Data Entry Collections Specialist
Resume:
*************@*****.***
ANGELA SHANKS
OBJECTIVE
I seek a company that will allow me to utilize my Financial Navigation skills to help build their company by advocating for all their patients while building stronger relationships with all insurance carriers. I will be a tremendous asset to your team through my ability to achieve Single Case Agreements, knowledge of insurance practices on all levels (repricing claims, paying claims, obtaining authorizations and CPT/ ICD10 coding, collections), building trust with patients through my amazing customer service and patient awareness, building a phenomenal mutually respectful relationship with insurance companies and their case managers not to mention my ability and willingness to go above and beyond for what best benefits the team and our patients.
EMPLOYMENT
3/2019 - Present Centene Corp Austin, Tx
Claims Liaison II
Head Claim Liaison for Tennessee market for Ambetter Health plan
Review and assess claims for proper processing for payment per provider contract
Review member responsibility per deductible, coinsurance, out of pocket
Review authorization denials and advise authorization group on how to update/correct authorizations based off of proper billing techniques
Review Single Case Agreements on file for providers and assess if claims were processed per SCA on file.
Review denials per contractual guidelines
Manage daily claims that are pending due to improper billing practices
Review and advise on processed payments and breakdown per member’s plan
Review and monitor que that pulls denied/pended claims due to various reasons of non-payment.
Run and monitor daily report for the entire pend code spectrum and provide reports to each department responsible for claims to have them review and process them.
Supply support to various departments on understanding why claims were denied/pended based off of CMS billing guidelines
Provide guidance to teams on how to advise providers on proper way to bill claims based off of CMS billing guidelines
Daily work in Databases:
oAmisys
oOmni
oMicrostrategy
oGolden6
oConfiguration Tracker
oMHP SCA Database
oCenPas
oTrucare (Authorization) Database
oEmdeon
11/2010 - 2/2019 North Austin Medical Center Austin, Tx
Transplant Financial Coordinator
Manage and facilitate all aspects of the financial department for NAMC Transplant Team (active charts; 454 patients with over 1100 revolving accounts).
Supervise all Insurance financials
Manage all patient charts for financial/ insurance changes.
Increased Transplant volume by $9.2 Million in 8 years by securing Out of Network contracts for patients that typically would have been redirected to a different facility.
Increased Single Case Agreements/ Letter of Agreements by 400% in the past 8 years. ** typically they averaged 2-3 a year prior to me coming on board.
Extensive knowledge of insurance gives me the ability to have a less than 48 hour turn around for verification and authorization for all insurances utilizing different websites and resources to assure that all information is valid and verified to allow the patient to begin our listing process.
100% of obtaining all authorizations from various insurances for evaluations as well as transplants completed in the utmost timely manner to allow for patients to smoothly transition into our care.
Advising every patient that is approved through the committee process on their individual policies and exactly what their out of pocket expenses will be after transplant occurs.
the MOST successful Financial Coordinator the center has had for obtaining Single Case Agreements for the center for insurances that we are not contracted with. (YTD is 85 prior to my arrival they averaged 5-6 a year)
Successfully negotiated 38 Single Case Agreements at the IN Network rate for Out of Network patients for state employees.
Advocate for patients and educated insurance providers and patients that are being referred to other facilities based on contracting and additional expenses that they may incur. Which in turn result in the allowance of them to come to our facility.
Build and maintain a great working relationship with various insurance Case Managers for the quickest resolution for our mutual patients.
Annual updates on over 400 patients to ensure their coverage is valid and up to date
Created a training manual for the role of Financial Coordinator
A/P Biller for the Transplant Center
Manage and facilitate all aspects of an insurance carrier for the transplant department (over 150 claims a month).
Process all HCFA’s submitted by Providers and verify coverage/eligibility for payment.
Verification of CPT and ICD 10 codes are valid and billable.
Build billing report for quick and easy price information for Director.
Re-price all claims based off of Medicare allowables
Issue denials to providers based off of timely filing/incorrect codes/incorrect patient status
Issue check requests to Director for approval
Help all patients will billing questions/concerns when they incorrectly receive billing during the pre-transplant stage.
Maintain and monitor Contract changes every 30 days per chart that I created to provide a quick reference in order to bill and process claims in a much more timely manner.
Implemented a system that for ALL claims indicating when they are received, evaluated, repriced and issued for check request in less than 30 days.
Created a training manual for the role of A/P Biller
PRN North Austin Medical Center/Contractor
6/2018 - 6/2019
Maternal Fetal Medicine
Worked as a contracted employee to help with collections, 180 day A/R at over $789,000 in less than 40 hours this amount was reduced to $12,000 of uncollectable amount.
Parallon
Worked as PRN for Parallon within hospital to help with identifying correct insurance I-Plans to clean up billing errors on the front end. Reduced erroneous billing by 46% by correcting I-Plans in less than 90 days.
I work a flexible schedule due to my work production and ability to do two full time workloads on a part time schedule. I am the only part time financial coordinator within our family of hospitals in 13 different transplant centers and I am the only financial coordinator that does AP Billing and contracting in addition to my other tasks. I am the only financial coordinator since the center opened that is not a full 40 hour a week employee.
09/2008 – 11/2010 Claimcare, Inc Austin, Tx
Data Entry/Insurance Follow Up
Daily Data Entry in GPMS database for seventeen (17) doctors. This includes, but not limited to entering all demographics from superbills, insurance cards and patient information sheets.
Verification of all insurance utilizing different websites to assure that all information matches that, which was received by the office.
If demographics were not received in full, I utilize different websites to try and locate patients, address and phone numbers if unable to locate at that time I add to a report and notate the account that information is still needed.
At last review, my error ratio was less than .001% and I work a flexible schedule due to my work production and ability to do a full time workload on a part time schedule.
I have been pulled from my data entry position to help other departments when needed, billing and follow up, including finding out special information for our CEO.
9/2006 – 7/2007 Pediatrix Austin, Tx
Hospital Assoc
Receive all notices of newborn babies in the regular nursery as well as NICU from the two (2) hospitals and create files for each of them
Verify all insurance and demographic information via parents/insurance carriers via internet databases and call centers.
Enter all demographics for the newborn babies for two (2) separate hospitals for regular newborn and NICU.
Enter all charges for the delivery and or consults for expectant mom
Confirm coverage for babies before releasing claims to insurance for payment
Reconciliation of all babies/moms charges at the end of the day as well as month end to assure that all information matches my records as well as what is in the system at the office and the hospital information and make appropriate changes.
Customer Service to parents when they would need additional help getting babies information and coverage corrected through insurance carriers.
8/2003 – 7/2006 Mission Internal Medical Mission Viejo, CA
Collections Specialist, Special Projects
Supervisor Collector over 10 other collectors/office staff
Lead Collector for Blue Cross and Blue Shield patient accounts for a 50-physician practice
Lead Collector for all HMO insurance plans. Specialized in accounts that were over 150 days old.
Collector for Medicare Secondary Claims Alpha A – H for a 50-physician practice.
Knowledgeable re: CPT & ICD-9 codes, as well as correct modifier usage
90% reimbursement rate for my appeals for denied claims
Maintained follow-up reports to assure claims did in fact get paid.
Reviewed and Interviewed possible new team members
Lead Trainer for newly hired collectors added to staff.
Authored Training Manual for department computer protocol/database and the job descriptions each position entails.
Interviewed possible new employees.
Co-Lead Counselor for FISH Philosophy. November 2004 through April 2005. Mission practices the "FISH philosophy" which is a technique to energize and engage the employees in order to produce better results for all
EDUCATION
12/2018 – Present AAPC Austin, Tx
Currently enrolled with AAPC to obtain my ICD-10 certification. Projected date of completion is 6/2019
10/2003 – 2/2004 Bryman College Anaheim, CA
While enrolled in Bryman's Medical Insurance Billing & Coding course, I maintained a GPA of 4.0, which allowed me to graduate with honors. Some of the course topics were: the Medi-Soft program, all Government Programs, Electronic Data Interchange, Collection Strategies, Medical Insurance and Managed Care. Coding topics were thorough as well, including CPT, ICD-9, HCPCS, Medical Documentation, and Evaluation & Management requirements.
Contact this candidate