Customer Service Data Entry

Simona Windom

adudod@r.postjobfree.com

323-***-****

Objective

Proven history of successful work and financial management expertise in the healthcare industry. Actively seeking a position to leverage problem-solving and communication capacities to enhance customer service and drive organizational success.

ST. Francis Medical Center

Lynwood, CA

Patient Account Specialist

2/8/2021

Duties Summary

Initiate appropriate claim Follow-up for High Dollar/Low Dollar Managed Care, HMO, PPO, Work Comp and Commercial claims

High Dollar Accounts Reduce A/R by collected on $150,000 and higher+ (Stop-loss claims reaches after a certain threshold has exceeded the insurance claim- Med-Assets/Contract System

Lower Dollar Accounts Reduce A/R by collected on $10,000 and under to $50.00 claims

45-50 claims a day

Reduce A/R by meeting collection goals and reviewing the aged accounts

Contacts insurance carriers and patient regarding delinquent accounts

Appeals and follow-up on denied and underpaid claims (Retro-Authorization and DRG's)

Negotiates payments in accordance with company policy/guidelines

Identifies bad debt accounts for write offs to outside collection agencies

Re-bills insurance companies when appropriate

Submit correction requests of any error including misapplied payments and overpayments

Resolving patient billing and collection issues utilizing excellent customer service and people skills.

EOB's to ensure contract reimbursement, fee schedules and negotiated rates were processed timely and accurately manner

Perform special projects and additional duties as assigned by manager

Review and Reconcile Bad Debt Accounts

Initiate Medi-care and Medi-cal follow-up

Review Medi-care and Medi-cal RA's

Concern Health Group

Medical Collector

Front & Back Office

Inglewood, CA

11/2018-3/2020

·Managed both front and back office

·Including billing support (HCFA 1500)

·Initiate appropriate claim follow-up for Managed Care, HMO, PPO,

·and POS claims

·Schedule and coordinate appointments

·Verify Insurance

·Reduce A/R by meeting collection goals

·Contact insurance carriers and patients regarding delinquent accounts

·Review EOB’s and Correspondence

·Assist patient with initial paperwork

·Ensure high quality customer service to patients

·Inform patients of credit card declines and other billing issues

Keck Medicine

Non-Government Collector (Physical Therapy)

Patient Account Management

Alhambra, CA

12/2017-7/2018

·Collect on physical therapy claims (HCFA-1500) and

·Manage patient accounts from the point of discharge through billing edits to

·contract management account net down to final collection of the expected reimbursement

·Initiate appropriate claim follow-ups for out-patient high dollar/low dollar Managed Care,

·HMO, PPO comp and commercial claims

·Reduce A/R by meeting collection goals and reviewing the aged accounts

·Appeal and follow-up on denied and underpaid claims (retro-authorizations)

·Contact insurance carriers and patients regarding delinquent accounts

·Resolving patient billing and collection issues utilizing excellent customer service and people skills

·EOB’s and Correspondence

Frankie’s Tuxedos Inc.

Manager

Inglewood, California

11/2014 - 12/2017

·Demonstrate proficiency and train store staff in all areas of tuxedo operations

·Ensure that all sales, returns and exchanges are recorded electronically

·Information is recorded correctly

·Monitor and react to merchandise needs

·Properly control inventory by reporting stock counts and inventory discrepancies

·Market the store tuxedo rental business needs

·Attend bridal shows and fashion shows to see the newsiest summer and winter inventory

·Market our services for prom and formal dances at local high schools

·Maintain a clean and neat store

ST. Vincent Medical Center

Patient Account Representative

Managed Care, HMO, PPO & Work Comp Commercial Collector

Los Angeles, California

2/2007 - 4/2014

·Initiate appropriate claim Follow-up for High Dollar/Low Dollar Managed Care, HMO, PPO, Work Comp and Commercial claims

·High Dollar Accounts Reduce A/R by collected on $150,000 and higher+ (Stop-loss claims reaches after a certain threshold has exceeded the insurance claim- Med-Assets/Contract System

·Lower Dollar Accounts Reduce A/R by collected on $10,000 and under to $50.00 claims

·45-50 claims a day

·Reduce A/R by meeting collection goals and reviewing the aged accounts

·Contacts insurance carriers and patient regarding delinquent accounts

·Appeals and follow-up on denied and underpaid claims (Retro-Authorization and DRG's)

·Negotiates payments in accordance with company policy/guidelines

·Identifies bad debt accounts for write offs to outside collection agencies

·Re-bills insurance companies when appropriate

·Submit correction requests of any error including misapplied payments and overpayments

·Resolving patient billing and collection issues utilizing excellent customer service and people skills.

·EOB's to ensure contract reimbursement, fee schedules and negotiated rates were processed timely and accurately manner

·Perform special projects and additional duties as assigned by manager

·Review and Reconcile Bad Debt Accounts

·Initiate Medi-care and Medi-cal follow-up

·Review Medi-care and Medi-cal RA's

Centinela Hospital, Brotman Hospital, Coastal Hospital and Daniel Freeman Hospitals

Patient Account Representative

Managed Care and Commercial Care

Centinela Freeman Health system

Culver City, California

11/2002 - 01/2007

·Initiate appropriate claim follow-up for high/low dollar HMO, PPO, Work Comp and Commercial claims

·Reduce A/R by meeting collection goals and reviewing the aged accounts

·Contacts insurance carriers and patient regarding delinquent accounts

·Appeals and follow-up on denied and underpaid claims (Retro-Authorization and DRG's)

·Negotiates payments in accordance to company policy/guidelines

·Identifies bad debt accounts for write offs to outside collection agencies

·Re-bills insurance companies when appropriate

·Submit correction requests of any error including misapplied payments and overpayments

·Resolving patient billing and collection issues utilizing excellent customer service and people skills

·EOB's to ensure contract reimbursement, fee schedules and negotiated rates were processed timely and

·Accurately

·Review and Reconcile Bad Debt Accounts

·Perform special projects and additional duties as assigned by manager

Education:

Business Administration

Morris Brown College

8/1993 - 6/1995

Westchester High School

Los Angeles, CA

Graduation 1993

Systems:

HBO, SMS-In vision, DDE, AS400 and Quick, CT-Vision VI-Web, Premise, Circus, Medicity, IMacs, Passport, IDX, PMOC, EPIC and Med Assets, Word, MS Excel, (Pivot tables, spreadsheets) Ten-key, Accounts Receivable, Data Entry, Emails, Copy and Fax. Knowledge of Dept. Managed Care Safety and Health laws, ICD-9/ICD-10 & CPT codes

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