Medical Billing Customer Service
Resume:
Raynell Clyburn
Ready for work ASAP. Please call me!
Newark, NJ 07106
advpn8@r.postjobfree.com
I am seeking a business office/medical position in a challenging environment with opportunities for growth, longevity and advancement. I am proficient with most current office software including Microsoft Word, Excel, Lotus Notes, AS-400, People Soft, McKesson Systems, Medical Manager and Misys Vision 0ptimum, Care Cloud, EMR Greenway EMR system, Epic, SMS, RASI, Navinet, eclincialworks, ect.
Willing to relocate: Anywhere
Authorized to work in the US for any employer
Work Experience
Medical Biller
Newark Community Health Centers, Inc. - Newark, NJ July 2022 to February 2023
Correcting and resubmitting the claims electronically and Hardcopy. Verified insurance eligibility. Submitting LOA for undocumented citizens. Verify medicare and Medicaid ID and eligibility, appealing the denied claims. Clearing edits for our clearing house. Updating payments of patients and setting up payment arrangements.
Collects payments owed by patients and keep accurate records of patients' account balances. They generate invoices, ensure that patients receive them, follow up on amounts outstanding, and make arrangements with patients regarding overdue accounts. Verifies patients’ insurance coverage, computes patients’ benefits, and compiles itemized bills. All employees of NCHC are responsible to practice good risk management, quality assurance, and deliver excellent internal and external customer service. All employees must understand and exemplify the organization's mission, vision, and core values.
Essential Duties/Responsibilities:
Essential duties/responsibilities include the following as well as other duties that may be assigned:
• Prepares insurance assignment form with data such as names of insurance company and policyholder, policy number, and physician diagnosis
• Contacts insurance company to verify patient coverage and obtain information concerning extent of benefits
• Computes total bill showing amounts to be paid by insurance company and by patient
• Telephones or writes companies with unpaid insurance claims to obtain settlement of claim
• Post payments and denials from Explanation of Benefits (EOBs)
• Provides denials to the assigned biller for resolutions
• Researches and resubmits denied claims
• Reviews entire patient account and resubmit claims or writes off any untimely claims
• Answering phones, responding to patient requests or transferring to the necessary department
• Processing medical bills by sending them to patients and insurance providers as necessary
• Accurate logging of payments received from providers and patients while maintaining current records and balances
• Maintain current records including billing addresses, contacting patients as needed
• Collecting co-payments or other fees upon admittance
• Help patients understand billing and charges for which they are responsible
• Follow up on delinquent payments and resubmit billing as needed Additional Essential Job Functions:
• Full-Time employment requires the ability to work a minimum of 40 hours per week
• Ability to work on weekends (Saturdays or Sundays)
• Ability to work on a rotating shift schedule
• Overtime, and standby status may be required at times to meet operational and patient care needs. Unit Secretary
RWJ University Hospital Somerset - Somerset, NJ
January 2022 to March 2022
I rotate within critical care department and cover all three areas including icu, ccu and intensive care. My work duties include answering heavy phone value and obtain messages for nurses, patients and staff, I update bed availability of any admission and discharges. I order supplies and obtain any needs of all three units, including wristbands from admitting, collection/ delivery of charts from all over the hospital, make deliveries to our hospital lab, updated our epic system of any changes to demographics as needed. Request any and all needs asked of nursing staff, doctors and/or patients families. Basic copying, fax, updated all units broads of current staff throughout shift change and update charge nurse of immediate needs. I keep all units clean and clear do to Covid-19’s needs of disposable grown and masks for both staff and visitors. Lastly I order grievance carts for families at the time of need. St. Clares hospital
Patient Registration - Denville, NJ
June 2021 to September 2021
Registrer patients to be seen for emergency room.
Billing Coordinator
IQVIA - Somerset, NJ
October 2019 to June 2020
Worked in billing department and also customer service for the pharmacy. I had edited Amy and all correction to bill out for discount to medications. I also answer phone calls to assist with helping the customer service department with all questions pertaining to discount coupons. Patient Accounts Representative
NJ Urology Associates of NJ - West Orange, NJ
January 2019 to April 2019
• Obtain payment via credit card payment for any patient and advice patient of any chances occur prior to making payment on account balance.
• Explain to patient there coinsurance and or deductibles if needed.
• Update and verify patient edibility of current insurance.
• Post payment and adjustments and work daily excel spread sheets of report from management.
• Complete any slt reports as needed
Precertification Representative
Radiology Associates of Hackettown
September 2018 to December 2018
• Submit authorization for medical treatment to insurance companies for approval of treatment and/or surgery
• Submit precert online and over phone for over 45-80 patients per day on average.
• Answer any phone calls and forward to correct location with the department.
• Verify insurance benefits online & over the phone Payment Poster
J&S Stark Consulting - Shrewsbury, NJ
November 2017 to January 2018
• Review and enter payments received from patients and insurance companies. Dealt with heavy volumes of Medicaid and Medicare payment and adjustments. Process carry overs, splits and payment reversals.
• Process allowances and adjustments for both sections of our Metro and Neuro departments based on the fee schedule.
• Prepare any zero check and refund request with proven documentation for processing.
• Generate daily reports of daily payment posted and adjustment for that day to insure accuracy.
• Assign any collections accounts to correct department for processing, review or correction if needed. Phad Administrator (Horizon Staffing Agency)
Auto Injury Solutions - Iselin, NJ
April 2017 to August 2017
• Review all IME cases to be assigned to Physicians and submit friendly reminders.
• Submit correction request to nurses once the physician review are completed.
• Assign all Prospective and Retrospective reviews to multiple physicians received from adjustor, nurse case managers and/or management.
• One on one with physicians to be sure each section of the review has been completed. Also, teach new physicians on bored have to navigate thought our computer system to all type phad reviews.
• Daily morning and afternoon internet meeting via skype or over the meetings base on work from home status.
Authorization Rep
Robert wood Johnson Hospital - Somerset, NJ
June 2016 to October 2016
• Submit authorization for medical treatment to insurance companies for approval of treatment and/or surgery.
• Verify insurance benefits online at Navinet and Optimum for New Brunswick Hospital and Hamilton.
• Keep record of daily accounts I have worked.
MVA/WC Authorization Rep
Oasis Medical & Wellness - Glen Rock, NJ
March 2016 to June 2016
• Submit authorization for medical treatment to insurance companies for approval of treatment and/or surgery over 60 patients.
• Advise patients and attorneys of approval, denial and appeals.
• Update excel and spreadsheets daily with current work activities.
• Submit 1st and 2nd levels of appeals.
• Various duties such as copying, scanning, answering heavy phone calls, and faxing. Administrative Assistance Rep
Horizon Staffing - Teaneck, NJ
January 2016 to February 2016
• Prepare folders for candidates to meet recruitment staff.
• Assist with adding candidate's information into the system.
• Various duties such as copying, scanning, answering all phone calls, preparing for office parties, ordering lunch, ETC.
Verification's Representative & Precertification Rep. (Horizon Staffing Agency) Somerset Orthopedic Associates & ASCS - Somerset, NJ October 2013 to January 2016
• Verify insurance benefits online & over the phone prior patient's surgery, • Front desk receptionist for check in and check out.
• Obtain precertification for surgery from various insurance companies.
• Obtain Authorization for MRI, CT, MRA & Arthrograms, Workers comp., MVA. Also advise patient of various locations referred by physicians.
• Provide outstanding customer service to patients with the process of receiving service from any of our following 5 locations.
• Various duties such as copying, scanning, phone calls, faxing and any additional request for management.
Verifications Representative
Surgicare of Fairlawn, Fairlawn, NJ
November 2012 to June 2013
Contract Position through Medix Staffing)
• Verify insurances for in and out of network for the complete Fairlawn Surgical Center.
• Provide outstanding teamwork to other employees who may have needed help on their surgical center.
• Obtain precertification from various insurance companies and very doctor's office prior to patient's surgery.
• Provide outstanding customer service to patient to understanding their deductibles, copays and/or medical benefits.
• Various duties such as copying, scanning, handle heavy phone volume calls in-bound and outgoing, faxing, all office duties ask of me.
Medical Biller
Palisades Medical Center
May 2012 to November 2012
Contract Position through Medix Staffing)
• Follow up on complete Aetna A/R for claims billed for SDS, ER, in-pt and out-pt services such as Maternity and Delivery, SDS, WC, Radiology Services, Observations.
• Maintain a daily average of 60 follow up accounts per day or more with Aetna.
• Allowance and post payments and adjustments of Claims.
• Review and prepare various refund request and follow on mail receive from insurance company.
• Review and advice patients of copays, co insurance and deductibles. Advise of various payment options.
• Review and appeal any denials on claims denied, or invalid coding issues or charges toward hospital contracts and/or 2ndry billing of all Aetna insurance claims. Insure payments received by contracted rate or DRG rate of PPO/HMO, Medicare, commercial insurances for in and out of network provider.
• Submit and follow up on COB letter or any insurance contract with insurance representative and patients to insure complete timely billing.
• Scanning of all letters and document received or out going on A/R.
• Various office duties such faxing claims, and completion of various reports from management, review and correct edit codes, ETC.
Medical Billing Rep
Med Assets Revenue Cycle - Mahwah, NJ
July 2011 to March 2012
Contract Position through Medix Staffing)
* Follow up on claims for Various Hospitals outside the State of New Jersey (Cullman Regional Medical Center).
* Maintain a daily average of 30-40 claims follow up on claims billed to Blue Cross Blue Shield of Alabama.
* Electronic claims submissions and Hardcopy submissions claims to various Commercial Insurance Companies, including corrected claims.
* Clear all edit codes for medical billing AR for Medicare, BCBS, and Commercials claims on daily basic and complete import & export of claims.
* Completed various report projects for Director, Manager & Supervisor for month end and audits. Medical Billing Rep
Urology Group of NJ - West Orange, NJ
January 2011 to June 2011
Contract Position through Medix Staffing)
* Responsible for handle customer service calls for the billing department
* Follow up on claims of various Insurances, follow up for Medicare Claims & responsible for submissions of 2ndry claims (hardcopy & electronic submissions)
* Performed Batching of Encounters & payment posting
* Responsible for handling self pay accounts, set up payment plans & settlement of high balance self pay accounts & handle all hardship applications (Approved & Deny Applications) Education
Some college experience, degree goals in progress! in Nursing/Social Science Social Science
Essex County College - Newark, NJ
1996 to 2018
High school diploma or GED
Skills
• Medical billing
• Medical collection
• Pain management
• EMR Systems
• Medical Records
• Medical Office Experience
• McKesson
• Hospital Experience
• Insurance Verification
• PeopleSoft
• Workers' Compensation
• Recruiting
• Critical Care Experience
• ICD-10
• Patient Care
• Employee Orientation
• Customer service
• Microsoft Excel
• Sanitation
• 10 key calculator
• Microsoft Office
• ICD-9
• CPT coding
• Contracts
• Typing
• Analysis skills
• Documentation review
• Epic
• Medical coding
• Anatomy knowledge
• Triage
• Medical terminology
• ICU experience
• ICD coding
• Phone etiquette
Certifications and Licenses
Medical Billing Certification
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