Medical Billing Senior
Resume:
A L I C E
D A V I S
Experienced Medical Billing and Collections Manager with over 20 years of
expertise in healthcare revenue cycle management. Proven track record of optimizing billing operations, improving collections performance, and leading high-performing teams. Adept at navigating insurance claims, regulatory compliance, and patient account resolution. Now seeking to bring my skills, leadership, and dedication to excellence to a dynamic organization where I can make a meaningful impact.
UnitedHealthcare, Dallas, TX, Jan 2019 - Current
Claims Analyst
PLUTUS/CAPTION BILLING, Dallas, TX, Dec 2018 - Dec 2019 Senior Medical Billing Manager
DIGESTIVE HEALTH ASSOCIATE BILLING GROUP, Dallas, TX, Dec 2015 - Dec 2018
Senior Medical Biller
PROFESSIONAL SUMMARY
WORK HISTORY
Research, investigate, and review each provider's area Medicare and Commercial rates before starting the negotiation process.
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Ensured compliance with state laws and regulations throughout the claims process.
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Analyzed data to identify patterns of fraud or abuse within claims processed.
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Utilized software systems for claim processing and documentation management.
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Prepare and issue a Letter of Agreement to the facility for review and approval prior to the patient's admission.
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Set up necessary steps for onboarding providers which may include but not limited to credentialing, setting up electronic vendors, assist with fee schedules and SOP's if needed.
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• Oversee the billing, claims and payment posting department.
• Provide weekly KPI reports to each provider to surpass monthly goalso. Prepared detailed reports summarizing current financial status by collecting, analyzing, and summarizing account information.
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Coordinated with department heads to forecast financial outcomes accurately.
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Identified opportunities for business growth through detailed market analysis.
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Reviewed contracts and agreements for potential financial impact before approval.
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• Assisted with internal and external audits to assess billing procedures. Organized data and forecasts to help complete accurate quarterly, yearly and project-specific budgets.
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Reviewed collection reports, determining status of collections and amounts of outstanding balances.
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Perform full cycle medical insurance collections for multi-physician and hospital services.
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Dallas, TX 75231
alicinaredapple@gmail.c
om
CONTACT
SKILLS
• ECW
• NEXTGEN PRACTICE
• WAYSTAR
• ATHENA
• EPIC
• CENTRICITY
• EMR
CLAIMCARE MEDICAL BILLING GROUP, Jan 2013 - Dec 2015 Billing/Collector Lead
January 1992
Business
Business Administration And Management
Mansfield Business School, Dallas, TX
January 1989
High School Diploma
High School Basics
H.G. Spruce High School, Dallas, TX
Upon request
• Follow up, correct, appeal and or re-submit corrected claims to payers. Investigate, respond to correspondence and requests from insurance carriers, sites and patients.
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• Review and work aged balance report upon receipt.
• Making all negotiated adjustments.
• Verifying payable diagnosis with Code-link and McKesson. Updated customer files with issued invoices, processed payments, and new account information.
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Processed invoices and updated billing information accurately and efficiently.
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Reviewed clinical statements and assigned standard codes using CPT, ICD-10-CM, or HCPCS Level II.
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Daily responsibilities include but are not limited to working claim rejections.
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• Gateway, uploading electronic payments, submitting electronic claims.
• Denials, appeals, daily correspondence, and negotiation with payer.
• Weekly meetings with providers to go over collections, billing, and goals.
• Assist staff with any assistance needed.
• Assisted in achieving department's collection goals. Communicated with attorneys regarding litigation cases involving overdue accounts.
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EDUCATION
REFERENCES
Contact this candidate