DENISE LILES

**** ******* **. *** * Raleigh, NC *7610 1-704-***-**** adzuag@r.postjobfree.com

Objective

An Interesting position with a growing company.

Experience

Duke Raleigh Hospital Out Patient Imaging: Financial Care Counselor

03/2016 TO 02/2019

●Analyze insurance coverage and benefits for service to ensure timely reimbursement.

●Obtain all Prior Authorization Certification and/or authorizations as appropriate.

●Facilitate payment sources for uninsured patients.

●Determine if patient's condition is the result of an accident and perform complete research to determine the appropriate source of liability/payment.

●Admit, register and pre-register patients with accurate patient demographic and financial data.

●Resolve insurance claim rejections/denials and remedy expediently.

●Calculate and collect cash payments appropriately for all patients.

●Reconcile daily cash deposit. Evaluate diagnoses to ensure compliance with the Local Medicare Review Policy.

●•Perform those duties necessary to ensure all accounts are processed accurately and efficiently.

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●Explain bills according to PRMO credit and collection policies.

●Implement appropriate collection actions and assist financially responsible persons in arranging payment.

●Make referral for financial counseling.

●Determine necessity of third party sponsorship and process patients in accordance with policy and procedure.

●Examine insurance policies and other third party sponsorship materials for sources of payment.

●•Inform attending physician of patient financial hardship.

●•Complete the managed care waiver form for patients considered out of network and receiving services at a reduced benefit level.

●Update the billing system to reflect the insurance status of the patient.

●Refer patients to the Manufacturer Drug program as needed for medications.

●Greet and provides assistance to visitors and patients.

●Explain policies and procedures, and resolves problems.

●Gathers necessary documentation to support proper handling of inquiries and complaints.

●Assist with departmental coverage as requested.

●Obtain authorizations based on insurance plan contracts and guidelines.

●Document billing system according to policy and procedure. Enter and update referrals as required.

●Communicate with insurance carriers regarding clinical information requested and to resolve issues relating to coverage and payment

Carolina Family Practice & Sports Medicine

07/2015 to 03/2016

●Scheduling appointments, answer phones, collect payments, Balance money, Assist patients as needed, Verifying Insurance and payment methods, Document Scanning, faxing, medical records

Utopia Homecare C.N.A

10/2010 TO 11/2011

Filed and maintain records, Heard and resolved complaints from patients, Operates switchboard on call service, scheduled appointments, greet persons entering establishment, collect and sorted messages and mail, Completed time sheets for employee’s arrival and departure times.

Holly Hill Hospital MHT

11/2010 To 9/2011

Assisted Patients, Documents eating input, Group activity, etc.

Rex Hospital C.NA

05/2000 TO 12/2009

Transported patients to treatment units, answered patients call bells, Observed patients conditions, measure input and output and vital signs, set up equipment such as IV and Oxygen tanks. Bath and groomed patient as needed.

Education

Thomas Healthcare Wake Forest Rd Raleigh

C.N.A Cerificate

Mary E Phillips

High School Diploma 1999

References

Available Upon Request

Contact this candidate