Leeta R. Thornton

Phone: 619-***-**** Email: adzx7s@r.postjobfree.com

San Diego, CA 92110

PROFESSIONAL PROFILE

Extensive experience in all aspects of healthcare claims, from initial contact and billing to final settlement to claims processing and adjudication.

Customer service skills including

Detail oriented, flexible, and adept at learning new skills and concepts quickly to prioritize and complete multiple projects accurately, and on time in deadline-sensitive settings.

Solid PC Skills including Word, Excel, Power Point, and Outlook

Knowledge of CPT, ICD 9, ICD 10, and RBRVS coding

PROFESSIONAL EXPERIENCE

Rose International temporary assignment with Kaiser Permanente San Marcos, CA

Customer Service Representative Jr. 07/2023 to present

Registering patients

Scheduling patients

Making follow up calls

Aston Carter temporary remote assignment with LabCorp, Inc. San Diego, CA

Program Specialist 10/22 to 06/2023

Conducts insurance verification and benefits for all insurance types. Coordinate prior authorizations with providers. Contact provider with findings

Process patient applications of various complexities to program specifications per eligibility and benefit findings.

Place follow up calls to patients and healthcare entities. Answered patient and healthcare inquiries as required.

BioTheranostics, Inc., a Hologic Company San Diego, CA

Patient Service Associate 08/20 to 07/22

Contacted patients to educate the client on the billing process and financial assistance program.

Scheduled appointments for return calls for patients.

Answered all inquiries regarding all aspects of products, testing process, and billing.

Verified eligibility and starts prior authorization, pre-certifications, and predeterminations as required.

Performed data entry as required.

U.S. Census Bureau San Diego, CA

Census Field Supervisor 02/20 to 7/20

Supervised 6-15 field representatives including training, payroll completion, data collection and measures of quality and quantity matrixes.

Point of contact for questions and concerns regarding completion of enumeration services.

Gap of Employment (>30 days) 01/2019-01/2020 - Shoulder injury requiring major surgery and rehabilitation. Fully recovered and able to work without accommodation.

Decipher Biosciences formerly GenomeDx Biosciences San Diego, CA

Benefits Coordinator 04/18 to 12/2018

Initiated insurance eligibility and benefit verification. Updated laboratory software as required.

Gathered and submitted all medical documentation for prior authorization; follow up all authorizations to denial or approval.

KForce at Temporary Assignment at Decipher Biosciences formerly GenomeDx Biosciences

Customer Support Specialist

Contacting clients for lab results via phone, fax, or email.

Updating laboratory software with results needed for billing purposes. Upload lab reports to accounts

Performing eligibility inquiries and updating laboratory software as required.

Leeta R. Thornton Phone: 619-***-**** Email: adzx7s@r.postjobfree.com San Diego, CA 92110

Medical Professionals San Diego, CA

Medical Biller 3 Temporary Assignment at Golden Hour 01/18 to 04/18

Performed medical claim follow up for ground and air ambulance services. Resolved claim payment issues including insurance company contact via phone or by formal appeal.

Worked daily correspondence including medical record requests, denial, and refund requests.

Answered phone inquiries from insurance companies and patients. Helped patients with billing questions, set up payment plans and took payments.

Genoptix Medical Laboratory Carlsbad, CA

Medical Billing Representative 04/17 to 12/17

Kelly Services Global, LLC Temporary Assignment with Genoptix Medical Laboratory

Medical Billing Representative

Performed medical billing follow up to final resolution of independent laboratory claims for all payers including State, Federal, and 3rd all types of third party payers for both contracted and non-contracted payers.

Completed follow up processes including review of payments, to insure reimbursement matched contractual agreements.

Reviewed all denied services. Conducted follow up with carriers including verbal communication to resolve issues immediately or by formal appeal when warranted.

Performed final account audits of accounts requested accurate adjustments, and billed patients. Worked daily reports of aging claims including correspondence.

Gaps of Employment (>30 days) 02/2017 – 03/2017 – Seeking Employment after completing externship.

Physource Solutions La Mesa, CA

Medical A/R Follow Up Clerk Externship Assignment 12/16 to 2/17

Performed medical claim follow-up, rebilling, eligibility and authorization verification with all carriers including Federal, State, Third Party (PPO, HMO, IPA, TPA) and Patient Billing.

Reviewed and reconciled patient accounts and executed adjustments based on EOB

Answered patient and insurance company inquiries to set up payment plans, collect payments and to answer inquires.

Gaps of Employment (>30 days) 12/2015 – 11/2016 – furthering education

Aetna, Inc. / Coventry Health Care, Inc. San Diego, CA

Provider Data Services Analyst / Credentialing Specialist 06/06 to 11/15

Lead person to perform audits of all northeast reginal credentialing issues list including review of all data elements, determining if IT correction is required, to resolve claims and credentialing issues.

Developed procedures to complete successful audits to align both Coventry National and Aetna guidelines.

Developed and trained processors in the use of the PITS ticket system to resolve suspended claims.

Worked closely with provider credentialing associates to resolve credentialing and re-credentialing issues

Evaluated and built client information files based on health agreement contracts

EDUCATION AND TRAINING

Medical Billing and Coding Specialist Brightwood College San Diego, CA

CPR Re-Certification Brightwood College San Diego, CA

Registered Medical Assistant Maric College San Diego, CA

High School Diploma George Washington High School Denver, CO

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