Payment Poster Reconciliation Specialist

NILEA BOLES

Paramount, CA ***** 562-***-**** ***********@*****.***

Revenue Cycle professional with 13 years of experience in Accounts Receivable, Payment Posting, Reconciliation, Collections and Appeals. Seeking a position in Revenue Recovery. Areas of strength include, analytical skills, researching, problem solving abilities while possessing a mindset of accuracy, attention to detail, and identifying solutions.

Project Management

Account reconciliation expert

Analytical researching

Data Analysis

Training

Internet Explorer

Excel

Microsoft office

Epic Hyperspace

Master Database

NextGen

Collections Management

Contract Manager

All Scripts

Relay Assurance

OCIE (Online computer information exchange)

ARS Supervisor, 08/2015 to 04/2021

NThrive – El Segundo, CA

Trained and developed 37 onshore and global colleagues for accounts receivable safety net projects Managed productivity and quality with focus on organizations best practice guidelines and contract obligations.

• Managed various healthcare function such as: Interpretation of Managed Care, Commercial Contracts, Medi-call and CCS confirmation of correct reimbursement, Insurance Verification, Authorizations, Billing, Account Follow Up

Analyze payer collections, appeals, denials and outstanding claims to expedite resolution of payment issue, improve efficiency and increase revenue

Created and implemented tools for colleagues to align with job duties with performance level resulting in improved communication, productivity and quality standards Prepared and presented weekly project performance reports and cumulative logs Analyze weekly ATB for trends, areas of focus to resolve aging accounts and denials root cause reports Attended weekly operations meeting to review KPI's, project metrics, project updates Developed strong partnerships with external clients to ensure contract obligation were being met Pඋඈൿൾඌඌ ඈඇൺඅ Sඎආආൺඋඒ

S අඅඌ

Wඈඋ H ඌඍඈඋඒ

Completed monthly inventory analyst using excel tools such as pivot table and vlookup Lead Reconciliation Specialist, 03/2012 to 08/2015 Pediatrix Medical Group – Orange, CA

Trained colleagues to ensure accurate and timely posting of correspondences, denials, explanation of benefits, recoupments and offset trends

Balanced daily payment batches

Reconciled payments against daily bank deposits in conjunction with accounting teams daily posting Communicated with insurance carriers and patients regarding chargebacks, insufficient funds and returned checks

Identified and reported payment discrepancies to personnel Analyzed and resolved accounts with overpayments due to coordination of benefits, incorrect contact rates, government regulations and incorrect billing Completed special projects to resolve 100% of insurance recoupments, offsets and takebacks Patient Accounts Specialist, 10/2011 to 03/2012

Pediatrix Medical Group Inc. – Orange, CA

•Maintained the patients accounts including verifying patient demographic information is populated, verified insurance eligibility and ensured all guarantors information was entered correctly.

•Contacted the insurance companies to obtain preauthorization for services.

•Performed root cause denial analysis, prepared and implemented action plans.

•Rebilled claims with additional supporting documentation to obtain higher reimbursement as necessary.

•Researched, appealed, and resolved claims rejections, underpayments, and denials with appropriate payer within payer specified deadlines.

•Prepared write-off requests with appropriate documentation and submitting to the supervisor. Collection Administrator, 05/2011 to 10/2011

Pediatrix Medical Group Inc. – Orange, CA

Bill and re-billed patient accounts to Commercial, Government and Managed Care, Health Plans electronically and hard copy

Responded to inquiries, questions, and concerns from patients regarding status of claims is clear, concise, and courteous manner

Monitored aging of claims to ensure timely follow-up and payment Verified claims were processed accurately through review and audit functions to ensure timely payment Identified, researched, and ensured timely processing of billing errors and corrections as related to claims

Coordinated, monitors, and manage follow-up on unpaid claims Request authorizations to different Health Plans or Medical Groups when not obtained Completed appropriate documentation of billing, follow-up, collection, and appeal efforts are recorded on accounts

Verified all payments were applied to appropriate accounts Updates accounts to correct Insurance Payer once eligibility has been verified for open dates of service Payment Poster, 12/2008 to 05/2011

Talbert Medical Group – Costa Mesa, CA

Accurately posted payments, denials and adjustments from various insurance companies both electronically and manually.

Posted patient payments to patient accounts

Identified and tracked recoupments, offsets and takebacks on spreadsheets Identified and calculated no or low payments by posting correct adjustment reasons Balanced all posted batches and ran daily transaction reports Verified all EFT deposits and scanned checked were posted by month end which increased meeting monthly and quarterly goals by 98%

Properly communicated and documented payment denials in management system and to appropriate billing representative

Claims Clerk, 05/2007 to 12/2008

Talbert Medical Group – Fountain Valley, CA

Reviewed insurance policy to define patients coverage Updated patient and provider demographics

Indexed, sorted and distributed daily incoming correspondence and claims Transmitted claims for payment or further investigation to appropriate claim processors Photocopying, ordering standard office supplies and maintain mailing supplies Organized information by using spreadsheet, database or word processing application High School Diploma: 2003

Paramount High School - Paramount, CA

Eൽඎർൺඍ ඈඇ

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