ALEXANDRIA ZEIGLER

Troy, MI *****

Phone: 248-***-****

adr47m@r.postjobfree.com

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