Authorization Representative Medical Billing
Resume:
EBONE' JENKINS
********@*****.***
OBJECTIVE
Medical Industry position offering challenge, responsibility, and an opportunity to utilize my experience to contribute to the timely and accurate insurance billing and collection of a quality practice. Professional Summary:
● Proficient in Epic, IDX, Meditech, Medisoft, AS400, Centricity, Cerner, GECB Benchmark, Microsoft Windows, Word, and Excel software. Billing knowledge using the UB 04 and the HCFA 1500.
● Experienced in CPT and ICD-9 coding, insurance billing and collections.
● Experience with all lines of insurance, HMO, PPO, POS, Medical, Medicare, Commercial, work denials, re-bill claims, medical records, verify authorizations, and coverage, file appeals, review and calculate proper reimbursements for high dollar accounts.
● Call insurance companies for claim status.
● Detail oriented, accurate, problem solver who thinks on her feet. Personal attributes include the ability to work well with people and the capacity to function independently. A loyal employee with excellent insurance billing and collection qualifications who will represent your practice in a professional manner. WORK HISTORY
KForce 2/2022-7/2022
Fulgent Genetics (Contract)
● Coordination of Benefits/ Insurance Verification for correct billing of Covid 19 testing and vaccination claims
● Insurance follow up
● Special Projects
● Reported trends to Management
● Lead for Overseas Team
KForce 5/2019 - 8/2020
St. Francis Medical Center/Seton Medical Center
Claims Contract Specialist (Contract)
● After claim has paid, break down and explain in detail how the claim paid
● Review contract and discrepancies
● If there are any underpayment appeal claims
● Report to management any trends from payors
Premier Healthcare Services 12/2018 - 04/2019
Home Health Agency
Authorization Representative (Contract)
● Requested Authorization via phone and online payer portal for Home Health from CCS, Medi-Cal, HMO and PPO (BlueCross, BlueShield, Cigna, United Healthcare, Aetna, etc.)
● Followed up with Regional Centers to make sure valid information is received that authorizations ran concurrently
● Ran Eligibility and made calls to payers to ensure patients didn’t overrun maximum coverage for the year, confirmed deductibles, and what their copay would be per services
● Worked with the Billing Department to make sure that they are billed for dates of service
● Assisted with Billing Inquires
● Verification of Insurance
● Knowledge of COB
Kelly Services 09/2018 - 10/2018
USC Keck Medical Group CBO, Alhambra, Ca
Patient Account Representative (Short-Term Contract)
● Interfaced information from one system to another
● Verified patient insurance information for eligibility
● Billed out initial claim electronic and via paper
● Mailed claims to insurances with medical reports when necessary Efficient Optimized Billing, Costa Mesa, Ca 01/2018 - 02/2018 Collections Specialist (Short-Term Contract)
● Collections on HMO and PPO Claims for Substance and Mental Abuse
● Appealed claims when necessary
● Followed up calls to insurance companies for timely payment Che Services, Los Angeles, Ca 09/2016 - 07/2017
HMO Authorization Coordinator
● Requested Authorization via phone and payer portals for Outpatient Services
● Followed up on requested Authorization for all HMO payers (BlueCross BlueShield, Aetna, United Healthcare, etc.) and requested Single Case Agreements when necessary for Psychiatry and Psychology
● Ran Eligibility and made calls to payers to ensure patients didn’t overrun maximum coverage for the year, confirmed deductibles, and what their copay would be per services
● Worked denials, medical records, re-billed claims, and verified coverage and authorizations, appeals, reviewed contracts for proper reimbursement, calculated stop loss for high dollar claims Dynamic Clinical Laboratories, Los Angeles, Ca 07/2016 - 09/2016 Denials Management (Short-Term Contract)
● Collections on PPO claims for underpayments and lack of payments, writing appeals while working Denial Convalo Health, Los Angeles, Ca 03/2016 - 07/2016
Reimbursement Specialist (Short-Term Contract)
● Claims Follow up on HMO and PPO claims for Mental and Substance and not limited to working Denials and Appeals
Downey Regional Medical Center, Downey, Ca 03/2013 - 03/2016 Claims Specialist
● Insurance Follow up for HMO, PPO and Managed Care
● Current and past A/R collections, Work Denials and Appealed when necessary update insurance, transferred copays and deductibles
● Worked on outpatient and inpatient claims, vast knowledge in DRGs KForce, Torrance, Ca 09/2012 - 02/2013
Providence Medical Institute
Medical Collections (Short-Term Contract)
● Insurance Follow up on PPO insurance. Worked on Eob’s, Aged A/R
● Called insurance to dispute incorrect payment or lack of payments
● Worked for the PJ building doing insurance follow up for Physician claims from 9/12-10/12 for someone on a LOA
● Worked for the RBO building doing insurance follow up for Hospital claims Progressus Therapy, Culver City, Ca 07/2010 - 01/2011 Community Based Specialist (Contract)
● Office Manager that was responsible for receiving referrals from the regional centers for speech therapy and also assigned them to therapist
● Made sure they had all necessary paperwork and that it was kept current
● Went to the regional centers and attended meetings along with dealing with daily issues. Was responsible for billing speech therapy services, timekeeping, and spreadsheets Cymetrix, Gardena, CA 06/2008 - 07/2010
Medical Collections
● Specialized in Denials, EOB reviewer worked on denied claims for various reasons such as pre-certification, medical necessity, non-covered, coordination of benefits and underpayment and timely filing appeals for all payers
● Used the Meditech System and Benchmark. Followed up on processing of claims and timely payments. Special attention to high dollar claims and workers compensation. Worked on Marina Freeman project and currently working on St. John’s Hospital
Consulting Work, Various locations 03/2006 - 05/2008
● Worked for different companies helping out in back logged A/R for inpatient and outpatient billing
● Knowledgeable in all insurance payers i.e. (Medical, Medicare, Blue Cross, Blue Shield, IPA’s and Medical Groups. Responsible for EOB’s and Appeals
Cedars Sinai, Los Angeles, Ca 03/2003 - 03/2006
Physician Billing Svc
● Specialized in Emergency professional billing Medicare and other billing areas, followed up on denials and appeals when necessary, insurance verification, and special projects along with correspondence while maintaining a quota of 40 accounts per day
Encore Staffing, El Segundo, Ca 03/2002 - 09/2002
Medical Biller (Contract)
● Health Systems Management
● Insurance verification using the Medi-Cal website and also billed claims using the Terms System per quota Dr. Umali, Gardena, Ca 09/2001 - 01/2002
Medical Biller
● Working knowledge of inpatient and outpatient billing for Medi-Cal and Medicare and all other insurance carriers such as HMO’ s, PPO’s, and IPA’s
EDUCATION:
● DeVry University, AS in Health Information Technology - (Graduated)
● Corinthian College/Bryman College
● Graduate of Medical Billing and Terminology with High Honors
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