EVETTE CHAPMAN BOYD

**** ******* **** ******** ** 21237

Cell-443-***-****

adxn70@r.postjobfree.com

CAREER OBJECTIVE:

To secure a position that will enable me to use my strong Healthcare Industry /Professional job experience with an established organization. With my more than twenty-seven years of experience, I can help improve productivity and efficiency therefore helping the growth of the healthcare organization/professional business.

HIGHLIGHTS OF QUALIFICATIONS:

•Strong analytical and problem solving skills

•Systematic and highly detailed oriented

•Over 27 years of professional experience.

•A team-spirited

•Self-motivated & dependable

•Exceptional communication skills

•Microsoft Excel

•Word application

•Internet and E-mail savvy

•Medical Terminology and billing knowledgeable

•Multiline phone systems & Fax Machine knowledgeable

•Switch Board

•Facets

•type more than 45 wpn

•Nasco EEC & FED processing

•Care Reference Tools

•Epic training

•Meditech training

•Blue2 Medical Records

•knowledge of UBO4, EOB

PROFESSIONAL EXPERIENCE:

Medstar Franklin Square Medical Center (Baltimore MD)

Patient Account Specialist (PFS denials dept.) 9/21-12/22

I work at home appealing technical and clinical denials within a set criteria. I do this by Interpreting and evaluating denials. Than I appeal in written correspondences or thru the many insurance websites that I have access to. Appeal also includes follow-up with payers to assure timely turn around for claims resolution and reimbursement. I’m able to do this because I interpret explanation of benefits, UBO4 and understand payer methodology all while working in a team environment.

I participate in weekly team meetings, training and workshops offered, to include but not limited to, CPAT Training, bulletin review, etc. I attended and successfully completed required continuing education units (CEU) for the PFS Training Program.

I also completes annual mandatory training (SITEL) within defined time frame. Adheres to department policies, Keeps current on specific changes as it relates to billing requirements and payer specific follow up. Maintains daily performance benchmarks which includes 60 cases a day includes evaluating appeals to include follow up with payers. Completes coding report updates within the standard set in a timely manner to begin the daily workflow process.

I escalate any payor issues to provider rep department. I work financial classes: H, I, J, and C for MedStar facilities located in Maryland. I verify medical insurances coverage for patient’s payment issues and assist patients in understanding medical insurance benefits. Responsible for reconciliation of reports to SMS and information that was posted. I contact patients thru written correspondences for updates ect.

Financial Counselor Oncology department 11/15 – 11/21

I help alleviate the concerns for patient and providers regarding financial concerns. I do this by educating patient about their insurance benefits which includes, copayments, coinsurance, benefit caps, out of pocket expense, payment policies and what the total cost of treatment would be.

I keep a rapport with patient throughout treatment. Behind the scenes I call insurances or use the many different insurance websites I have access to. To see if any prior authorizations are required for patient chemotherapy or any other treatment. if there is I communicate with doctors and nurses to receive correct clinical information to get authorization before patients come in for first treatment.

If patient requires financial help I help navigate patient through a financial package to submit for help.

I update all patient charts with their new information regarding insurance authorization co pays ect

Johns Hopkins Bayview Medical Center (Baltimore MD)

Patient registrar 08/11 - 11/15

Responsible for providing pre-registration and discharge services for patients in a variety of departments, clinics, etc. Functions include telephone utilization, insurance verification, chart preparation, referral verification, and cash collection activities. Responsible for registration of patients; TOS collections; billing and batching; obtaining authorizations for procedures; referral management; insurance proficiency, excellent computer skills customer service oriented; excellent telephone, etiquette skills. I scheduled appointments for the patients. I was efficient at using up to eight different templates for different doctors paying attention to the different templates per provider. Perform well with frequent interruptions and communicate calmly when dealing with emotional issues.

CareFirst of Maryland (Owings Mills MD)

Claims processor II, Data Entry and Full Service Rep 02/19/96- 07/01/11

I resolved edits for Medicare, Professional, Regular and Institutional claims in the Nasco Blue Card Department. This consists of making the necessary data corrections to resolve edits through EEC (Electronic Error correction) system. I resolve edits only when claims did not go through first pass in FDE. While performing I also work with www.acsf.com and TRMS daily to view electronic paper claims that I work on. I have mastered how to calculate Medicare, COB, tertiary insurance on claims accurately and in a timely manner. I am also efficient with working in the CARE system when needing to find pricing or a correct provider.

Data Entry

Adjudication of professional, institution, and Medicare claims for host and home members. I verify all information from documents submitted by providers. Data entering rev codes, hcpc, icd9 codes and any other pertinent information submitted by the provider. I render final decisions on all Institutional Dialysis, Medicare and Professional claims for the payments process. Reviewing invalids and quality failed claims to assist in resolving claims problems in order to issue payments. I also adjust claims to pay or reject claims in system not to pay. Currently keying on Nasco system using fde and eec functions. This Nasco system gives certain guidelines to follow before finalizing the claims submitted. I alone handle all dialysis claims in my unit making sure claims are in it final status and authorize for payment. These claims require great math skills, accuracy and speed to be completed in a timely manner. I keyed in institutional, professional and Medicare claims at a pace of 60 claims and hour. Also coded medical claims and distributed them among other employees.

Full Service Rep

Adjudication of health claims for client base of Federal employees, including processing servicing and maintenance. I also did Electronic billing for third party carriers for payments. I corresponded with members for verification of MCO/HMO, PPO, Medicare, Blue Cross/Blue Shield, third party insurance billing eligibility of benefits. All responsibilities performed in accordance with the highest standards.

Greater Baltimore Medical Center (Baltimore MD)

Patient Finance Representative 04/1992-06/1994

Hospice care coordinator of benefits, billing for procedures performed at the hospital. Verifying benefits of patients as well as making sure services are authorized to be rendered. Checking HCPC codes, Icd-9 codes verifying with insurance companies to make sure it is covered.

EDUCATION – TRAINING:

*Comprehensive insurance Training, Certificate 1/2013

*Course work toward AA Degree, Essex community college 4/2005

*Advanced Career Training /Information Processing Diploma 2/1995

*Diploma, Dundalk High School, Diploma 6/1991

REFERENCE:

Marjorie Hicks

Franklin Square Hospital (financial Counselor of oncology department)

443-***-**** adxn70@r.postjobfree.com

Myra Abdulah

Johns Hopkins Bayview Medical Center (Manager of Geriatrics department)

410-***-****

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