Document Reviewer Loan Processor

TAWANDA MOFFETT

Dallas, TX ***** 469-***-**** ***********@*****.***

PROFESSIONAL PROFILE

Well-regarded professional with 10+ years of medical billing, reimbursement and appeals experience. Verifies and ensures the accuracy, completeness, and appropriateness of diagnosis codes based on services rendered.

Experience with general medical office programs and medical technologies: Meditech, Microsoft, Excel, AIMS, Jet bar, and Centricity, Athena.

Uses clinical and coding training to abstract, analyzing, evaluate, and identify documentation accurately to approve or deny records for the coding process.

Works effectively with diverse clients and staff.

KEY QUALIFICATIONS

Claims Processing ICD-9-CM HCPCS CPT ICD-10-CM

Electronic Health Records (EHR) Electronic Medical Records (EMR)

Managed Care (HMO, PPO, and POS) Third-Party Payers Worker’s Compensation

Payment Integrity CMS 1500 CMS 1450 (UB-04)

Payment Posting Revenue Cycle Management Scheduling

Insurance Verification Insurance Billing Procedures

Practice Management Medical Office Procedures HIPAA Compliance

Reimbursement Methodologies Fee Schedules Outpatient / Physician Inpatient / Facility

EDUCATION

Ultimate Medical Academy Associate of Science in Medical Billing and Coding, 2018

Ultimate Medical Academy Diploma Medical Billing and Coding, 2015

PROFESSIONAL EXPERIENCE

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Wipro Ltd. Clearwater, FL 02/2022-09/2022

Recon Ops Analyst 1-Enrollment

Responsible for assists with accurately reconciling and resolving financial discrepancies between HPS/CMS data.

Review and research discrepancies in a timely in a timely fashion to meet deadline.

Locate and identify errors and trends while providing actionable next step to management.

Documented procedures, process and workflows in the following platforms, CMS, EDI, Pre-Audit, Service Link, and EMC.

Aids Healthcare Foundation Dallas, TX 08/2021-02/2022 Medical Billing Analyst

Monitors accuracy of billing process. Manages assigned accounts for coding review, unpaid and overpaid claims, and ensuring invoices correspond with balance reports. Analyze coding form proper reimbursement and compliance. Evaluates payments and assisting with operational improvements. Performs research on appeals and grievances. Recommend appropriate resolutions to billing disputes. Collaborate with other departments to improve efficiency. Performs recovery activities on complex claims.

Manages monthly portfolio of $10million in deliverables per month.

Consistent review of high dollar claims for recoveries.

Performs trend analysis that increases effectiveness for biller training.

Wells Fargo remote (contract) Arizona 01/2021- 05/2021

Loan Processor

Project document reviewer for SBA CARES ACT payroll Protection Program sole proprietor loan originations queues. High attention to detail to solve problems quickly and adequately. Worked with customers and SBA to resolve accounts and finalize payments.

Assisted PPP originations team in processing over 260,000 applications with over 83,000 SBA guarantees and loan funding of over $3 Billion.

Partnered with a line of business to identify, mitigate risk exposure associated with a line of business processes, guidelines, policies, and procedures.

Utilize systems BDCMS, ORT, and CPS

Provided support for document controls and worked with contract documents.

Dallas Medical Physician Mesquite, TX 04/2019-2/2020

Billing Coordinator

Oversee several physicians’ insurance claim processing, billing procedures, superbills, and payment posting. Handled billing Medicaid via Health Care Financing Administration (HCFA) Form 1500 or electronically. Appealed claims within the specified guidelines and deadline; followed up and collected payment.

Milon and Associates, LLC Addison, TX 06/2015 – 12/2018

Medical Billing Manager

Managed various revenue generation activities. Oversaw auditing, reimbursement, coding procedures and billing processes from clients. Interviewed, hired, coached and evaluated staff. Worked with the appeal process and administer payroll. Ensure compliance standards are met, credentialing and prepare monthly RCFA reports. Establish and reviewed performance metrics. Handled all client escalations.

Enhanced patient pay platform by implementing outbound call automation.

Developed top performing employees

Midas Laboratory Addison, TX 07/2014 - 04/2015

Medical Collection Specialist

Performed collections efforts on complex healthcare accounts from both patients and providers. Built relationships to help increase consistent revenue. Handled account escalations, appeals and made recommendations to management staff to increase revenue.

Assisted in performing reconsideration appeals on denied Medicare claims which resulted in 1.5% increase in revenue.

Exceeded monthly recovery goals and maintain quality score of 98%.

Guardian EMS Carrollton, TX 07/2011 - 07/2014

Team Leader / Medical Billing Specialist

Provided office management and leadership support for the EMS Medicaid team. Handled billing Medicaid via Health Care Financing Administration (HCFA) Form 1500 or electronically. Reviewed Medicare, Commercial explanation of benefits (EOB) and Medicaid Remittance for denial. Appealed claims within the specified guidelines and deadline; followed up and collected payment.

Assisted in building the Medicaid billing and appeals department.

Collaborated with reimbursement and posting departments to implement new billing processes which resulted in increased on time payments.

Recognized as a top performer within the company.

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