Regina Dianne Shack

PO BOX ****

Chattanooga, TN 37409

706-***-****

OBJECTIVE

It is my objective to pursue a career that allows me to help serve those

Around me and grow in the community.

WORK HISTORY

06/01/2021-Present Mountain Management-Financial Assistance Counselor 423-***-****

Knowledge of accounting, credit, collection laws, current insurance and government financial assistance programs and regulations, as well as clinic financial options, payment alternatives, insurance billing/authorization requirements

Knowledge of federal and state payer requirements (Medicare, DSHS, HMO/PPO Contracts), medical terminology, abbreviations and coding protocols (e.g. / ICD-10),

Ability to explain reimbursement questions regarding health-plan eligibility, benefit issues, co-pay requirements and medical referral requirements, billing processes, hospital and clinic statements and availability of financial assistance, alternative medical financing and assists in completion of applications and/or contracts in order to meet patient needs while assuring maximum reimbursement

Receive and process charity care and/or financial assistance applications, work with health insurance providers to determine coverage and benefit limits

Verify financial information to determine insurance coordination of benefits, pre-certification/prior authorization requirements, estimates of procedures, calculates payments requirement, and informs patient of acceptable payment arrangements on balance, both current and previous

9/10/07-06/21 Erlanger Health System-Financial Advocate 423-***-****

Serve as a liaison to explain hospital charges, financial assistance

Programs and providing various financial assistance forms.

Completing TennCare applications for uninsured patients if they meet the

Financial guidelines. I also complete Newborn Presumptive Eligibility

After every baby on my work que is born to a mother already receiving

TennCare I am able to add newborns to Ga Medicaid after birth.

Responsible for screening self-pay patients at hospital bedside for

Eligibility in various governmental and non-governmental programs.

Responsible for identifying all sources of potential payers including

Auto insurance, workers' compensation, commercial insurance, private

Insurance, TPL, etc. and assisting patients in the process of applying for

Any benefits for which they may be eligible.

Verify insurance information and update patient demographics

Collection of patient financial responsibilities

Prepare collection reports

Work with clinical staff to update patient information in timely manner

Obtain Precertification for outpatient procedure such as MRI, CT, PET scans

And submit clinical. Also performed peer to peer reviews, and on occasion if the

Procedure changes after already approved the CPT may need to be up-coded or

Down-coded

Updating diagnosis and CPT codes

Coordinate patient care with Utilization management

Request face sheets from transferring hospitals.

Push images to PACS

Organizational skills and commitment to teamwork

Submit appeals for denied radiology claims

Work account Maintenance to discuss patient account balances and create

Estimates for upcoming procedures or hospital stays to collect any patient

Responsibility

01/2014-02/201 PM Pediatrics-Front Desk/Billing follow up Part time 423-***-****

Provide excellent customer service to patients

Check in patients

Verify benefits, collect co-pays and patient balances schedule

Follow up on outstanding claims and rebill as necessary

Post insurance payments from EOB as well as patient payments

Scan patient forms and labs

Balance end of day reports

Complete daily deposits

Worked Aging Accounts Receivable to collect Bad Debts

Posted Insurance Payments and downloaded remits from the website as well

As manually entered from the mail.

Billed secondary claims

Filed appeals for denied claims

10/2012-01/2014 Cigna HealthCare-CSA Medical Call Center Choice Fund Analyst 800-***-****

Provide excellent customer service to members and providers

Verify patient eligibility and benefits

Verify in/out of network providers

Check claim status and resolve claim issues

Send adjustable claims back to be reprocessed

Provide excellent customer service to members and providers

Choice fund trained to handle HRA, HSA & FSA account issues and

Access to account balance information

05/2008-9/2012 Med Write, Inc. - Claims processing 423-***-****

Enrolled physicians/practice with ZirMed clearinghouse as needed

Provide excellent customer service patients and providers

Check all charges entered for errors

Batch and submit all claims to insurance or clearinghouse for all accounts

Payment posting and AR follow up

Download remits and reports

Work all errors or forward to designated person for that account

Enter coordination of benefit info to submit secondary claims

Enter daily charges and hospital charges for 2 primary accounts

Answered billing questions from patients (8 accounts we handled)

Coded and entered charges for thoracic surgery group in Kansas

Maintained good working relationship with physicians and PA’s out of state

08/2007-05/2008 Northgate Neurology 423-***-****

Entered daily office charges and hospital charges

Coded and entered Ambulatory EEG’s performed

Check all charges entered for errors

Generate and submit all claims to insurance or clearinghouse

Payment posting and AR follow up

Download remits and reports

Work all errors or forward to designated person for that account

Enter coordination of benefit info to submit secondary claims

Enter daily charges and hospital charges for 2 primary accounts

Answered billing questions from patients

Filed Appeals for insurance denials

11/2002- 08/2007 Chattanooga Neurology & Headache Center 423-***-****

Provide excellent customer service to scheduled patients and referring physicians

Check in patients

Verify patient insurance and demographics

Collect and post office visit co- payments and old balances

Schedule radiology procedures/obtain precertification and authorizations

Triage patients- patient assessment, blood pressure/pulse and temp

Preparation of all medical records request and billing appropriately

Worked the AR and insurance follow up aggressively

4/2000-11/2002 Baptist Health Center - Front desk, billing specialist 205-***-****

Provide excellent customer service to scheduled patients

Worked both check-in/check-out windows

Verify patient insurance and demographics

Worked Aging Accounts Receivable to collect Bad Debts

Enter coordination of benefit info to submit secondary claims

Collect and post office visit co- payments

Entered daily office charges, hospital charges, some ambulatory charges

Prepared deposits and balanced daily

Answered billing questions from patients

Worked AR and insurance follow up aggressively

Filed insurance appeals for denied claims

Triage patients- patient assessment, blood pressure/pulse and temp

EDUCATION

Georgia Northwestern Technical College, AS of Applied Science Degree Business

Management, currently enrolled

Miller- Motte Technical College, Massage Therapy Program-Diploma

Graduate April 2005

Northwest Shoals Community College, Medical Office Administration

Certificate Graduate May 2002

Phillips High School, Bear Creek, AL Graduate 1992

REFERENCES

Allan Commons, Financial Advocate 423-***-****

Dedora Swanson, Payment Posting 423-***-****

Victoria Stamey, Site Coordinator 423-***-****

Contact this candidate