Revenue Cycle Medical Biller
Resume:
DENISE M.C. HOOKS
**** ****** ******* **. ******, TX 77301 - Phone - 314-***-****
Email · **********@*****.***
Summary: Meticulous, results-driven, and quality-oriented Revenue Cycle Professional, with an extensive background in front and back-end revenue cycle operations. Seeking a position in a challenging and stimulating work environment that will allow me to use my skills and knowledge for organizational and personal growth. Ability to work independently, while maintaining firm deadlines, with sound analytical and problem-solving skills, managing numerous tasks and interacting cross-functionally with other teams.
EXPERIENCE
7/2023 - PRESENT
SR. PATIENT ACCOUNTS SPECIALIST – EMERUS HEALTHCARE HOLDINGS- THE WOODLANDS, TX
Review credit balance refund 1-348 request for 5 staff members. Perform quarterly audits on team (40+) accounts. Assign return mail to the team. Review refund requests from various insurance payers. Communicate with collection agencies. Returning phone calls regarding the overpayments. Run reports for the team. Create reports weekly. Assign work as needed weekly. Have team meetings to keep the team motivated. Respond to all emails that are received. Perform any assignments sent from management. Responsible for answering incoming and outgoing patient and facility calls. Request pertinent information from patients and insurance payers for account resolution. Review outstanding accounts for errors and submitted to facilities for corrections. Process adjustment and self-pay requests. Responsible for processing hospital claims and resolving denials (or resubmit them to secondary or tertiary insurance providers. Filed appeals on behalf of different facilities. Refile primary, secondary, tertiary. Review EOBs for denial reasons and underpayments. File appeals & Grievance.
1/2023 -7/2023
REVENUE CYCLE QUALITY SPECIALIST, ADDISON GROUP - HOUSTON, TX
Responsible for contacting insurance companies regarding outstanding reimbursements. Requesting necessary documents from providers to support medical necessity for rejected claims. Process adjustment and forward self-pay account to patient reimbursements. Responsible for resolving denials. Follow up on claims and update system. Work accounts to maintain timely filing. File appeals. Work from productivity spreadsheets as assigned. Updated patient demographics and insurance information. Forward accounts to the posting when errors are found. Perform any additional services that is requested by my supervisor. Appeal & Grievance.
7/2019- 2/2020
Orthopedic Clinic / Biller and Admin, HEALTHCARE MEDIA, LLC-Spring, TX
Responsible for contacting insurance companies regarding outstanding reimbursements. Requesting necessary documents from providers to support medical necessity for rejected claims. Process adjustment and forward self-pay account to patient reimbursements. Responsible for resolving denials. Follow up on claims and update system. Work accounts to maintain timely filing. File appeals. Work from productivity spreadsheets as assigned. Updated patient demographics and insurance information. Forward accounts to the posting when errors are found. Perform any additional services that is requested by my supervisor. Appeal & Grievance.
9/2018 – 12/2018
NURSING HOME MEDICAID BILLING SPECIALIST, HMG SERVICES – THE WOODLANDS, TX
Work several facilities. Appeal & Grievance. Filed orthopedic claims on behalf of 3 clinic. Retrieved calls from emails and dispatch them the VOB representatives. Returned calls to patients that have billing issues. Returned calls to insurance providers. Filed appeals. Worked reports for all 3 clinics (as needed). Followed- up on accounts that has outstanding balances or non-payments. Notated all accounts with my findings Collections. Appeal & Grievance.
June 2017 - August 2018
A/R PAYMENT POSTER/ MEDICAL BILLER / MEDICAL CODER, VISUALUATIONS - SPRING, TX
Payment posting manual /Electronic (ERA’s)-patient and insurance payments. General A/R inquires and aged A/R buckets. Reviewed patient account balances. Requested adjustments. Filed appeals & grievance. Posted various remits, Medicaid, Medicare, commercial. EDI transactions/troubleshooting. Hospital billing.
3/2017- 5/2017
FMA ALLIANCE HOSPITAL BILLER / COLLECTIONS (CONTRT POSITION) ADDISON GROUP-HOUSTON, TX
Filed appeals on behalf of different facilities. Refiled primary, secondary, tertiary. Reviewed EOBs for denial reasons and underpayments. Filed appeals & Grievance.
2/2013 – 11/2016
MEDICAL BILLER/MEDICAL CODER/CLIENT REPRESENTATIVE PARALLON/HCA - ST. LOUIS, MO
Responsible for answering incoming and outgoing patient and facility calls. Requested pertinent information from patients and insurance payers for account resolution. Reviewed outstanding accounts for errors and submitted to facilities for corrections. Processed adjustment and self-pay requests. Responsible for processing hospital claims and resolving denials (or resubmit them to secondary or tertiary insurance providers). Educated providers on insurance and coding /denial trends. Edited hospital templet forms to increase patient response. Filed appeals. Worked with UB04’S & HCFA’s-1500. Followed up on claims and updated system. Educated patients regarding their benefits. Responsible for auditing aged accounts to ensure timely filing and ensure the claim met the necessary requirements given by insurance providers. Reviewed patient bills for accuracy and completeness and obtained any missing information. Month End Closing / Invoice all clients and maintained fee schedules for all clients. Created Excel reports for clients which detailed information regarding rejected claims, trends and projected revenue and created medical manuals and policies, procedures. Educated patients regarding their liability pertaining to their insurance. Hospital Billing. Filed appeals & Grievance.
EDUCATION
6/84 YEAR
DIPLOMA, O’FALLON TECHNICAL HIGH SCHOOL
3.0 GPA
7/92 YEAR
CERTIFICATE, ST. LOUIS COLLEGE OF HEALTH CAREERS
NO GPA
Management
Training
Collections
Excel
Revenue Cycle Management
Analytical Problems Solving
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