Medical Billing Contract Coordinator
Resume:
REGINA WATSON
Pembroke Pines, FL 33025
Email ********@*****.***
PROFESSIONAL EXPERIENCE
CVS WFH Plantation, FL - Pharmacy Intake Specialist Tech 2020-current
Responsibilities include but not limited to Process and review prescriptions and claims, read and interprets physician’s medication orders, complete all required documentation receive via fax to ensure all patient and doctors information is matching up with what was receive on the fax, obtaining accurate information for Part D & Part B drug processing completed and summit to either clinical or pharmacy for review, Performs other tasks as assigned.
Performant Financial Corporation-Sunrise, FL Healthcare Billing Recovery Specialist 2020-2020
Responsibilities include but not limited to working with Healthcare (GHP) and/or Non-Group Healthcare(NGHP) Provider delinquent accounts under the CMS Medicare Secondary Payer recovery program Updates client and/or company systems with clear and accurate information working from queue, review account claim and other documentation to verify payment liability for claims that may have been paid by Medicare in error, updated demographic information, notes from contact dialog and attempts, payment commitment, as well as account status updates as applicable.
Benelynk- Sunrise, FL-Case Management Advocate 2019-2020
Responsibilities include but not limited to conducting telephonic outreach services to assist low-income Medicare beneficiaries, conduct screener, inquiries consisting of analyzing and assessment of state Medicaid eligibility criteria into Medicare Savings Programs/Medicaid, Respond to customer questions and complaints and troubleshoot problems with services or products, Meet daily, weekly and monthly production department goals. Meet monthly conversion percentages of total department caseload converting from Potentially Eligible status to In-Progress, In-Progress to Pending and Pending to Approved.
Aetna Pharmacy, Plantation, FL - Accounts Receivable Specialist-201*-******
Responsibilities include but not limited to working closely with Pharmacy Team to ensures that patients receive prescriptions on time, taking incoming calls from patients, Pharmacies, different departments within Pharmacy updating patient's data, phone number, shipping address change of prescription, cancelation of prescription, adding, transfer patients to correct department, working the queue, patient task, to make sure that prescription are being ship.
Macy's Department Store, Plantation, FL- Sales Customer Services- 2013-2017
Responsibilities include but are not limited to demonstrating outstanding customer service skills. Meeting hourly selling and loyalty, inform customer on providing product knowledge. Working as part of a team to meet individual, department and store needs.
Sunshine State Health Plan, Sunrise, FL - Provider Data Contract Coordinator-2011-2013
Responsibilities include received provider contracts and verified information for accuracy. Prepared contract/credential applications for enrollment process, worked CRMs via incoming info from provider for address changed, phone numbers, etc. Updated requested information, created label for mailing. Reviewed practitioners and providers addresses in Portico System ensuring it transferred over to the Amisys system for correction and updates. Maintained and updated provider database, worked with project manager on training new employees on system, Audits and quality, special projects HEDIS outreach.
Pediatrix Medical Group, Sunrise, FL - HSO Customer Services Accounts 2009-2011
Responsibilities included taking incoming calls for Newborn Hearing Screen, returning voice mail calls from clients, insurance agents, etc. Assisted clients with balance inquiries, payment information, process of credit cards payment, setting up payment plans, and creating adjustments. Worked with Medicaid reports, updating accounts as needed, insurance verification and other special projects.
Jackson Health Care, Miami, FL -Patient Information ID Associate 2009-2009
Responsibilities included working hospital front desk, receptionist, customer services, confirming proper ID upon entering the hospital, creating visitor security pass, advising visitors of patient location within the hospital. Working closely with security to ensure proper safety of hospital.
NSU, Davie, FL -Medical Billing Specialist Team Leader/Collector II 2007-2008
Oversaw and assisted in training other medical billing specialists at the external optometry clinic location. Verified and monitored patient accounts, obtained and tracked insurance authorizations, submitted claims, reviewed EOB\rquote s, and post insurance payments for the Davie clinic location. Completed and provided all required reports for the clinic administration, including post patient charges, payments and adjustments into the medical management accounting system. Analyzed and evaluated all vision insurance, reviewed aged accounts for receivables, credit balances, and adjustments, processed refunds, answered incoming calls and responded to inquiries. Traveled to the other Eye Care Institute locations as necessary to provide support and assistance to Chief Operations Officer and Clinic Operations Administrator.
BCBS of Florida, Ft. Lauderdale, FL -Associate IV Provider Coordinator 2006-2007
Ensured accurate and timely administration of Provider registration, contracting, maintenance, and termination processes through preparation and completion of legal business documents such as credential applications, provider contracts, and business letters. This involved coordination with network management and providers on processing future prospects or notification of participation changes, performing in-depth research, and applying appropriate established business rules. Ensured accurate and timely processing of BCBS of Florida Provider number assignment based on the provider's medical license, credentials, and taxonomy. Ensured accurate and timely loading of provider demographic data, contractual arrangements, and payment terms in multiple systems in compliance with policies and supported system interdependencies to transmit information through interface logic. Researched and resolved provider file discrepancies by applying appropriate standard contract and pricing methodologies, analysis, HEDIS Project, and problem solving to facilitate resolution of provider claim payment issues and contractual arrangement issues. Participated in mandatory corporate provider contract and management initiatives, provider data audits and maintenance, and continuous improvement initiatives as subject matter experts and or performs specific assignments related to provider data and contract loads.
United Health Care, Sunrise, FL -Medicare Personal Service Specialist 2005-2006
Answered incoming calls from members and non members on Medicare products. Resolved member issues, which included pharmacy access to care, benefits, claims eligibility and other issues. Updated and educated members on the best use of their plan benefits, and responded in writing to member correspondence. Worked with other plan employees to find solutions, and provided resolution to members and other duties as assigned by management.
EDUCATION:
Detroit Business Institute-Detroit, MI, Business Studies
COMPUTER SKILLS Systems Proficient in MS Office application (Excel and Work) Internet, Reflection Financial, Atrium, Acclaim, IDX Maintenance, Ostar Merck Medco, WHI, MHS, Diamond, PIP, IMS/PFE, On -Line Provider Directory, Client Letter, Siebel & Quest. GPMS, Master Database, Medifax, Express Bill Pay Cerner Power Work, Revenue Mgr, Meditech, Passage Point, Jacks, Facets, e-Billing, express Scripts.
BUSINESS KNOWLEDGE \b0\fs20 Working Knowledge of CPT-4 and ICD-9 (Vol.I, II and III), HCPCS, revenue codes, medical terminology, insurance terminology, and contract terminology. Solid understanding of provider reimbursement, methodologies, including but not limited to: fee for services, per diem, DRG, flat rate, capitation and discounted fees.
Reference upon request
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