Certified Medical Claims and Billing Specialist Collections
Resume:
Rebecca Williams
Portland, OR 97216
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I am a highly experienced Certified Medical Claims and Billing Specialist with over 30 years in the field. As the owner of Sunnybrook Billing Services, LLC, I manage all aspects of medical claims and billing, collections, credentialing and contracting. My expertise includes accounts payable and receivable, denial claim management, and appeals, along with proficiency in EPIC Hospital Billing and various software systems. My background also encompasses administrative roles, nursing services, and legal support, making me a versatile professional. With a Bachelor's degree in Social Sciences and multiple certifications, I ensure compliance with regulations while delivering exceptional customer service. Skills & Qualifications:
Certified Medical Claims and Billing Specialist, Collections, Credentialing, Contracting, Consulting, Accounts Receivable, Accounts Payable, Inventory Management, Month-end Financial Preparation, Reports and Analysis, Bank Reconciliations, Re-configuring Fee Schedules to appropriate Medicare/Medicaid allotted amounts, EMR, EHR, ADP, DME
ADMINISTRATIVE NURSING
Medical claims and billing service CMA/CNA
EPIC Hospital billing Unit Secretary
Home health /Hospice billing Hospice, Palliative Care Pre-certification, Insurance Verification
Registration, Scheduling
Referral Follow-up
Accounts Payable/Accounts Receivable Management
Collections and Appeals, Revenue Cycle
Denial claim management
Grievance & Appeals
Medicare/Medicaid/VA
WC and PIP/MVA
CPT and ICD-9/ICD-10 Coding
HCFA-1500 & UB-04 Electronic Billing
Providing Credentialing and Contracting Needs for Individuals and Group Practices Working with Paralegals and Attorneys
Professional Experience:
SUNNYBROOK BILLING SERVICES, LLC (http://sunnybrookbillingservices.com/) -- Portland, OR 08/1996 to Present – Owner/President
● Perform all Administrative and Nursing skills and requirements as given.
● Collection Specialist on $Million Account Receivables to Decrease Outstanding Balances.
● Generate monthly/yearly end client financial statements.
● Reconcile bank accounts, improved cash collection and control.
● Create organizational, departmental and client budgets emphasizing client billing, financial reporting, including invoices and receipts.
● Obtain referrals and pre-authorization as required
● Verify benefits and eligibility
● Scrub claims for completeness
● Transmit claims using billing software,including electronic and paper claim processing
● Follow up on unpaid claims within standard billing cycle time frame
● Reconcile claim remittances
● Post payments
● Manage claim discrepancies and denied claims
● Answer all patient billing and insurance inquiries
● Set up patient payment plans and work collection accounts
● Maintain current insurance rates within billing program
● Run, manage and report on claim and invoice status reports MEDIREVV – Portland, OR
06/2021 to 02/2024 - Revenue Cycle Specialist
● Optimize cash flow and minimize bad debt by managing accounts receivable billing, collections, and follow-up activities. Claim scrubbing and review, Billing reports and analysis.
● Resolve payer rejections and denials through the appeals process as per payer requirements.
● Follow up with insurance companies to track outstanding claims and facilitate resolution.
● Review and respond to insurance correspondence to ensure accurate reimbursement for medical claims.
● Achieve or surpass productivity and quality benchmarks.
● Handle payer correspondence, edits, and aged accounts receivable, rectifying billing errors as needed.
● Stay updated on payer rules and regulations to maintain knowledge.
● Prepare various correspondence such as claim forms, appeals, and notifications.
● Engage with patients and guarantors to address outstanding insurance balances while delivering exceptional customer service.
● Ensure compliance with HIPAA and other regulatory requirements to safeguard patient confidentiality.
● Strive for continuous improvement in performance metrics like touches to resolution, appeal resolution rate, and average work time per claim.
● Effectively utilize various computer applications and accurately document all actions taken.
● Perform other duties as assigned.
● 30+ years high-volume insurance, denials, and appeals.
● Demonstrate ability to maintain high productivity and quality standards.
● Strong written and verbal communication skills.
● Proficiency in Microsoft Office Suite; experience with EPIC and SharePoint.
● Capacity to work independently, multitask, analytical skills, team player, and problem-solve effectively. Education:
UNIVERSITY OF MARYLAND @ COLLEGE PARK -- College Park, Maryland 05/1992 Bachelor of Arts and Social Sciences (Sociology) (Pre-Nursing) Certificates & Licenses:
CERTIFIED MEDICAL CLAIMS AND BILLING SPECIALIST (CMBS)-- February 1998 CERTIFIED NURSING ASSISTANT (CNA) -- March 1996/2005 CERTIFIED MEDICAL ASSISTANT (CMA) -- June 2005
CERTIFIED EKG INTERPRETATION & MANAGEMENT -- June 2007 Software:
EPIC, OCHIN, DENTRIX, JaneApp, Centricity, NextGen, Office Ally, Medi-Soft, Meditech, Oracle, Microsoft Office (Word, Excel, PowerPoint, Outlook, OneNote, Access, Publisher, Teams, SharePoint, OneDrive and Forms), Availity, TX-ACE, HIPPA billing systems, Windows apps, QuickBooks, Infinity
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