KRISTAN M. ALTIER

**** **** **. ***. ***.

Parma, Ohio 44129

adxmk1@r.postjobfree.com

740-***-****

EMPLOYMENT EXPERIENCE

In my position at OSU Internal Medicine I work daily with patients, physicians, managers, staff, insurance companies, billing, coding and drug companies to ensure patients claims are paid promptly. May 2017 – Current OSU INTERNAL MEDICINE LLC

• Work daily in Epic updating patient demographics and insurance information, filing claims and transferring to various departments.

• Work daily with office staff, prior authorizations, utilization management and pharmacy staff for multiple infusion location to obtain proper documentation to work denied claims to obtain payment

• Review patient claims to determine correct CPT codes, diagnosis codes, authorizations, certification, signatures, and other information necessary to resolve issues with claims have been applied correctly in order to secure payment from the insurance company or patient.

• Request new and retro authorizations when able in order to ensure claims are processed and paid.

• Verify and correct patient information in registration by utilizing IHIS to review patient insurance cards and drivers’ license for current and correct information.

• Prepare appeals and write letters of medical necessity, request for reconsideration and reopening’s of infusion claims as required by the insurance company to ensure payment is received.

• Verify balances on patient invoices by reconciling payments, adjustments and denials before forwarding claim to the next payer.

• Verify patient insurance eligibility by utilizing RTE through IHIS, multiple insurance websites, telephone voice response and direct call contact with representatives.

• Perform insurance follow up, collections and denial processing daily.

• Identify denial trends involving physician issues and CPT and modifier issues and report to management

• Maintain spreadsheet for drug co-pay programs for the purpose of billing requirements, fax numbers and addresses as well as individual program details. May 2015 – Current OSU INTERNAL MEDICINE LLC

In my this position at OSU Internal Medicine I worked daily with patients, physicians, managers, staff insurance companies, billing, coding and drug companies to ensure patients are covered and authorized to receive infusion.

• Verify patient benefits and eligibility utilizing websites and direct calls to companies then convey information regarding benefits to patients.

• Responsible for identifying patients needing continuation authorizations or urgent new requests for treatment and assigning to staff as well as following up to ensure work completed timely.

• Responsible for filing and following up on authorizations for government and commercial payers via the Authorization and Referral work lists in IHIS Carepoint East Infusion

• Work with patient and physicians to qualify patients for drug co-pay assistance programs and free drug programs when doctor referral contains off label diagnosis or patient does not have the ability to pay

• Responsible for verifying ICD 10 codes on referrals and Therapy plans fall within payer policies to ensure coverage of claims prior to filing authorizations

• Work with physician when authorization request results in a denials by notifying of physician of peer to peer review options when available or filing appeals to insurance companies

• Work directly with billing and coding managers and staff to resolve all denied claims with authorization, coding, or provider issues to ensure we obtain full reimbursement

• Work directly with the pharmacist to ensure correct coding has been applied to Therapy Plans

• Verify patient have obtained all necessary lab work required prior to scheduling, notify patients when labs are needed, take steps necessary to have labs entered into system or sent to outside lab per patient request

• Locate and maintain major payer medical necessity guidelines and update in OneNote system

• File drug co-pay patient assistant applications to drug companies and follow up until approved or denied

• File EOB’s to drug companies on behalf of patients to obtain payment from drug co-pay programs

• Run drug co-pay credit cards and post payments to patient accounts

• Work daily in IHIS utilizing Referral and Follow up work lists, Registration, AR functions, Payment Posting, Scheduling

• Answer incoming calls from patient, physicians, other departments and outside facility and determine need and handle call in the appropriate manner

• Schedule patients via telephone and face to face

• Currently a Super User with IHIS

September 2012 – May 2015 OSU INTERNAL MEDICINE @ Ackerman Rd. May 2012 – September 2012 NESCO @ OSU INTERNAL MEDICINE Worthington, OH 614-***-**** I began working with OSU Internal Medicine through NESCO temporary agency and was hired fulltime in AR Follow up. As an AR Follow up representative I was responsible for resolving claim errors and insurance rejections then resubmitting claims to secure payment for OSU Internal Medicine.

• Worked daily in IHIS updating patient demographics and insurance information, filing claims and transferring to various departments.

• Work daily with office staff at CarePoint East Infusion Clinic providing documentation for drug co- pay programs.

• Update office drug co-pay spreadsheet for the purpose of documenting information sent to the drug co-pay programs.

• Review patient claims to determine correct CPT codes, diagnosis codes, authorizations, certification, signatures, and other information necessary to resolve issues with claims have been applied correctly in order to secure payment from the insurance company or patient.

• Request new and retro authorizations when able in order to ensure claims are processed and paid.

• Verify and correct patient information in registration by utilizing IHIS to review patient insurance cards and drivers’ license for current and correct information.

• Prepare appeals and write letters of medical necessity, request for reconsideration and reopening’s of infusion claims as required by the insurance company to ensure payment is received.

• Verify balances on patient invoices by reconciling payments, adjustments and denials before forwarding claim to the next payer.

• Verify patient insurance eligibility by utilizing RTE through IHIS, multiple insurance websites, telephone voice response and direct call contact with representatives.

• Perform insurance follow up, collections and denial processing daily.

• Work with a various departments forwarding information obtained through follow up and rejection activities to assist them in providing requested information to insurance companies.

• Identify denial trends involving physician issues and CPT and modifier issues and report to management

Oct. 2009 – April 2012 RESOLUTIONS BILLING Queen Creek, AZ 480-***-**** PAYMENT POSTING SPECIALIST DEPARTMENT LEAD

As Posting Lead it was my responsibility to ensure the Posting Department reached their daily goals and monthly goals. In addition I was responsible for carrying out the directives of the Executive Team by implementing policies and procedures in the Posting Department.

• Analyzed daily the status of monies to be posted within the contracted time agreements of 15 different medical practices and implemented a plan to ensure work was accomplished.

• Communicated with providers, insurance companies, fellow employees and management on a daily basis via telephone and written communication.

• Received directives from management and developed a plan of action for the posting department.

• Assisted team members with reconciling patient accounts.

• Developed reports and spreadsheets for monthly balancing purposes with providers.

• In addition to Posting Lead I was responsible for posting $250,000.00 a month in insurance payments for my assigned providers.

• Read and interrupted insurance explanations of benefits to determine how to process claims.

• Posted payments using Advanced MD, Kareo, Lytech and GE Centricity software.

• Knowledge of ICD 9, CPT, HCPCS.

• Provided training to new posting clerks.

• Provided quality customer service to the patients of 15 medical practices. 2006 – 2009 FAIRFIELD CHRISTIAN ACADEMY Lancaster, OH 740-***-**** ADMINISTRATIVE ASSISTANT

As the Administrative Assistant my responsibilities included fulfilling the needs of the Middle / High School Office as directed by the Principal, while meeting the needs of 40 teachers, and communicating to the families of 285 students on a regular basis.

• Preparing all correspondence to parents, students, coworkers, and outside agencies.

• Maintaining student permanent files; hard copy and via web based software program.

• Compile and maintain all attendance records in accordance with state regulations.

• Compile student grades, prepare, and print student report cards and transcripts.

• Work with STI software programmers on a regular basis to provide information that assists the company with making programming changes.

• Prepare and maintain school newsletters, prepare presentation for school assemblies. 2003 - 2006 HOCKING COUNTY JOB & FAMILY Logan, OH 740-***-**** ELIGIBILITY REFERRAL SPECIALIST

In the position of Eligibility Referral Specialist it was my responsibility to interview and determine the eligibility of the customer to receive assistance through state and federal insurance, food and cash programs.

• Conducted face to face interviews with new and re-applying customers to determine eligibility for Medicaid, Food Stamps, and Cash Assistance.

• Requested and compiled client medical information from physicians and hospitals.

• Communicated eligibility to physicians and hospitals on behalf of the customer.

• Maintain case files for over 400 customers in accordance with state regulations.

• Investigated client program abuse and scheduled hearings according to agency guidelines.

• Identified client needs for social services and made referrals to outside agencies.

• Attended training classes to remain current on federal and state changes. 1997 - 2003 HOCKING VALLEY COMMUNITY HOSPITAL Logan, OH 740-***-**** COLLECTIONS CLERK

As the Collections Clerk my responsibilities were to determine the needs of the customer while ensuring the hospital received payment for the services provided.

• Ran reports of unpaid bills and contacted patients to setup contracts for payments, reviewed contracts monthly to verify payment status and contacted customers in arrears via telephone and letters to obtain payment

• Determined what claims went to outside agencies after all in house efforts had been exhausted.

• Worked with insurance companies to verify customer eligibility and benefits and billed for payment.

MEDICAID INSURANCE BILLER

In the position of Medicaid Insurance Biller I was responsible for verifying correctness of claims before billing insurance companies, verifying customer coverage, and working denied claims for rebilling.

• Billed Medicaid primary and secondary, billed all secondary insurance to Medicare, corrected rejected bills and re-billed.

• Determined customer eligibility for the hospital indigent program.

• Worked secondary (to Medicare) EOB’s for denied claims, determined the issues and re-billed for payment to insurance.

• Attended continued education classes in insurance field to remain updated on changes. SKILLS AND ACTIVITIES

MEDICAL BILLING SOFTWARE: IHIS, IDX, GE Centricity, Advanced MD, Kareo, Lytech & HDS. IHIS Super User

OSU Training Program in Clinical environment 2015 and ongoing OSU Training Program in AR Follow up and Rejections since May 7, 2012 MEDICAL TRAINING as a Nursing Assistant through Fairfield Medical Center completed in 1990 – learned to obtain blood pressures, temperatures, pulse and respirations and charting SOFTWARE PROGRAMS: Thorough knowledge of Word, Excel, Publisher, PowerPoint, STI School Software, CRISE state program and the InfoNow web based school program. OFFICE EQUIPMENT: Multi-functional copier, printer, fax machine, laminator, multi-function calculator. EDUCATION

University of Phoenix, Phoenix Arizona

Completed 1 year toward Associates Degree, Business Administration RELEVANT COURSE WORK

Contemporary Business Communication

Effective Essay Writing

Critical Thinking

Communication

PROFESSIONAL REFERENCES

Kari Dougherty, Rheumatology/Nephrology Department Manager (Previous Infusion Manager) 543 Taylor Ave.

Columbus, Ohio 43203

Phone: 614-***-****

adxmk1@r.postjobfree.com

Kim Whiston, OSUP, Inc. Coding Manager

700 Ackerman Rd.

Columbus, Ohio 43202

Phone: 614-***-****

adxmk1@r.postjobfree.com

Kathy Young, Owner and Manager

Resolutions Billing & Consulting

270 E. Hunt Hwy Suite 16, #110

Queen Creek, Arizona 85143

Phone: 480-***-****

Craig Carpenter, Principal

Fairfield Christian Academy

1965 N. Columbus St.

Lancaster, Ohio 43130

Phone: 740-***-****

Contact this candidate