Appeals Specialist Customer Service
Resume:
Connie Green
**** ****** **.* Houston, Texas ****1 *
***-***- **** * *********@*****.***
Summary
Successful clinical appeals specialist with 20 + years in the healthcare industry.
Excellent communication and problem-solving skills resolving patient billing inquires along with complexity of health care insurance.
Skills
Documentation and reporting
Customer service
Integrity
Dependability
Willingness to learn
Problem-solving
Effective communication
Miro Soft: Word, Excel, Outlook, PowerPoint
Work History
Jan 2020 – Apr 2020 Patient Account Specialist
Christus Health-TLRA/Inficare Technologies
Researched and resolved rejections and underpayments.
Responsible for follow-up on medical billed claims to insurance carriers for medical services rendered.
Managed and collected delinquent payments on patient’s accounts within the required time frames.
Ability to problem solve.
Conduct continuous follow up by phone, payer’s website, or mail on delinquent
patient’s accounts until the account is resolved.
Reported payor issues and top priority patient accounts to company leadership.
Post contractual adjustments.
Research, appeal, and resolve balances on patient accounts.
Feb 2005 – Dec 2018 Clinical Appeals Specialist
HCA- Patient Account Services
•Managed medical denials for over twenty-two hospitals and over twenty-five specific payers.
•Supported, managed, and collected hundreds of accounts, including multiple accounts with A/R over $1 million.
•Assisted in training and deployment of the newly hired.
•Review patient’s medical records and utilize denials and regulatory knowledge and skill as well as knowledge of payer requirements to determine why cases were denied and whether an appeal is required.
•Accept accounts into the denial web tool to determine root cause and denial.
•Conduct continuous follow up by phone, payer’s website, or mail on appealed claims until the account is resolved.
•Collected on 90-day medical accounts or older.
•Identify and resolve problems in a timely manner; gather and analysis information skillfully, work well in-group solving situations.
•Demonstrated knowledge of HIPPA privacy and security regulations by appropriately managing patient information.
•Volunteered with multiple service projects within the company.
•Provided excellent customer service to customers and co-workers.
•Excellent verbal communication and listening skills.
• Prepared convincing appeal arguments that is sound and supported by evidence of the payer’s denial.
Software: Outlook, Artiva, Meditech, Host, Midas, Miro Soft Word, excel, and Health Stream.
Created appeals for claims that have been denied or short-paid.
Education
Houston Community College
Pursuing an associate degree in Interior Design. Relevant course work: History of Interiors, Drafting, Lighting Design, Textiles, Professional Practices, History of Interiors, Art History,
Certificates
Interior Design Decorator
Interior Designer
Interior Design Colorist
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