Data Entry Patient Representative

Valerie F. Galoia

***** ** ***** **, ****** WA **058 206-***-**** *********@*****.***

Proven record of facilitating support services and managing fast-paced office operations. Strong organizational and communication skills with the ability to concurrently direct multiple business affairs. A multitude of versatile skills transfer into any administrative setting to create and maintain high levels of efficiency, productivity and confidentiality. Advanced understanding of customer needs with diligent attention to detail resulting in superior customer service and high levels of client satisfaction.

Additional Strengths and Competencies

HIPAA Regulations A/R Collections Hospice and Contract Billing Insurance Claims

Medical Receptionist Bankruptcy/Estate Claims Processing Medicare/Medicaid

Medical Coding: ICD-9 Terminology DRG Codes Data entry experience/Ten Key by Touch

Billing Systems and Software: Advanced Epic, WAMED, Onehealthport, Claim Logic, Mckesson, Star, Epremis,, Chartmaxx, Excel, Word, Passport, Endeavour, Availity, MedAsset,Payspan,

PROFFESIONAL OVERVIEW

uwmc/haborview medical center 03/2018-Current

financial counselor

•Interview patients and determine appropriate insurance opportunities

•Complete applications which include Health Care Exchange; Medicaid, Medicaid Expansion and Medicare Part D

•Manage and resolve a high volume of phone inquiries and referrals

•Manage all aspects of the UW Medicine’s Financial Assistance application process

•Appropriately access patient’s needs and potential funding

•Obtain and verify insurance thru various web tools

•Document progress of each case in Epic notes

•Prepare price estimates

•Collect payments

•Demonstrates knowledge and understanding of patient privacy rights

•Maintains confidentiality of all medical, financial, or other sensitive materials in printed, electronic or verbal form

•Accesses and uses the minimum necessary patient identifiable information to perform job responsibilities and duties for authorized purposes only.

•Interpret hospital’s policies, procedures and services to patients, patient representative, inter/intra-hospital departments and community facilities

•Perform work that supports patient financial relations, resolution of billing problems and the financial assessment protocols of UW Medicine

•Perform other related duties as required

Swedish Medical Center, Seattle, WA 07/2010 -12-2017

Patient Financial Services II

Follow up with insurance plans for primary, secondary and tertiary claims by phone and in writing

Answer all information requests from payers and trace all claims to payers ensure claims have been paid or denied appropriately and in a timely manner

Re-submit claims to government agencies, and insurance companies

Submit claim appeals with supporting documentation as necessary and resolve aged insurance balances

Review AR system and EOB’s to resolve incorrect denials or underpayments

Process incoming correspondence, write untimely appeals, send medical records

Maintain patient accounts, billing, collections, billing adjustments, credit, and third-party payments

Ensure a high level of customer service at all times

Requests missing Electronic Remittance Advice (ERA) files daily.

Balances manual and electronic deposits and reconciles payments/batches daily.

Performs the outlined code for posting practices with emphasis on accuracy.

Handles correspondence appropriately.

Answers inbound calls from billing offices, patients

Bills secondary insurances as contracted.

Scans, indexes, and files all back-up information appropriately.

Process insurance OFFSETS/Balancing Batches

Working Credits/Process Refunds if applicable.

Training new temporary and new employees.

ACS, Kent, WA 03/2010 to 07/2011

Patient Financial Services/Advocate Lead

•Collect information, conduct research to solve customer issues

•Informed customers about services available and assesses customer needs

•Schedule work to ensure accurate phone coverage; monitor priority of calls and shifts escalated calls to assure resolution to problems

•Prepare standard reports to track workload, response time and quality of input

•Assist in planning and implementing department goals and makes recommendations to management to improve efficiency and effectiveness

•Assist patients with financial applications, including charity care and establish payment plans to patients that come in daily In need of assistance due to hardships.

•Documents complaints by listening to patient and patient family complaints; documenting details; determining what resolution is sought.

•Maintains patient rights by educating patients; responding to patient and patient family complaints; resolving patient issues; reporting unresolved issues.

•Alerts legal department and administrator by documenting unresolved complaints and potential legal actions.

•Maintains patient and family confidence by keeping complaint information confidential.

•Resolves complaints by listening to patients and their families; directing them to a physician or supervisor; helping them present facts to the hospital representative; developing acceptable resolutions; following-up on outcomes.

Valley Medical Center, Kent, WA

Billing/ Patient Financial Services II 01/2008 to 02/2010

Audited accounts to suggest potential projects and permanent solutions

•Kept strict confidentiality on all patient information

•Edited claims in electronic billing system (E-Premis)

•Answered patient calls with questions or concerns regarding their account

•Worked with hospital IT to have front-end billing issues corrected

•Provided financial counseling in the Emergency Department for uninsured patients

•Collect co-insurance and deductibles

•Served in multiple capacities, including Financial Counselor, Medical Billing Specialist, Insurance Claims Collections Specialist, and Account Transaction Specialist

•Resolved problem accounts for Medicaid, Healthy Options, Labor and Industries, Basic Health Plans, Medicare and Medicare Managed Care plans

•Reviewed income for poverty to offer financial assistance

Responsible for verifying all registrations to ensure that the billing address and payer information have been accurately entered into the ADT system in compliance with HIPAA regulations

Processed all billed insurance claims reviewed all insurance payments, determined if account needs to be turned to self-pay status or if secondary insurance needs to be billed

Rebill or fax bills to insurance companies as needed to expedite payment

Determined insurance eligibility and benefits either on-line for plans who provide the information electronically or by contacting the insurance company’s claims department

Contacted and followed up with the insurance plan or Primary Care Physician Group to obtain authorization for plans requiring authorization for services

Re-submit claims to government agencies, medical service bureaus, and insurance companies

Submit claim appeals with supporting documentation as necessary and resolve aged insurance balances

Quest Diagnostics, Seattle, WA

Billing Coordinator/Temporary 03/2007 to 12/2007

Responsible for problem resolutions, and requisitions that require special handling.

Data entry of billing mnemonics and all required billing information that appears on imaged requisitions.

Worked in all billing queues and maintained high levels of speed, accuracy and customer satisfaction.

Maintained compliance and HIPAA standards.

American Medical Response, Tukwila, WA

Billing and Coding Specialist 01/2001 to 03/2007

Processed insurance claims and expediting billing and payment for insurance accounts.

Match attachments, bill group, and individual insurance claims accurately and in a timely manner.

Reviewed assigned electronic claim submission reports.

Resolved and resubmitted rejected claims.

Followed up and collected on outstanding insurance claims. Researched and resolved accounts as assigned.

Processed daily and other special reports, unlisted invoices, unlisted letters, error logs, stalled reports and aging.

Document bankruptcy claims in Accounts Receivable Billing System and process bankruptcy write offs on appropriate accounts.

File creditor's claims against deceased estates with county courts for reimbursement

Performed outgoing calls to patients and insurance companies to obtain necessary information for accurate billing.

Answered incoming calls from insurance companies requesting additional information and/or checking status of billings.

Inspected work accuracy of junior data entry employees.

Maintained compliance and HIPAA regulations at all times.

london byrd medical center, Faagalu,American Samoa 06/1996-07/1997

Medical Records Specialist

Scan records into the EMR (Electronic Medical Record) following The LBJ Medical scanning protocols. Identify documents that should not be scanned and route them appropriately according to policy.

Create orders or other system entries in the electronic medical record system to provide a repository for some specific scanned items.

Assemble the paper record following HIM procedures and understand the general purpose of each document in the record.

Request records from offsite storage via the internet and over the phone. Communicate clearly to the vendor and follow procedures to ensure timely delivery

Assure the confidentiality of each patient record. Understand and follow LBJ confidentiality standards for protected health information.

File or dispose of scanned documents per policy

Pull and File charts in HIM department.

EDUCATION

Bachelors of Science, Human Services

University of Phoenix

T.T.C.I. Diploma/Salutatorian

Travel/Tourism

High School Diploma

General/Studies

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