Medical Billing Data Entry
Resume:
Shavon L Williams
**** * ******* ***. ****** City, MO 64151 816-***-**** aduqgn@r.postjobfree.com
Objective
Experienced, dedicated and detailed oriented Medical Billing/Patient Account Representative, seeking a full time position where there are opportunities of growth. Passionate about the healthcare. Familiar with medical terminology, data management, data entry, conducting billing practices, and electronic health records to minimize insurance claims issues. Utilizing concise and clear writing skills, filing, keyboard skills, ability to handle high volume calls, and excellent administrative skills.
Education
Avila University, Kansas City, MO
Bachelor of Art 2024
Psychology
Experience
Conifer Health Solutions 7624 Warren Pkwy, Frisco, TX 75034
June 2021 - Present
Patient Account Representative
Properly greet and salute each caller accordingly
Reviewing patient records and pathology reports for accuracy
Analyzing and compiling patient information for research purposes
Determining the correct codes for patient records
Interacting with medical professionals and assistants to ensure accuracy
Follow up with the appropriate parties to ensure billing issues are resolved and paid
Analyze explanation of benefit forms to ensure insurance companies have paid for charges
Proven ability to give positive customer service to patients, providers and clients
Follow insurance guidelines, claims submission process and procedures
Verified other health insurance coverage
Generate claims and remittance advice using provider portals
Maintain patient confidentiality and information security
Responded to patient billing directed to suitable departments for further assistance
Demonstrates working knowledge of all appropriate billing forms, UB04, 1500 or state specified forms
Demonstrates working knowledge of the electronic billing system with and understanding of edits and reports
Resolves claim processing issues on a timely basis by reviewing claim inventories and taking appropriate action
Communicates timely and in a professional manner with the Billing Services Manager for any issues or billing delays identified
Research payer denials related to referral, pre-authorization, medical necessity, case management, non-covered
services, and billing resulting in denials and delays in payment.
Initiate appeals with insurers appropriately.
Submit detailed, customized appeals to payers based on review of medical records and in accordance with Medicare,
Medicaid, and third-party guidelines
Initiate Peer to Peer reviews as appropriate and communicate thoroughly and accurately with payers and Peer Review organizations to resolve denials
Coordinate appropriate status determinations using Medicare
guidelines
Identify denial patterns and escalate to management as appropriate with sufficient information for additional follow-up, and/or root cause resolution
Review payor communications, identifying risk for loss reimbursement related to medical policies and prior authorization requirements; escalates potential issues to clinical stakeholders, managed care contracting, and Revenue Cycle leadership as appropriate
Assist with complex, specialized billing and follow-up workflows
Saint Luke’s Medical Group 901 E 104th Street, Kansas City, MO 64131
December 2019 - March 2021
Medical Billing Specialist/Patient Account Specialist
Properly greet and salute each caller accordingly
Reviewing patient records and pathology reports for accuracy
Analyzing and compiling patient information for research purposes
Determining the correct codes for patient records
Interacting with medical professionals and assistants to ensure accuracy
Follow up with the appropriate parties to ensure billing issues are resolved and paid
Analyze explanation of benefit forms to ensure insurance companies have paid for charges
Proven ability to give positive customer service to patients, providers and clients
Follow insurance guidelines, claims submission process and procedures
Verified other health insurance coverage
Generate claims and remittance advice using provider portals
Maintain patient confidentiality and information security
Responded to patient billing directed to suitable departments for further assistance
Demonstrates working knowledge of all appropriate billing forms, UB04, 1500 or state specified forms
Demonstrates working knowledge of the electronic billing system with and understanding of edits and reports
Resolves claim processing issues on a timely basis by reviewing claim inventories and taking appropriate action
Communicates timely and in a professional manner with the Billing Services Manager for any issues or billing delays identified
Research payer denials related to referral, pre-authorization, medical necessity, case management, non-covered
services, and billing resulting in denials and delays in payment.
Initiate appeals with insurers appropriately.
Submit detailed, customized appeals to payers based on review of medical records and in accordance with Medicare,
Medicaid, and third-party guidelines
Initiate Peer to Peer reviews as appropriate and communicate thoroughly and accurately with payers and Peer Review organizations to resolve denials
Coordinate appropriate status determinations using Medicare
guidelines
Identify denial patterns and escalate to management as appropriate with sufficient information for additional follow-up, and/or root cause resolution
Review payor communications, identifying risk for loss reimbursement related to medical policies and prior authorization requirements; escalates potential issues to clinical stakeholders, managed care contracting, and Revenue Cycle leadership as appropriate
Assist with complex, specialized billing and follow-up workflows
Cerner/RevWorks 3315 North Oak Trafficway Kansas City, MO 64116
November 2017 - December 2019
Medical Billing Specialist
Properly greet and salute each caller accordingly
Reviewing patient records and pathology reports for accuracy
Analyzing and compiling patient information for research purposes
Determining the correct codes for patient records
Interacting with medical professionals and assistants to ensure accuracy
Follow up with the appropriate parties to ensure billing issues are resolved and paid
Analyze explanation of benefit forms to ensure insurance companies have paid for charges
Proven ability to give positive customer service to patients, providers and clients
Follow insurance guidelines, claims submission process and procedures
Verified other health insurance coverage
Generate claims and remittance advice using provider portals
Maintain patient confidentiality and information security
Responded to patient billing directed to suitable departments for further assistance
Demonstrates working knowledge of all appropriate billing forms, UB04, 1500 or state specified forms
Demonstrates working knowledge of the electronic billing system with and understanding of edits and reports
Resolves claim processing issues on a timely basis by reviewing claim inventories and taking appropriate action
Completes the SSI daily balancing to completion each day
Communicates timely and in a professional manner with the Billing Services Manager for any issues or billing delays identified
Research payer denials related to referral, pre-authorization, medical necessity, case management, non-covered
services, and billing resulting in denials and delays in payment. Initiate appeals with insurers appropriately.
Submit detailed, customized appeals to payers based on review of medical records and in accordance with Medicare,
Medicaid, and third-party guidelines as well as UW Health policies and procedures
Initiate Peer to Peer reviews as appropriate and communicate thoroughly and accurately with payers and Peer Review
organizations to resolve denials
Serve as a resource for hospital case management departments regarding concurrent denials
Coordinate appropriate status determinations using Medicare
guidelines
Identify denial patterns and escalate to management as appropriate with sufficient information for additional follow-up,
and/or root cause resolution
Make recommendations for additions/revisions/deletions to work queues and claim edits to improve efficiency and reduce
denials.
Review payor communications, identifying risk for loss reimbursement related to medical policies and prior authorization
requirements; escalates potential issues to clinical stakeholders, managed care contracting, and Revenue Cycle
leadership as appropriate
Assist with complex, specialized billing and follow-up workflows
Aerotek/TriWest Healthcare Alliance 7930 NW 110th St. Kansas City, MO 64153
May 2016 – September 2017
Patient Service Representative
Over 2 years’ clerical experience in healthcare setting
Highly skilled in greeting patients and documenting their concerns
Hands-on experience in explaining the benefits of the programs to the patient
In-depth knowledge of using solid judgment when the patient has an urgent complaint
Proven record of verifying all information and existing charts with patients
Able to give accurate and detailed information to patients
Proven ability to give positive customer service to patients, providers and clients
Greet patients in a friendly and respectful manner
Verified other health insurance coverage
Prepared new authorizations, patient charts carefully and accurately
Scheduled and confirmed patient appointments
Responded to patient billing directed to suitable departments for further assistance
Properly salute each caller accordingly
TridentUSA Mobile Clinic Rocky Mount, NC 27738
August 2014 – January 2015
Practice Manager
Verified patient's information by coordinating with nursing staff; recording medical history; confirming purpose of clinical visit
Prepared and scheduled patients for visit by recording current vitals and weight
Recorded patient's history summary
Completed diagnostic and procedure coding
Maintained a safe, secure and healthy work environment by establishing and following standards and procedures; complying with legal regulations
Secures patient's information and maintains patient confidence by completing and safeguarding medical records
Enhance the company's reputation by accepting ownership for accomplishing new and different roles, responsibilities and requests that explore opportunities to add value to job accomplishments.
Villa St Francis Overland Park, KS 66062
January 2009 – February 2015
Certified Nurses Asst/Activities Asst
Personal care functions including: bathing, skin care, toileting, grooming, oral hygiene, and dressing, undressing and feeding
Measured and recorded intake and output, weighed patients, positioned and repositioned and properly transferred patients, demonstrated appropriate knowledge for safe of medical equipment
Helped with keeping the patients' rooms clean and supplied
Answered patient's call light and took appropriate action
Observed and immediately notified nurse of any abnormalities or incidents with patients
Maintained confidentiality in relation to all patients, healthcare staff and documentation
Meet annual inservice requirements in accordance with company policy and state regulations
Maintained and enhanced skills through attending staff development training
Appearance complied with company dress code, and maintained a cooperative manner towards patients/family and all members of the healthcare team.
Overland Park Nursing & Rehab Ctr Overland Park, KS 66212
March 2006 – March 2008
Administrative Asst/Certified Nurses Asst
Responsible for maintaining office filing and recordkeeping systems; enters, edits and retrieves data
Processes forms such as employee time sheets, AP/AR spreadsheets
Maintained confidential files and other related information for department needs, document preparation; spreadsheets and flyers
Answered and routed multiple phone calls
Conveyed information both orally and in writing; answered inquiries from visitors; family, vendors and staff regarding general information, departmental rules, regulations, policies and procedures
Greeted and directed visitors
Prepared and sorted mail, distributed faxes and emails, maintain office inventory and ordered when necessary, and operate standard office equipment.
Awards and Acknowledgments
Awarded employee of the month 2012 Villa St Francis
Awarded employee of the month 2006 Overland Park Nursing and Rehab Center
Professional References
Lashaunda Bynum Private in-home care- Nursing Overland Park, KS Coworker
Paula Johnson Truman Medical Center- Nursing Kansas City, MO Coworker
Charles Williams
Ministry- Community Outreach- Project Planning
Kansas City, MO CEO 816-***-****
Contact this candidate