Data Entry Accounts Receivable

"ELIZABETH TASSONE-DOWNS

Pawling, NY ***** 914-***-**** **********@*******.***

Charge Entry Medical Coding & Billing Accounts Receivable Collec;ons Registar Administra;ve Pa;ent services Surgery & DME Prior-Authoriza;on Claim Appeals Insurance Verifica;on Specialist Payment Poster"

"Detail-oriented Charge Entry Medical coder and billing professional, AR Account Receivable representa=ve, Colla=ons, Registar Administra=ve, Pa=ent Services, Prior-Authoriza=on Specialist DME, Physical Therapy, Chiroprac=c and Procedures, Claim Appeal, Insurance

Verifica=on Specialist, Payment poster are addressing inquiries and resolving issues while maintaining workflow. Enter accurate data to process charges, payments, denials, and adjustments. Provide diagnosis codes to data entry team to expedite processing. Work effec=vely with minimum supervision, mee=ng goals and deadlines. Team player and trainer, suppor=ng development of organiza=onal capability. Comfortable contac=ng insurance carriers for AR claim follow-up and Call pa=ent to collect the Out of Network provider payments and account balances. Proficient in MS Office (Word, Excel), QuickBase, SharePoint, Power Point, SequelMed, AdvanceMD, USMON, AthinaMedical, MedeClinicalWorks,NextGen Office, ePaces Portal, Insurance Carriers Portals, Ppaya Payment Portal, ProviderFlow Electronic RegistraNon Portal, MedSuite, Athena, SUNRISE PORTAL. Tri-lingual in English, Spanish, and Italian; excellent interpersonal skills.

SKILLS

• Medical coding and billing

• DME Prior-Authorization

• Patient Registration Admission

• Claims appeals specialist

• Balance billing

• WC & NF claims follow up

• Surgery Prior-Authorization

• Account receivable

• Data entry

• Collections

• Patients account coordinator

• Intake

• Insurance benefits verification

• Word and Excell

• Overhead Calls from patients, and inbound callers

Northwell Health/Anesthesia Management Services, Chappaqua, NY 10514 October 2020- May 2025

Medical Biller/AR Billing Specialist

Coordinated phone calls to the major insurance carriers to follow up on claims status, handle the Claims denials, worked on Claims appeals online and fax and paper appeals, submitting corrected claims, verify"

"eligibility coverage, denied claims due to provider ‘s credential issues Faxed the W-9 Form to update the provider’s file, account adjustments, corrected payments posting errors, called insurance carrier for Surgery-prior-authorization, pain block injections, denied, Search and printed supporting documents from the Hospital portals, handled special projects on Excell spreadsheets such as, claims denials, patient’s outstanding balances, and sent Excell spreadsheets to the insurance carriers provider relations representatives.

JOB TASK:

• Claims status

• Claims denials and appeals

• Confirmed insurance carrier liability

• Confirmed WC cases/carrier-claim# -injury date-WC Board #

• Communicate with attorney offices for litigation status

• Maintain Regional fee Schedule changes

• Coordinate state reginal fee schedules that apply based on the providers’ contact

• Obtain WC Board Eligibility

• Obtain necessary attorney information related to the claimant

• Pain Block injections prior authorization verification

• Surgery prior-authorization verification

• Excell spreadsheets special project unpaid claims.

E14 MedicalArts Family &b Internal Medicine/ Multiple -Specialties Clinic New York, NY April 2020-June 2020

DME Prior- Authorization Representative

• Coordinated phone calls to the insurance carrier to obtained DME Prio-Authorization approval

especially those that are expensive or frequently subject to overuse.

• Verified members DME benefits, eligibility and member responsibility

• Submitted documentation, including a prescription and other relevant medical information, to demonstrate that the DME item is medically necessary for the patient.

PRACTICEMAX, Brewster, NY August 2008 – March 2020 Account Receivable Representative

• Coordinate phone calls to clients' customers to request information; handle inquiries and respond to requests.

• Verify patient’s eligibility with insurance carriers, provide diagnosis codes and extract data from USMON to prepare HCFA 1500 for Data Entry team and I also, posted the charges into the system Prepare invoices and execute collections activities process client payments and formulate

financial adjustments for account balances."

"• Review outstanding balances and contact the patients to collect payments Worked in Claims appeals department, managing payer’s details and working with payers to resolve them by supporting appeals arguments Place overhead calls for other departments Correct claims for resubmission, added Modifiers to the claims if needed it and contact surgeons' offices to request information to support the claims collaborate with insurance carriers to follow up on claim payments.

• Coached new billing representatives’ recruiters’ group of six on daily processing functions.

• Trained new recruiters base in Cebu, Philippines by training them how to check patients’ eligibility, also taught to enter the Data entry charges and claims follow up. Therefore, the grate achievement is that I have been given new tasks, and the new recruiters are successfully trained to carry on with their assignments.

• Trained seventeen new staff members in Philippines to prepare for transition of department responsibilities following acquisition and allow for reallocation of tasks to other priorities conducted training on SiquelMed program, account processing, and accounts receivable within one month I conducted the training via Skype and remotely.

• Expedited payment process from X days to 15 days for denied out-of-network claims by calling patients to request completion of appeal forms.

• Created spreadsheets with provider and facility contact information and formulated outreach protocols, hereby increasing collections and reducing backlog Arranged six-month payment plans with customers as needed and/or initiated collection agency involvement.

• Created Spreadsheets for Appeal Claims to be follow up the process status.

• Worked on big projects provided by the manager for claims on hold.

• Created spreadsheets with CPT codes and their description for the Data Entry Department.

Danbury Internal Medicine, Danbury/ Praxair Cancer Center CT June 2003 – July 2008 Account Receivable Medical Billing Representative

• Managed premium billing function supervising activities of three team members.

• Provided information to patients and coordinated payment arrangements.

• Reviewed outstanding balances on Excell to make the proper account adjustments and mailed statement to the patients.

• Managed claims corrections for resubmission reconciled billing and created invoices Followed up

with insurance companies on claim status Placed overhead calls Resolved claim issues prior to resubmitting."

"• Selected for project involving outreach to insurance carriers to follow up on payments by specific physician; resolved payment backlog.

Education:

GED Earned - The State of New York Education Department

Bachelor of Science in Applied Management -Grand Canyon University 2020-2026 AHIMA - CCS-P in process

AAPC – CPC in process"

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