Accounts Receivable Call Center
Resume:
Kathy Moore
Raleigh, NC *****
*********@*****.***
Proactive and meticulous Reimbursement and Customer Services professionals with 15+ years of experience driving operational excellence in the medical field. Proven track record of increasing patient flow and client satisfaction through great patient care coordination and patient access services. Excellent in managing and training staff, scheduling employees, supervision clinical operations and preparing budgets to ensure profitability, productivity, and medical operational success.
RareMed Solution (PSC) Patient Service Call Center - Pittsburgh, PA
Reimbursement Specialist
March 15, 2024, to November 15, 2024
Processes and follows up on payer issues with various entities for completion.
Researches and resolves account activity.
Follows up on outstanding accounts receivable, appeals, and negotiations.
Provides communication on the methods and principles used for billing to the customers and resolve concerns.
Participates in the flow of the account throughout the revenue cycle process.
Maintains accuracy and integrity of the revenue cycle system and accounts therein.
Collectively works with team to meet organizational targets.
Duke University Health System, PRMO; Durham, NC
Customer Service Patient Account
August 29, 2011 – January 29, 2024
Collect delinquent account payments from patients and carriers.
Collect payment on delinquent accounts by processing forms, generating correspondence, responding to appeals.
Contact insurance carriers to obtain authorizations and referral approvals for services and procedures.
Research medical records to gather information and substantiate medical justification for procedures as required by insurance carriers. Submits requested medical information to insurance carrier.
Evaluate accounts, billing, payments, and posting of accurate charges for a highly specialized and complex medical service.
Obtain information from patients to verify insurance coverage and financial status to obtain proper reimbursement
Post payments and denials to patient accounts, reconcile accounts, research and resolve a variety of problems relating to posting of payments and charges, insurance denials, secondary billing issues, credit balances, sequencing of charges, and non-payment of claims. Contact patients, physicians and insurance companies to obtain information necessary for account resolution through write-offs, reversals, adjustments, refunds or other methods.
Research and determine if carrier denial of claim is valid. Abstract information from medical records to support appeal of carrier denials and/or make recommendations to change coding of charges in accordance with ICD-9 and CPT codes. Resolve denials of claims with carriers and patients.
Researches, analyzes, resolves and collects patient accounts receivable.
Utilizes a variety of systems to analyze insurance and demographic information responds to requests for account information processes a variety of records and reports and contacts third party carriers, patients and employers to resolve outstanding accounts. Accurately documents collection activities performed on
Advise patients of programs available to provide coverage and persuade patients to apply. Establish payment plans for patients who have no method of payment when all options are exhausted outstanding accounts receivable.
When dealing with indigent patients, expedite completion of applications for Medicaid and other programs (via GFS) by reviewing applications for accuracy and completeness
SCA Blue Ridge Surgery Ambulatory Center, Raleigh, NC
Patient Account
November 3, 2001- June 1, 2010
Assumes the responsibility for the coordination of an effective, efficient admission process for all patients by receiving referrals, gathering and verifying pertinent information and completing necessary procedures to schedule and admit inpatients and /or outpatients.
Skills:
Collaboration, In-depth knowledge of revenue cycle processes, medical billing, coding (CPT, ICD-10), and insurance regulations and Imaging Solution. Customer Service interaction. High attention to detail and accuracy
Technical Skills:
Maestro Care Epic, Meditech Software, Salesforce, Hyland, Siemens, IDX, DHIS,Microsoft Office Suite, ICD-10, HCPC, CPT, Diagnostic Related Group (DRG), Call Center Customer, and electronic health record (EHR) systems. Excellent analytical and problem-solving abilities.
Education:
NC Wesleyan University, MS, Strategic Leadership
NC Wesleyan College, BS Healthcare Administration,
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