Renee Mouton

Buckeye, AZ *****

623-***-****

adrptr@r.postjobfree.com

PROFESSIONAL SUMMARY:

Seeking Medical Claims Review and Processing Administrative Medical Clerk Complex Authorization Specialist, and Registered Medical Assistant, Unit Health Coordinator, where I can use my skills in clerical and medical back office knowledge, and experience to provide excellent, compassionate family health care, and customer service. To utilize my clerical skills to the best of my ability, as well as my customer service skills.

PROFESSIONAL EXPERIENCE:

I have 40 Years in the Medical Office and Hospital Health Care Organizations.

25 Years as a Registered Medical Assistant

20 Years as a Unit Health Coordinator in a Hospital Setting

Artesia ABC Adult School (GED) 1978

Compton Community College 1976

The Bryman School

EMPLOYMENT:

2017-Present: Arizona Health Care Cost Containment, DFSM.

2016- 2017: Trizetto Processing medical and Hospital Claims check new claims for various items, and approved to process for payments, Validates the information on all medical claims, or deny claims, Terminology, processing COB, EOB, Verifying Claims information. CPT, HCPCS, ICD-9 and ICD-10. Experience with UB CMS-1450 and CMS 1500 claims. Medicare billing and payment and coverage. Processing claims utilization review QA procedures, CMS payment,Medicare Physician Fee Schedule, Lab, DRG’s, Outpatient Payment System, Ambulatory Surgical Center, ESRD, Ambulance, Anesthesia.

2014-2016: TriWest Health care Alliance Administrative Medical Clerk Complex Authorization Specialist

1998-2014: Maricopa Health Integrated Health Systems Lead R.M.A.

1985-1998: Yuma Regional Medical Center Lead Unit Secretary

1978-1985: Ronald E. Jefferson, M.D. Internal Medicine

JOB DUTIES:

AHCCCS CLAIMS CUSTOMER SERVICE REP MEDICAL CLAIM PROCESSOR

Responds to telephone inquiries and orders from patients and referred sources.

Providers information on equipment, supplies and services. We determines the best

Method for providing services. Verifies insurance and payment types. Compare Claims to the CMS 1500, and the UB04. to make sure all data entry is accurate and correct, and matches whats on the Claim forms, Performs data entry. Distributes paperwork to appropriate departments. Assist with the billing process as needed.

Process Claims in a timely manner, denying claims, processing claims placing outbound to providers to verify information on claims. And resolved providers and patients, complaints when is problems and coordinate appropriate corrective actions.

Processing State Ahcccs claims for Medicare and Medicaid For

FFS work claims adjustments as they pertain to encounters and reconciliation

Determine approval or denial of waivers request, process claims. Answering providers phone calls, verifying all claim information, obtaining medical records for processing claims. Problems solving claims when providers have questions. Reports member insurance benefits not identified a time of claim submission to AHCCCS.

Medical Claims Processing, third party liability and or Coordination of Benefits.

Administrative Medical Clerk Complex Authorizations Specialist

Review and Enters Authorizations and Referrals from VA and Providers.

Communicate with Clinical staff, place outbound phone calls to the Veterans and Providers.

Ensures accurate Data Entry and Completion of Authorization, from Veteran information.

Medical records, referrals Authorization forms, Assist Patient Service Reps (PSR) in obtaining Consults

Reports within turn around times. Medical Processor for Auth Entry Data, SAR Medical Documentation,

Medical Documentation, Medical Documentation Claims, Choice Programs Consults.

Responds to inquires from the Veterans and Providers, regarding the VA program.

Consistently meet Department Productivity and performance.

JOB DUTIES:

Lead R.M.A, Referrals Coordinator

Oversees back office scheduling.

Lead all back office personnel under the direction of the Medical Director/or Management.

Assigns duties and responsibility for back office staff.

Performs ongoing training and development for back office personnel.

Maintains pharmacy inventory system.

Participates with the Center Medical Director in hiring of New Back Office Staff.

Performs, any other tasks and duties as assign.

Prepares patients for exams.

Chart Preps/closing charts in Epic EMR

Vital signs.

Assist Physician’s during examinations.

Maintain Supplies, clean stock rooms with required supplies.

Performs UDS, HIAC POC, URINES POC, PREGNACY URINE TEST, ACCU CHECKS POC.

Performs Front Office Duties, answering multi phone lines.

Patient check in-outs

Dispenses Medications as by Physicians EMR System Epic Hyperspace

Referral Coordinator over all Internal and External though out the MIHS.

Insurances verification /and Approvals.

Certifications:

CPR certified, expires May 02, 2015

American Registry of Medical Assistants March 26, 2014

Registered Phlebotomy Technician, December 07, 1979

Electrocardiograph Technician Certificate Of Merit October 20, 1979

Completion ivpcare The Specialty Pharmacy November 09, 2004

Administrative Skills:

HIPAA Certificate Medical Terminology

Filing Charts

Insurance Billing

Medical Coding

Customer Service

Telephone Reception

PowerPoint, Word, and Excel

Inventory Management

Referrals Coordinator for all of the Comprehensive Health Care

Online Insurance Prior Auths and Verification’s

EMR Running Hyperspace Epic Systems, and ARK Epic Super User

CLINICAL SKILLS:

CPR Certified

Anatomy and Physiology

Phlebotomy

Vital Signs

Performing EKGs

Patient Care

Urinalysis

Surgical Set-Up

Lead Registered Medical Assisistant

EDUCATION:

Diploma in Medical Assisting from Bryman School December 1979

Graduated from ABC Adult High School, July 30th, 1979

EXPERIENCE:

Maricopa Integrated Health Systems (Phoenix, Arizona ), Medical Assistant, Referrals Coordinator ( 2000 -2014 Present)

Texas Neurology Consultants, LLP (Plano, Texas ) Front Office Manager (1990-2000)

Responsible for insurance filing. Took blood samples and recorded vital signs from patients. Assisted in minor surgical procedures. Expedited stocking of supplies.

REFERENCES:

Sam Diltop: Essculations Specialist (480) 480-***-**** Co-Worker

Norma Manskar -Medical Management Supervisor -623-***-****

Heather Roland – Supervisor, Maricopa Internal Medicine – 602-***-****

NP Tracy Demistry – Clinical Resource Leader, Maricopa Internal Medicine 602-***-****

Jenny Neal –Registration Lead – 602-***-****

Contact this candidate