Customer Service Patient Access
Resume:
HEATHER CHAVEZ
**** *** *** ***********, ** *****
Work: 913-***-****
Cell: 913-***-****
*******@*****.***
*******.******@**.***
Objective: To obtain a position, where my knowledge and experience in healthcare and cost recovery operations can be fully utilized.
Education:
Hermantown High School Hermantown, MN
Degree Received: High School Diploma May-2011
Skills:
* I have a broad knowledge of laws, rules, regulations, policies, and related directives regarding eligibility for VA Health care and Knowledge of Joint Commission on Accreditation of Healthcare Organizations (JCAHO) as well as Medicare/Centers for Medicare & Medicaid Services (CMS) and/or VHA medical record documentation requirements confidentiality of health information (e.g., Privacy Act, Freedom of Information Act, Health Insurance Portability and Accountability Act (HIPAA); and the release of information from medical records.
*I have an ability to work independently to perform numerous tasks and assignments to completion simultaneously, utilizing problem-solving techniques in the accomplishment of work. This is verified by my weekly billing numbers and efficiency rate.
*I am proficient in Microsoft Office, Excel, Power-point, Outlook, Vista, Huron, Teams, and Nuance (ACM).
* I have advanced knowledge of classification systems, such as current versions of ICD, CPT, SNOMED or HCPCS.
*I have a broad knowledge of healthcare reimbursement, third party insurance policies and requirements, accounting regulations, billing, eligibility, compliance regulations
*I have through the years developed excellent customer service skills
*I control, review and evaluate system error reports from payers, and other sources.
*I collect, analyze, prepare, and track data for preparation of statistical, financial and administrative reports and processing.
*I advise and keep my supervisor and manager informed of all changes regarding the VISN I am working in.
*I maintain a log of error reports, sources, corrective action taken and timelines.
*I develop and presents reports of patterns and trends by carrier, organization or provider.
*I communicate the organizations strategic plan, mission, values, and vision.
*I am knowledgeable in problem-solving methods and techniques that are used day to day working at CPCPAC.
*I ensure that corrective actions are executed within established policies and schedules.
*I process refund reviews, pre-payments, claims matching, rated eligibility, and audit requests from agency entities.
*I monitor claims transmission from CPAC to payers.
* I Identify trends, patterns, deviations, errors and other activity in order to develop remedial actions.
*I work closely with coding to make sure the correct ICD-10, CPT, and HCPCS are assigned and coded for both inpatient and outpatient stays.
*I report on software patch implementations.
*Through the lean six sigma process I have become efficient in researching and analyzing problems. I served as team leader for all lean six sigma projects I have been on. I am currently lean Yellow/Bronze Belt certified and lean Green/Silver Belt certified
*I am Black Belt certified for the CPCPAC.
*I serve as a sponsor/trainer to new employees in our VISN. I have assisted in the training of countless employees since I have been at the CPCPAC.
*I audit, evaluate and review for bills as well as for the performance of new billers.
*I coordinate training for new employees within my VISN.
*I have taken several training sessions that are offered to CPCPAC staff through out the year to obtain and refresh my knowledge of CPCPAC service principles.
Job History:
Central Plains CPAC Leavenworth, Ks
Employed Date: 11/2016-current
F/T: 40Hrs.
Duties:
-Processes refund reviews, pre-payments, claims matching, rated eligibility, and audit requests from agency entities.
-Explains the intricacies of the Medical Care Cost Recovery program to customers and their representatives.
-Reviews First Party debt directly related with the Debt Management Center Program, Treasury Offset Program, and the Cross-Servicing Program prior to payment offsets.
-Sponsor to new employees
-Broad knowledge of healthcare reimbursement, third party insurance policies and requirements, accounting regulations, billing, eligibility, compliance regulations.
-Training new billers in outpatient billing as well as other billers in different areas of billing such as inpatient billing.
- Monitors reports to assure all possible billable cases are processed; and ensures proper sequencing of diagnostic and procedural codes and assigns modifiers as needed.
-Use of a wide range of office software applications such as Microsoft Access, Excel, and Word to prepare complex documents with spreadsheets/tables/graphs.
-Knowledge of a full range of healthcare support function and operations, such as registration, admissions, insurance verification and financial reporting.
-Collects, analyzes, prepares, and tracks data for preparation of statistical, financial and administrative reports and processing.
- Ability to plan and organize diverse work activities with often conflicting deadlines and priorities.
- Ability to communicate effectively verbally and in writing.
Lincare Lenexa, Ks
Employed Date: 06/2016 – 11/2016
F/T: 40Hrs.
Duties:
-Create invoices for Facilities for their O2 supplies and O2 equipment rentals.
-Bill monthly for healthcare services and equipment.
-Work the accounts receivable report.
- Broad knowledge of healthcare reimbursement, third party insurance policies and requirements, accounting regulations, billing, eligibility, compliance regulations.
-Use of a wide range of office software applications such as Microsoft Access, Excel, and Word to prepare complex documents with spreadsheets/tables/graphs.
-Knowledge of a full range of healthcare support function and operations, such as registration, admissions, insurance verification and financial reporting.
-Knowledge of healthcare laws, regulations, policies and related directives regarding eligibility for healthcare, cost recovery and healthcare revenue operations and practices.
-Use of regulations and handbooks governing third party insurance billing, the Freedom of Information Act, the Privacy Act of 1974, HIPAA.
-Use of regulations governing release of information procedures.
-Ensures that all billable cases are identified and that bills are generated.
- Call facilities that have unpaid balances and to discuss payment status on their open invoices.
- Researches and resolves problems and posts payments, adjustments, denial codes, and non-payment collections.
- Monitors reports to assure all possible billable cases are processed; and ensures proper sequencing of diagnostic and procedural codes and assigns modifiers as needed.
- Ability to communicate effectively verbally and in writing.
- Ability to plan and organize diverse work activities with often conflicting deadlines and priorities.
-Utilize a wide variety of revenue, accounting and account management principles required to be able to reconcile accounts, investigate payment discrepancies, make frequent and varied account adjustments.
-Exercise sound judgment in determining the appropriateness of data and information provided on a claim.
-Utilize in-depth knowledge of Medical Care Cost Recovery (MCCR) Act, regulations and handbooks governing third party insurance billing.
ACENTA/Dr. Marsh's Office Fort Smith, AR
Employed Date: 5/2015-02/2016
F/T: 40 Hrs.
Duties:
-Call and confirm patient appointments.
-Responsible for answering and fielding all phone calls, also making them an appointment if needed and answer any questions.
-Responsible for sending out medical records by mailing or faxing to the correct facility that requested them.
-Use of regulations governing release of information procedures.
-Entering and verifying patient’s demographic and insurance information.
-Collect all copay’s and past due balances from patients at time of service.
-Ensures that all billable cases are identified and that bills are generated.
-Validates claims for billing purposes ensuring eligibility and referring questionable coding for review.
- Monitors reports to assure all possible billable cases are processed; and ensures proper sequencing of diagnostic and procedural codes and assigns modifiers as needed.
-Verifies patient insurance coverage for inpatient and outpatient services, entering updated information, and maintaining the database Insurance coverage information is obtained through automated databases, direct patient contact, and contact with insurance companies.
- Broad knowledge of healthcare reimbursement, third party insurance policies and requirements, accounting regulations, billing, eligibility, compliance regulations.
-Use of a wide range of office software applications such as Microsoft Access, Excel, and Word to prepare complex documents with spreadsheets/tables/graphs.
-Knowledge of a full range of healthcare support function and operations, such as registration, admissions, insurance verification and financial reporting.
-Knowledge of healthcare laws, regulations, policies and related directives regarding eligibility for healthcare, cost recovery and healthcare revenue operations and practices.
-Use of regulations and handbooks governing third party insurance billing, the Freedom of Information Act, the Privacy Act of 1974, HIPAA.
-Provide other healthcare team members are informed and are assisted in the daily operations.
Sparks Medical Center Van Buren Van Buren, AR
Patient Access Registrar
Employed Date: 3/2013-5/2015
F/T: 40 Hrs.
Duties:
-Greet patients coming into the ER department.
-Maintain excellent customer service skills, while the correct procedures and guidelines are being upheld within the hospital.
-Provide other healthcare team members are informed and are assisted in the daily operations.
-Obtain the correct the demographic and insurance information from the patient.
-Counsel the patients about their patient responsibility at time of service and collect payment.
-Requested medical records from other facilities if needed as well as sent out records.
-Verifies patient’s insurance coverage for inpatient and outpatient services, entering updated information, and maintaining the database. Insurance coverage information is obtained through automated databases, direct patient contact, and contact with insurance companies.
-Verifies benefits, policy number, pre-certification requirements, insurance company contact Information, and effective dates of coverage.
-Coordinates completion of forms with patients, administrative staff, and providers, and obtains information required for tort cases, workman's compensation, OWCP, and personal injury cases.
-Ability to communicate effectively verbally and in writing.
-Knowledge of a full range of healthcare support function and operations, such as registration, admissions, insurance verification and financial reporting.
-Knowledge of healthcare laws, regulations, policies and related directives regarding eligibility for healthcare, cost recovery and healthcare revenue operations and practices.
-Ability to plan and organize diverse work activities with often conflicting deadlines and priorities.
-Broad knowledge of healthcare reimbursement, third party insurance policies and requirements, accounting regulations, billing, eligibility, compliance regulations.
-Use of regulations and handbooks governing third party insurance billing, the Freedom of Information Act, the Privacy Act of 1974, HIPAA.
-Use of regulations governing release of information procedures.
-Use of a wide range of office software applications such as Microsoft Access, Excel, and Word to prepare complex documents with spreadsheets/tables/graphs.
References
Joann Tollison...House supervisor
Dondru Berry…Former Co-worker
Cynthia Hogue...Patient Access Supervisor
Regina Little
Contact this candidate