Nina Annette Nyman

***** * ***** **

St Hedwig, TX 78152

Phone: 210-***-****

Email Address: adwtut@r.postjobfree.com

WORK EXPERIENCE:

**/**** ** **/****; 04/2022 to 12/2022. Insurance Collector University Health, 4502 Medical Dr, San Antonio, TX 78229 Contact: Human Resources 210-***-****

• Underpayment research on high dollar claims

• Write off contractual adjustments

• Appeal claims due to underpayments

• Respond to Insurance requests for Itemized Bills or Medical Records

• Verification of eligibility and claim status via Provider portals

• Maintain daily work via ATB report

• Place account write-offs over limit on Managers Log

• Set up packets for Refunds

• Accounts worked: Commercial, Tricare, ChampVA, Managed Care, Medicaid, Transplant Cases, PIP, Non-Contracted to include the “No Surprise Act” for 2022

• Cross-Train new employees; oversee Data Search Collectors and assist with questions

• Programs used: MedAssets, Contract Manager, IDX, OnBase, nThrive, Sunrise, EPIC 12/2021 to 03/2022. RAC Coordinator

University Health, 4502 Medical Dr, San Antonio, TX 78229 Contact: Human Resources 210-***-****

• Review correspondence and determine if account is to applied to RAC audit

• Request Release of Information (ROI) for Medical Record requests and Itemized Bills

• Monitor and maintain spreadsheet to include ROI, records sent, audit reviews for DRG or Medical Necessity reviews

• Provide status to Utilization Management (UM) for possible appeals

• Audit reviews for refund requests

• Notate accounts as to whether there are findings or no findings on the review

• Provide documentation to UM or Coding for appeals

• Reindex correspondence to Collection Department if not part of RAC 04/2015 to 06/2016. Reimbursement Specialist.

The START Center: South Texas Oncology and Hematology, 4348 Medical Dr, San Antonio, TX 78229 Contact: Human Resources 210-***-****

• Work accounts over $10K using Centricity program

• Work weekly denials and set up for appeals

• Work weekly accounts based on aging report

• Submit request for refunds and for adjustments

• Complete requests for Medical Records from payers

• Review payments for possible appeals

03/2012 to 04/2015. Patient Account Specialist II

Cancer Care Centers of South Texas, 100 NE Loop 410, Ste 600, San Antonio, TX 78216 Contact: Jennifer Coward, Human Resources, 210-***-****

• Maintain patient accounts on a daily basis by working aged reports

• Work accounts over $10K

• Work with patients on setting up a payment plan

• Accept patient payments on account balances via credit/debit card or personal check

• Setup accounts for payment monitoring and/or submission to collections

• Submit appeals and second level appeals to insurance carriers, including Medicare and Medicaid

• Verify claims processed correctly through verification of benefits

• Verification through Medicare in whether patient is under Hospice Care or Skilled Nursing; filed claims accordingly

• Submit adjustments to be written off patient accounts; work accounts that are capitated and fee-for-service

• File claims to secondary and tertiary carriers

• Follow-up with patient and Insurance for balances due on the accounts by way of insurance explanation of benefits or remits that have been received through Availity, Fisacure, or TotalView Programs

• Work credits & submit refund requests to accounting

• Provide monthly reports to management on returned statements

• Backup to assist in payment posting.

02/2011 to 03/2012. Billing Specialist

Center for Disease Detection. 11603 Crosswinds Way, Ste 100, San Antonio, TX 78233 Contact: Human Resources 210-***-****

• Open, scan, and verification of Insurance Cards with verification ran through on edit lists

• Upload claims to EMDEON for electronic billing

• Print out CMS-1500 forms and mail paper claim to various insurance companies

• Work incompletes and rejects in EMDEON

• Post electronic remit advices with $0 pays or rebill claims with corrected data

• Post any denials for rebills and or write-offs

• Rebill any claims that have amendments to the correct insurance payer

• Work on Aging Reports.

12/2009 to 2/2011. Collector/Accounts Receivable Specialist The SCOOTER Store. 1650 Independence Dr, New Braunfels, TX 78132 Contractor through Aerotek.

• File claims to Medicaid, Medicare, Medicare Advantage Policies, and other group insurance carriers, as well to secondary insurance

• Appeal claims, status calls for payments, refunds if needed

• Contacts made to multiple insurance payers for payment collections

• Maintain spreadsheet of problem accounts for appeals and make appeals and/or second level appeals as needed

• Resolve the accounts by payments, write-offs, or adjustments

• Review contracts for correct payment

• Answer customer calls in regards to any balance billing received 01/2009 to 08/2017. Area Representative Sunbelt Region (Supplemental Income) International Student Exchange. 119 Cooper St, Babylon, NY 11702 Contact: Larisa Waloski, Regional Director 214-***-**** As an Area Representative for the San Antonio & surrounding area:

• Placement of High School foreign exchange students with Host Families

• Verify school acceptance of student placement

• Supervise student throughout the program by calling once a month and visiting student bi- monthly

• When problems or conflicts arise within the host family & exchange student, a problem identification and problem resolution form are submitted to corporate.

• Maintain monthly progress reports

• Assure all documents required for hosting are filed with student folder for audits by the Department of State

• Setup and provide Organization information for potential host families at local community events.

• Be available for questions by the student and/or family and resolve any issues that might arise

• Encourage students to obtain community service hours

• Attend workshops and additional webinar classes as needed. 02/2005 to 12/2009. Recovery Specialist / Appeals & Billing Benefit Recovery. 1111 N Loop West, Ste 1000, Houston, TX 77008 Contracted at Wilford Hall Medical Center, 2200 Bergquist Dr, Ste 1, Lackland AFB, TX 78236 Contact: Jimmy Rhodes; HR Dept 832-***-****

• Contractor for the United States Air Force located at Lackland AFB

• Review accounts for payment accuracy and any adjustments, write-offs, and or appeals are completed

• Run daily and/or weekly Ad Hoc reports

• Reconcile paid accounts received from various insurance companies, to include Medicare/Medicaid, Workman's Comp, Victims of Crime, Auto carriers

• Appeal claims according to Federal Guidelines

• Answer calls from patients, insurance carriers, and other military sites

• Maintain spreadsheet of problem payers’ to appeal as a massive appeal

• Maintain and report monthly billed and collected accounts to other military treatment facilities

• Bill inpatient accounts & outpatient Civilian Emergencies for several air bases to various insurance carriers; utilizing patient demographics & insurance information; obtain preauthorization and /or pre-certifications

• Verify benefits & billing address

• Complete daily cash voucher reports

• Work correspondence and refunds

• Update database, excel spreadsheet, and various programs (CHCS, AHLTA,TPOCS, ARMS). EDUCATION:

Bachelor’s Degree/ Wayland Baptist University (Health Care Administration) Associates Degree / San Antonio College (Interpretation for the Deaf) RHIT program / St Philip’s College Graduate 1975, East Central High School.

TRAINING:

KASET Training in Customer Service Claims Processing

- 6 week intensive course through Principal Financial Group Stephen Ministry Leadership – 40 hour course

AWARDS:

University Graduate with Honors (3.6 GPA)

2015 Dean's List - 1999/2000 *2005/2008 Scholarship 2000 Employee of the Month – 1994

ADDITIONAL EMPLOYMENT ADDENDUM

Group Administrators (1995 – 2005) Claims Processor / Benefit Analyst Caremark PSD (1993 – 1995) Sr Claims Processor / Team Lead Gallagher Bassett Ins (1992 – 1993) Claims Processor Principal Financial Group (1988 – 1992) Claims Data Analyst / Claims Examiner Zurich American (1985 – 1988) Mail and File Clerk

GPM Life Ins (1982 – 1984) Mail and File Clerk

Contact this candidate