Medical Billing Data Entry
Resume:
ALEXANDRIA ZEIGLER
Troy, MI *****
Phone: 248-***-****
************@*****.***
SUMMARY:
Over 20 years of experience in Customer Service. >5 years of experience in Medical Billing.
>5 years of experience in healthcare.
Extensive experience in medical billing claims processing, outbound calls to insurance companies, Read and interpret Explanation of Benefits, Identify and correct claims issues, Contact payer for billing discrepancies.
Expert in Handling and resolving customer complaints, Answer questions concerning medical billing, insurance coverage, provider information etc.
Proficient in MS Outlook, MS Word, MS Excel, A & G Appeals Denial Database, CVS Caremark, Alequeus (DMS) and CHAMPS- Ohio Medicaid Processing System, QNXT, Relay Health/Eprimus, Invision, Parallon, Rev Cycle, Citrix, Epic and Ability (DDE)
EDUCATION:
High School Diploma, Marian High School Bloomfield Hills, MI
Davenport University, Grand Rapids, MI online
Health Administration
Completed 28 credits, including 16 credits in administration
EXPERIENCE
Trinity Health – Farmington Hills, MI
Commercial Billing Analyst Jul 2019- Present
Proof reading and updating billing
Submit claims to various insurance payers: Workmen’s Compensation, Auto carriers, HAP, Cigna and other commercial payer
Correct claims rejected by the insurance payer
Verify all patient’s eligibility & insurance coverage
Evaluates accounts, resubmits claims, and performs adjustments, write-offs and/or balance reversals, if charges were improperly billed or if payments were incorrect
Following policy on rebilling/ adjustment requests for late charges
Meeting daily goals
Using various websites
Updating Insurance information
Working rejections
Researching and resolving payment discrepancies
Beaumont Health Southfield, MI
Billing/Follow-up Rep Dec 2017- Jul 2019
Completing primary and secondary claims
Following - up on claim holds
Rebilling /cancelling claims.
Reviewing claims after analyzing readmission reports
Following policy on rebilling/ adjustment requests for late charges
Answering questions and assist patients in regard to billing questions as needed
Meeting daily goals
Using various websites
Calling payer requesting claim status
Updating Insurance information
Working denials/rejections
Researching and resolving payment discrepancies
Posting all adjustments appropriately to maintain accurate account balances for all accounts
Submitting corrected claims, appeals or reconsiderations
R1 (Aerotek) Southfield, MI
Billing Specialist Jul 2017- Dec 2017
Review patient accounts ensuring claims are accurate and billable
Identify and resolve claim edits and understand billing guidelines
Proactively fix claims rejections errors and submit claims based on payer requirements.
Initiate contact and respond to inquiries from various external sources.
Comply with all government and third-party payers regulatory mandated requirements for billing and collections
Answers questions and assist patients in regard to billing question as needed
Processing Medical Resource Group (MRG) accounts – combining Physicians and Hospitals charges.
Ability to read and understand Explanation of Benefits ( EOB) forms
Knowledge of medical terminology
Practical knowledge of patient accounting systems such as Invision, Ability(DDE), Mckesson, Centrix and Star
Quality in Real Time Troy, MI
ADR Medical Reviewer Administrative Assistant Aug 2016-July 2017
Maintain tracking tool to note reviews/appeals for each agency
Log in and review documentation sent by each agency to ensure all paperwork needed to process a review/appeal is received
Log in and maintain tracking of completed appeal documents
Send completed reviews/appeals to agencies/reviewing entity
Maintain tracking of all documents returned to agencies
Review ADRs for chart order and completeness via chart audit tool
Maintain knowledge of types of denials, documents needed for appeals and communicate with the agency if documents are needed so that they can be obtained
Provide denial/appeal examples to agency if requested
Answer questions from customers related to review/appeal process
MedaRx Charlotte, NC Oct 2015-Aug 2016
Hospital Medical Billing Specialist
Medical billing
Claims processing
Make outbound calls to insurance companies
Read and interpret Explanation of Benefits
Review delinquent accounts
Identify and correct claims issues
Determine if claims paid according to contract
Contact payer for billing discrepancies
Universal claims, stop loss, surgery, and anesthesia, high dollar complicated claims, COB and DRG/RCC pricing
Coded referrals with correct ICD-9 and CPT codes of inpatient and outpatient procedures.
Registration/Billing lab fee
Preparing appeals
Westmed (Aerotek) Charlotte, NC Feb 2015-Jun 2015
Customer Service Representative
Centricity EMR
Openscape
Onbase
Rx Refill
Servicing 53 doctors with 11 specialties
Taking messages in a professional manner
Communicate with physicians, providers and patients
Answering high number of inbound calls from patients, medical offices and
Prescreening and scheduling patients for appointments using appropriate insurance guidelines, confirming appointments, triaging calls and taking messages in a professional manner.
Communicate with physicians, providers and patients
Answer questions concerning medical billing, insurance coverage, provider information etc.
Aon Hewitt (Randstad) Charlotte, NC Sept 2014-Jan 2015
Customer Service Representative
Obtain client information by answering telephone calls, interviewing clients, and verifying information
Establishes insurance policies by obtaining client information, determining eligibility, and maintaining database
Maintaining and improving quality results by adhering to standards and guidelines, recommending improved procedures.
Manage employees’ benefits program
Assist in the annual enrollment process for active employees and retirees
Assist in updating indicative data for benefit purposes
Transferring or Referring client to the appropriate channel(s) when necessary
Molina Healthcare of Michigan, Troy, MI Sept 2010- Sep 2014
Inquiry Dispute/Appeals Resolution Coordinator
Conducts all pertinent research to evaluate, respond and close incoming Member Appeals and Hearings accurately, timely and in accordance with all established regulatory guidelines inclusive of appropriate review of claims and prior claim payment history
Attend Administrative Law Judge hearings, testifying as an expert witness; and to assist the Medical Director
Process Special Disenrollment For-Cause Requests
Research, respond, and track all inquiries from outside agencies including the OFIS, MDCH, and FIA.
Customer Service - Medicare and Medicaid Coordinator Processor
Printing, editing and preparing letters mailing to Members and their Primary Care Provider
Problem solver
Taking high volume calls from members and providers a day
Scheduling transportation for members
Claims processing experience
Data entry
Approving authorizations for outpatient surgeries
Entering monthly authorizations into Molina Database
Claims review and Provider Dispute or Member Appeal resolution
Responsible for data entry of patient referrals for surgeries, MRI’s, CT scans, Physical Therapy, and durable
Contact this candidate