Patsy L. Fuller

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

Spring Hill, TN 37174

Cell: 931-***-****

adzh9g@r.postjobfree.com

SUMMARY

Accomplished professional with over 20 years of experience in Healthcare billing, collections, quality control and benefits coordination. Extensive computer operations and networking support for multiple clients. Strong business background developed through line and staff positions. Solution oriented with an eye toward bottom line results. Additional skills in communication, project leadership, staff, and client relationship management.

* Supervision * Medicare

* Handbook development * Medicaid/TennCare

PROFESSIONAL EXPERIENCE

Community Health Systems, Franklin, TN 2015-Present

Long Term Care Billing Specialist – RCSC

• Resolve claim processing issues in a timely manner, evaluating problem claims

• Ensure accurate and complete account follow-up by demonstrating a thorough understanding of carrier, UB04 claims form preparation, 1500 claims form preparation to ensure all appropriate internal collection steps have been taken

Community Health Systems, Franklin, TN 2013-2015

• Review assigned claims working within the established productivity standards

• Assess each account for Balance accuracy, payer plan and financial class accuracy

• Resolve claim processing issues on a timely basis by reviewing claim inventories

• Ensure accurate and complete account follow-up by demonstrating a thorough understanding of carrier, UB04 claims form preparation, 1500 claims form preparation to ensure all appropriate internal collection steps have been taken

• Perform other required duties in a timely, professional, and accurate manner

• Document all activity taken on an account in the patient account notes

• Communicate effectively and professionally with strong attention to details and problem solving both verbally and written

Community Health Systems, Franklin, TN 2010-2013

Accounts Receivable Travel Team Specialist

• Follow up calls and / or letters to insurance companies and third parties

• Identify and trend core issues causing claim denials and claim payment delays

• Bill or re-bill insurance claims

• Work suspended claims, rejections, remittances, correspondence, and return mail

• Document any needed contractual or discounts for management approval

• Record all action taken on the individual account

• Communicate and report all core issues to supervisor weekly

• Travel to hospitals owned by CHS

Ingenix, Franklin, TN 2004 to 2010

Claims and Coordination of Benefits Analyst, 2007 - 2010

Identified over $1,000,000.00 of overpayments for three consecutive months.

Worked with team members to ensure project goals were met.

Responsible for identifying erroneous insurance claims.

Recommended solutions to Management on any issues that would impede the accurate and timely review of claims.

Improved procedures and processes for more operational effectiveness and recovery of overpayments.

Audited claims to insure validation of information. This could include but was not limited to providers, members/and or health insurance carriers.

Ensured contract compliance and authorizations.

Researched medical claims using contracts to recognize and recover overpayments.

Quality Control Analyst, 2004 – 2007

Tracked client inventory daily to ensure QC was performed in an efficient and timely manner.

Provided analysis of reviewed claims and overpayments identified by claims analysts.

Guided analysts in ensuring future claims accuracy.

Reported to Director of Operations, Regional Director and QC Supervisor known issues regarding analyst’s productivity and comprehension of the claims review process.

Medassist, INC., Franklin, TN 2000 to 2004

Account Resolution Specialist

Worked with insurance companies to facilitate proper processing of claims.

Collected delinquent accounts for Tenncare and Medicaid for other states.

Traveled to other states to work in the hospital setting.

Urology Healthcare Group, Franklin, TN 1999 to 2000

Collector

Collected past due accounts and set up payment plans with patients.

Williamson County Board of Education, Franklin, TN 1996 to 1998

Substitute Teacher/Teacher Assistant

Worked in a classroom with ten special needs children, including Down syndrome, cerebral palsy, mental retardation and other conditions.

City of Milbridge, Milbridge, ME 1996

Town Clerk

Presided at town meetings, managed vital statistics and collected real estate taxes.

Maplecrest Nursing Home, Sullivan, ME 1995 to 1996

Administrator

Managed a thirty-four bed long-term healthcare facility during final phases of closing.

Served as liaison for Union/Management issues.

Supervised and evaluated fifty employees.

Hogan-Berry Regional Center, Danvers, MA 1994 to 1995

Administrative Officer

Trained, scheduled, supervised and evaluated up to twenty-five employees in a residential Intermediate Care Facility (ICF/MR) nursing setting for adults with mental retardation.

Mental Retardation Worker I

Provided activities of daily living.

Cherryfield Foods, INC., Cherryfield, ME 1991

Executive Secretary

Provide clerical support to the CEO, CFO and President

Medical Financial Services, Bangor, ME 1990 to 1991

Payroll/Accounts Payable Clerk

Process payroll, accounts payable, accounts receivable for three nursing homes

Created employee handbook for nursing homes

Narraguagus Bay Health Care Facility, Milbridge, ME 1984 to 1990

Office Manager

Process payroll, accounts payable, accounts receivable

Answer multi-line phone and route calls

Create reports for weekly staff meetings

Bi-weekly state Medicaid billing

Receive payments and make deposits

EDUCATION

Masters in Education, University of Phoenix, Phoenix, AZ, 2010

b.s. in Business Administration, University of Maine, Machias, ME 1993

a.s. in Small Business Management, University of Maine, Machias, ME 1991

Administrator-in-training, Narraguagus bay healthcare, Milbridge, ME 1990

State of Tennessee, department of commerce and insurance

prelicensing education 2011

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