Nina McCauley

San Antonio, TX *****

adrkod@r.postjobfree.com

+1-210-***-****

Authorized to work in the US for any employer

Work Experience

reimbursement specialist

Acquisition Billing Services - San Antonio, TX

May 2017 to December 2021

medical billing and collections for neurosurgeons

tracking claims for collection and billing

calling all major insurance companies for collections working with over hundred medical surgeons in facilities throughout Texas writing appeals and letters for each facility that we facilitated for Collections Specialist

Integrity Ancillary Management - San Antonio, TX

August 2015 to February 2017

AR Collection/WC

• Scrubbed, printed and mailed claims for four hospitals

• Worked collections for WC claims for four hospitals and three labatories

• Appealed denied and low payment claims

• Tracked all activity using spreadsheets and Centricity software. Accounting Specialist

Infused Solutions - San Antonio, TX

February 2012 to August 2015

Brooke Army Medical Center Uniform Business Office Medical Clerk II

• Responsible for all VA patient collections and correspondence

• Created Standard Operating Procedures book for collecting and administrating VA claims

• Tracked outstanding account using spreadsheets and CHCS

• Worked with directly with VA Administration on payments due the varies Military facilities nation wide Emergency Room Clerk

Decypher Corp - San Antonio, TX

September 2010 to February 2012

Brooke Army Medical Center Emergency Room Medical Clerk

• Register and Verified beneficiary eligibility for all patients in CHCS

• Organized and presented all patient charts to required personnel

• Entered laboratory and radiology order per physician's request

• Edited all patient charts as deem necessary during emergency visit.

• Contacted all hospital department for private consult with physicians

• Answered telephone for entire department

• Monitor all patients laboratory and radiology developments

• Discharged all patient according to department requirements

• Identify the availability, schedule, cancel, and reschedule appointments following Military Healthcare System (MHS)

San Antonio Military Medical Center Medical Clerk

SpecPro, Inc - San Antonio, TX

February 2008 to October 2009

• Make contact with beneficiaries seeking Primary Care or Specialty Referral Appointments

• Enter appointment information in CHCS using MCP Module

• Verify beneficiary eligibility, update Legacy DEERS information as necessary or refer patient to DEERS

• Register new patients in CHCS

• Identify if beneficiaries have Other Health Insurance (OHI) and follow the necessary procedures

• Enter/update patient demographics as per hospital San Antonio Multi-market and DoD Healthcare policy

• Request assistance from a Referral Management Nurse to clarify consults, assist in determining patient appointment priorities, or obtaining clinic appointments when necessary

• Identify the availability, schedule, cancel, and reschedule appointments following Military Healthcare System (MHS) directives and the MTF business rules using the appropriate Access To Care (ATC) category matched to the appropriate standard appointment types and detail codes within the appropriate ATC standards

• Create, maintain, and update spreadsheet or database tools in order to track specialty and referral appointment requests

• Follow up and retrieve results from network referrals

• Provide results to referring provider within healthcare standards using AHLTA or other directed mechanisms, including Outlook mail, CHCS, or fax notifications

• Electronically distribute consults and referrals to specialty clinics for review or action

• Maintain and update desktop standard operating procedures for day-to-day use in scheduling appointments or contacting supported clinics

• Attend and participate in training activities designed to enhance workflow, standard operating procedures changes, adjust to changing mission requirements, or to address facility or installation issues. Client Services Department Supervisor

Benefits Plus of Texas - San Antonio, TX

October 2004 to November 2007

• Daily data entry for office Adviser Assistant program.

• Contacted potential and current clients.

• Conducted employee meetings with potential and current clients.

• Made customer service calls on a daily bases.

• Completed individual and group applicants for submission to insurance carriers.

• Assist clients in premium payments and claim issues.

• Monthly renewal quotes for groups.

• Completed employee enrollment and terminations.

Insurance Verification Specialist

Pros - San Antonio, TX

August 2004 to October 2004

Customer Services (Temporary Agency-Aetna)

• Responsible for TRS-HRA Account information.

• Answered all incoming calls pertaining to Texas Retirement cards.

• Developed spreadsheet for call that requited further assistants Supervisor of Customer Services

Cuellar & Associates - San Antonio, TX

February 2003 to June 2004

• Responsible for all customer service issues for San Antonio area.

• Responsible for getting past and present claims paid for clients.

• Assist in completion, reviewing & filing of enrollment forms for groups & individual clients.

• Followed up on clients' payments & premium billing issues.

• Commutated closely with insurance company's underwriting, benefits & claims departments.

• Kept track of all clients & insurance groups' information.

• Ran group & individual medical insurance quote.

• Provided CORBA & State Continuation forms & information for former employees. Education

some college

Skills

• Medical Terminology (10+ years)

• Accounting (10+ years)

• Medical Billing (10+ years)

• Insurance (10+ years)

• Collections (10+ years)

• Office Administration (10+ years)

• Business Management (10+ years)

• CPT Coding

• Medical Collection

• ICD Coding

• ICD-10

• Medical Records

• Underwriting

• Insurance Verification

• ICD-9

• Medical Coding

• Transcription

• Medical Office Experience

• Accounts Receivable

• Microsoft Outlook

• Clerical Experience

• HIPAA

• DoD Experience

• 10 Key Data Entry

• Medical Scheduling

• Phone Etiquette

• Quality Assurance

• Auditing

• QuickBooks

• Anatomy Knowledge

• Communication skills

Certifications and Licenses

CPR Certification

Certified Medical Assistant

Medical Coding Certification

CCMA Certification

Additional Information

Professional Administrator with over ten year of work experience including Medical and Customer Services domains. Detailed oriented team player that also works well independently and has a proven record of successfully managing multiple projects simultaneously. Extensive work experience with data entry with 10-Key, versed with ICD-9CM, CPT coding, processing all claims types including inpatient & outpatient claims as well as excellent oral and written communication skills.

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