Data Entry Medical Records

I am an experienced hard-working individual with a professional and positive attitude seeking a position in the medical field. I am also a critical thinker with the ability to adapt to a rapid pivoting environment, as well as communicating with supervisor and colleagues voicing opinions to resolve conflicting problems.

Professional Experience

Gainwell Technology 04/2020-Present

Senior Assistant Claims Examiner

Alpha/Numeric Data Entry, Ability to review, correct, deny and process

UB/CMS claims, Review Patient Chart Notes/Medical Records

Adhere to HIPAA rules and regulations, Research and repair errors

Adapt to constant changes in work instructions

Familiar with Edit Resolution Tool and Share Point

Process CMS/UB04 claims and Reimbursements

Meet deadlines & daily production

Retinal Consultants 08/2019-04/2020

Pharmaceutical Acct Representative

Incoming/Outgoing Calls, Appointment Scheduling and Obtaining Pre-authorization /Verifying insurance coverage eligibility

Prepare payment agreements, payments, adjustments and refund requests per policy guidelines

Making Clear concise notes & Review Patient Chart Notes/Medical Records

Prepare appropriate forms for co-payments or co-insurance the payment needs at the time of visit

Attach chart notes or referrals with claims if needed

Knowledge of CPT / ICD-9 & ICD 10 Coding

Interact with patients face to face and or answering Incoming and making outgoing calls

Complete 1st and 2nd level appeals on denied, unpaid or underpaid claims

Follow up on unpaid balances, appointments, patient and or referring physicians to obtain missing information

Knowledge of Medical Billing and Coding, UB04/CMS 1500 claims, HMO, Medi-Cal, Medi-care & PPO

Ensure payments according to Medicare or Payer contracts

Assist patients with financial or co-pay programs available

Programs used are Next Gen 5 Pacific Management, E-Care One Source, Microsoft Excel and Microsoft Outlook.

Knowledge of Sutter Health & Hills Physician Insurance Portal

Enrolling patients for CDF Co-pay Assistance

Target Corporation Distribution Center 05/2018-08/2019

Warehouse Worker

Drive Equipment

Breakdown lanes & walls

Scanning

Report issues to control center

Help assist departments when needed

Kelly Services Via Health Net Federal Services 11/2015-05/2018

Authorizations & Appointing

Confirming HIPAA

Verify eligibility (Choice First, Waitlist, 40 miles)

Processing Request for Additional Services.

Processing Coordinated Care Service Authorizations

One on one representative training

Mentors newly hired representatives

Providing floor support & Reporting to superiors

Abide by work instructions

PC3 Edits, Fargo and Indexing

Adapt to constant changes in work instructions

Ability to switch projects when needed

Able to complete projects with others as well as by myself

Outbound calls to providers and patients confirming appointment information and scheduling.

Proficient computer skills in Microsoft Excel, Access, Word, Lotus Notes DOMA & Quantom Choice

Overseeing paper working

98% QA Accuracy

Knowledge of Medical Terminology

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