Customer Service Medical Billing
Resume:
Glynda Peck
Sun City Center, FL *****
************@***.***
Professional Summary
Seeking a position as a
(Revenue Cycle Specialist
Medical Billing & Collections )
US Remote
With a progressive and innovative organization that;
• Values employee input and loyalty
• Encourages and supports employee development
Preparing HCFA’s, UB04 for billing and collecting, denials, including Medicare/Medicaid, VA claims, and commercial insurance. For both Physician and Hospital accounts. Setting up providers to be enrolled in government contracts and regular contracts and maintaining the providers system. Research problems of provider denials for contract enrollment and resolve the issue. Review Prior Authorization and get one if needed or expired. Verify insurance for eligibility and correct insurance. Billed infusion services, Electronic billing (Waystar), setup payment arrangements, posting payments, claims processing, customer service. Excellent Communication skills. Working EOB’s/MEOB for payments or denials. Knowledge of using CPT/ICD-10/HCPC books to look up DX codes, procedure codes and HCPC codes and use the computer to look codes. Other skills, using Excel, word, PowerPoint, outlook email. working remotely on EPIC, internal ACE, Meditech, Waystar Clearinghouse. Attend meetings thru Google and Teams. Work Experience
Revenue Payment Specialist
Signature Performance-Remote
January 2024 to April 2025
Job Duties: Working in the Meditech system off of an Excel spreadsheet all commercial accounts. Doing follow up for all A/R for the insurance companies by going to their Web Portals or calling them on the phone for status. Resolve any issues as to why the claim has not been paid or send information they are requesting and medical records, gather them through EMR and send them usually by their Web portal. Change, add or update any insurance information and bill Secondaries as well. Fill in working the VA accounts,
Medicaid accounts and some Medicare using insurance their Web portal. Post adjustments or move money to the correct buckets. Filling in for Provider Enrollment resolve why a provider claim is denied due to EIN or NPI. Adding providers for enrollment to the government and regular insurance for new providers. Working in Waystar Clearinghouse, correcting edits for rejected claims or if the claim did not go through. Fix the rejections and rebill claims, if needed send medical records and any other documents in Waystar as well. Work Remote only Meditech System Revenue Cycle Specialist II
Tandym Healthcare-New York, NY
March 2023 to January 2024
Job Duties: Working old A/R accounts no response Work Queue all accounts. Verified if the insurance has paid and if the money has any problems with posting, would correct the payment posting and change insurance if necessary. Using the insurance website and calling insurance companies to verify eligibility and prior authorization if needed. Will verify if they have the claims. Edit the claims if they were rejections through Electronic Billing/clearinghouse to get the claim out to insurance. If needed send corrected claims that were denied, by electronic or paper. Sending appeals after research of denial problem and send appeals with the claim and any documents needed to support the appeal. (Temporary Contract) EPIC System & Remotely
Claims Denial Specialists
ConiferHealth-Remote
September 2022 to February 2023
Job Duties: Work Comp Review Account that have been denied by Work Comp Insurance, to determine the course of action needed. Writing appeals and sending all documentation necessary with the denial. Call insurance companies for status on claims not paid or no response from the insurance. Review contracts to make sure we were paid correctly and if not send an appeal or reconsideration for additional money. Work on the insurance websites and make phone calls. Attending Google team meetings and work remotely. Epic System (Temporary Contract)
Claims Resolution Specialist
EnableComp-ArgosHealth-Remote
December 2021 to September 2022
Job Duties: Call insurance to see if they have received our Work Comp bill, Itemized bill and Medical Records.
Will send appeals or reconsiderations, to show this has good cause/medical necessity to be paid. Using insurance websites to resubmit bills thru them or our electronic billing. Closing accounts with payments and moving money to correct buckets and take adjustments. Verify with the Fee Schedule from different states if the claim was paid correctly. Adding insurance and moving to the 2nd insurance after payment or denial. Remote Epic system (Temporary Contract) Claims Analyst
RTR Financial Services-Remote
March 2021 to December 2021
Job Duties: Call insurance companies for physician’s unpaid medical bills. Working in a queue following up and billing VA claims, Medicare and commercial insurance companies claims. If they have been paid, check to see if they paid according to the contracts or policy guidelines. Sending appeals for denied claims. Payment posting, take adjustments, and move money to patients or 2ndary insurance if money is due for copay, coinsurance, or deductibles Reprint claims (HCFA 1500) if needed, send medical records and send any other information that is needed to get the claim paid. Send appeals requests to other department within the company to complete. Moved accounts to other work queues, due to company policy if they needed additional work. Worked closely with my team and other coworkers, attended meetings by Zoom. Remote work for the Kentucky Medical Hospital, the physicians side. (Temporary Contracted Position)
Patient Financial Specialists
SwedishAmerican Hospital-Rockford, IL
December 2016 to March 2021
Job Duties: Working in the Revenue Cycle department I work in a work queue following up and billing VA claims, Medicare and commercial insurance companies claims. Bill Outpatient Hospital and Physician billing. If they have been paid, check to see if they paid according to the contracts or policy guidelines. Payment posting, take adjustments, and move money to patients or 2ndary insurance if money is due for copay, coinsurance, or deductibles. Add and change insurance on accounts, take our codes or diagnosis that need to be removed or add them with coding dept. Using the websites of all insurance companies, WPS, and VA check the status of claims and patient eligibility. Currently working all the VA Claims, checking with the Mediregs program for comparable payment. Changing claims over from Choice VA to TriWest and verify everything was added correctly. Optum printing, appealing & billing Medicare,
UB04’s with prior authorization and mail to them for payment. If the first follow-up call denied will send appeal. Printing medical records if the insurance company is requesting them or if sending appeals. Epic system Hybrid/Remote
Education
High School Diploma
HARLEM SENIOR HIGH SCHOOL-Loves Park, IL
Bachelor's Degree in Health Information Administration University of Phoenix-Phoenix, AZ
Skills
• Medical Billing (10+ years)
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