Medical Billing Customer Service

Josephine S Acosta

Bloomfield, CT 860-***-**** **************@*****.***

Data-centric and results-oriented Leader in Accounting & Finance with a focus on Accounts Receivable, medical billing, and Coding with 25+ years of experience in preparing client invoices using a myriad of billing systems. Open client and matter codes for client engagements to ensure new matter setup captures. Support month-end procedures related to billing functions, apply cash receipts to open client invoices, and escalate un-allocated cash receipts. Partner with billing and payer collection teams through coordination of expense reimbursement and payer contracts

Professional Experience

Prospect/ECHN – Manchester/Rockville Hospital/Woodlake at Tolland NH Manchester CT

Claims Denial/Reimbursement Coordinator November 1998 to Present

Coordinate communication with both Care Management and HIM team via correspondence, insurance payers and emails to identify services that do not meet medical necessity, level of care and Suggested DRG reassignment audits

Enter 1000 + identified cases into the Care Management system ACM (All Scripts) for coding review and/or appeal within an eight-month period

Utilize 20 + payer audit systems to check status of request, confirmation of documentation requested or corrected claim for suggested DRG are met and work closely with Senior Audit Representative to ensure payer audit guidelines are met

Independently reviewed and implemented audit procedures per payer product (s)

Utilize in-house vendor records release system to ensure records have been submitted to the auditors and reduced the HMS (Medicaid) denial rate for missing documentation from 95% to zero while reducing automatic overpayment retractions within thirty days to retractions after all level of appeals exhausted and/or review by P2P committee by diligently following cases

Created and implemented procedures for Medicare and Medicaid Exhausted Claims, Medicare Provider Liable claims, lower-level reporting for inpatient services that do not meet medical necessity and facility has agreed to accept observation level, secondary billing, Veterans Affairs, Nursing Home Consolidated billing

Perform Medical billing in full cycle to include primary, secondary, tertiary, consolidated, Part A Benefits Exhausted, rejected, voided corrected claim and demographics for Blue Cross, United Healthcare, Oxford, Cigna, Aetna, Wellcare, Medicare, Medicaid, Nursing Home, Veteran claims and numerous of miscellaneous insurances for all products

Identify trends at claim submission and processed/denied level utilizing payer websites systems, contracts, provider services, to forward findings for implementation to reduce claim denial and decrease the interruption of revenue

Work accounts containing higher degree of complexity via higher degree of investigation, communication and customer service skills utilizing denial management reports and correspondence following through to resolution of reimbursement

Provide support to the Director and Manager by training new associates and externs, assisting co-workers and VA vendor to optimize billing process for ensuring maximum profitability for the facility and helping with workflows

Detail and proficient identifying and resolving refund requests, reconsiderations, appeals, claim rejections and other outstanding balance issues

Core competencies

Performance Optimization, Continuous Process Improvement, Training & Development, Customer Service, Program Management, Project Management, Employee Engagement, Computer & IT Skills, Diversity, Equity, & Inclusion. Completion of Certified Professional Coder (CPC) accredited program with AAPC

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