972-***-****

advupe@r.postjobfree.com

SKILLS SUMMARY:

● Experience with Medical Billing, Accounts Receivable, Worker’s Compensations, Leave of Absence Case Management, File Audits and Customer communication.

● Proven ability to aggressively analyze, investigate, calculate, post and manage billing accounts in relation to All Lines of Insurance claims to secure company revenue.

● Experience in processing Short Term Disability and Worker’s Compensation claims which required outreach to providers and claimants and extensive medical review for payment determinations.

● Understanding of primary code classifications: ICD-10, CPT and HCPCS

● Knowledge of unfair debt collection practices and insurance guidelines.

● Strong interpersonal and communication skills as well as the ability to maintain professionalism under pressure.

● Proficient in Microsoft Office products and various medical billing systems including ERA.

● Able to adapt and quickly learn new policies, systems and procedures.

EDUCATION

09/2011-05/2013

COLLIN COUNTY COMMUNITY COLLEGE

CERTIFICATIONS

Texas All-Lines Adjuster License #2394462

Some college credits obtained

EXPERIENCE

12/2019 - 11/2022

CLAIMS CSR - RENFROE ADJUSTER STAFFING (CONTRACT)

• Handled inbound/outbound calls from insured.

• Entered/updated insure’s billing information, demographic and claims information.

• Provided claims status

09/2019 – 12/2019

CLAIMS SPECIALIST - DONOVAN & WATKINS STAFFING (CONTRACT)

• Maintain accounts receivable records to ensure aging is up to date, credits and collections are applied, uncollectible amounts are accounted for, and miscellaneous differences are cleared.

• Collaborating with patients or customers, third party institutions and other team members to resolve billing inconsistencies and errors

• Initiate reports weekly/monthly to maintain accuracy.

• Posted customer payments by recording cash, checks, and credit card transactions.

• Contact Medicare, Medicaid, Commercial carriers for claim status and payment details.

• Prepare and submit claims electronically to the clearinghouse.

• Perform claim corrections and follow up activities to ensure timely reimbursement

11/2017 – 06/2019

A/R SPECIALIST - MEDICAL PRACTICE SOLUTIONS

• Enters information necessary for insurance claims such as patient, insurance ID, diagnosis and treatment codes and modifiers, and provider information. Insured claim information is complete and accurate.

• Follows up with insurance company on unpaid or rejected claims. Resolves issue and re-submits claims.

• Reviews Explanation of Benefits for proper reimbursement.

• Resolves collections by examining customer payment plans, payment history, credit line; coordinating contact with collections department.

• Posting payments to patient’s accounts and processing statements.

• Completes re-bill request as necessary to facilitate timely and proper claims reimbursements.

• Corresponds with Medicare, Medicaid, and Commercial payor for resolution on unpaid accounts.

• Assist in streamlining and improving the accounts receivable process identifying areas of performance improvement

12/2015 – 11/2017

A/R BILLING SPECIALIST - US RENAL CARE

• Reviewed and analyzed opened unresolved claims and took appropriate steps and resources to resolve.

• Communicate via email and phone with customers and insurance companies in regards to billing and collections.

• Aggressively follow up on denied and rejected claims.

• Processed daily reports for patient billing and A/R payment details.

• Reconcile the accounts receivable ledger to ensure that all payments are accounted for and properly posted.

• Monitoring and maintaining assigned accounts

• Submitting and reviewing of authorizations.

01/2015 - 05/2015

A/R SPECIALIST - MMB STRATEGY

• Reviewed Laboratory Claim payment details.

• Collect and manage account reviews

• Prepare and submit claims electronically to insurance companies.

12/2013 – 01/2015

AR REPRESENTATIVE - MEDI-LYNX

• Processed all insurance correspondence and performed research to ensure that claims are paid timely.

• Conducted detailed review of Explanation of Benefit forms.

• Research and respond to all patient inquiries via phone, email and mail

• Updated patient demographic information and initiate account adjustments as needed

• Follow up with insurance companies on appeals to resolve unpaid and denied claims.

• Resubmitting of claims in timely manner for proper reimbursement.

• Complete all assigned projects in a timely manner.

07/2010 – 10/2013

STD/LOA CLAIMS MANAGER - CIGNA

•Managed Short Term Disability and Long Term Disability claims in addition to FMLA/MLOA leaves that run concurrently.

• Performed full scale absence claim management including initiating claims, phone contact to employees and healthcare providers, Investigate and analyze information and documentation received, and made pay determination based on the relevant information.

• Calculate and schedule payments. Update and entered state and Workers Compensation off-sets.

• Performed research regarding payment issues and partner with payroll as needed.

• Accurately determine eligibility for and entitlement to disability benefits and informed claimants by phone regarding determination or additional information needed

• Served as benefits liaison between Account Managers, HR and Vendors.

• Partner with the clinical team on complex or escalated cases.

• Developed plans to address disability obstacles and plans with claimants’ attending physicians, nurses, pharmacist and employers.

• Monitor long term claims and partnered with the Long term disability department regarding claim transition as needed.

• Partner with the Accommodations team regarding rehabilitation plans and on-going medical treatment for employees. Coordinate with vocational rehabilitation counselor utilizing the American Disability Act language.

Only companies/businesses seriously employing should respond.

TANEA CLARK

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