments, and adjustments
Contact this candidate