Revenue Cycle Medical Claims
Resume:
Jeanie Millender
**********@*****.***
PROFESSIONAL ATTRIBUTES :
Over twenty-five years of experience in Healthcare Management, specializing in Medical Claims, Hospital Billing, and Management. Highly organized and able to manage multiple projects within required scope and time constraints Possesses strong analytical and problem-solving skills. Strong attention to detail, positive attitude, excellent work ethic, effective within a team and non-team environment.
Software applications: Epic training, Med Metrix, Microsoft Office Applications, Epic, McKesson, Allscripts, Facets, Availity, MED METRIX, Diamonds, Convergence, Seibel, I-claims, Bill Review, Medical Manager, S.O.A.P/Auditing and Change/rely on. various other in-house software. Healthcare Products: Medicare A&B, BC/BS Products, Commercial Insurance, MCO Medicaid, Disability, Workers Comp, General Liability, Tricare, Self-Funded Groups, and Self-Pay entities. Employment History: Claims Analyst-Medical, Medical claims Processor, Insurance Physician Analyst, Revenue Cycle Analyst, Customer Service Rep, Provider Credentialing, Eligibility, Insurance Validation, Medical Billing, Dental, Behavioral Health, Credit Analyst, Collections, Pharmaceutical, Durable Medical Equipment, and Skilled Nursing/Long Term Care.
EDUCATION:
INOVA Health Systems/Epic certified Business Administration: Inova Comm. College- Alexandria VA. 2 years. Thomas Nelson University, Hampton Virginia-2years. Strayer University, Woodbridge VA 2 years PROFESSIONAL EXPERIENCE:
Autism Behavioral Therapies-Woodbridge, VA Oct. 14, 2023-4/24
• Analyze claim denials and rejections.
• Analyze credits/overpayments.
• Research account issues
• Insurance eligibility
• Aged report resolutions
• Medical insurance correspondence
• Knowledge of all insurance products including government, Medicaid, Medicare, and self-funded groups
• Analyze problem claims and provide resolutions.
• Communicate claim issues with revenue cycle departments.
• Billing and assistance with billing functions to assure proper submission.
• Appeals
• Time management
KForce- Chesapeake Regional Healthcare Nov 2021-May 2022 contract assignment
Claims Lead
• Analyze claim denials and rejections.
• Analyze credits/overpayments.
• Research account issues
• Insurance eligibility
• Aged report resolutions
• Medical insurance correspondence
• Knowledge of all insurance products including government, Medicaid, Medicare, and self-funded groups
• Analyze problem claims and provide resolutions.
• Communicate claim issues with revenue cycle departments.
• Billing and assistance with billing functions to assure proper submission.
• Appeals
• Time management
UMC Hospital/Dr. Erondu- Anesthesiology 9/2021 – 11/2021 contr Claims Analyst
• Analyze claim denials and rejections.
• Credits and refunds
• Analyze credits/overpayments.
• Research account issues
• Insurance eligibility
• Aged report resolutions
• Medical insurance correspondence
• Knowledge of all insurance products including government, Medicaid, Medicare, and self-funded groups
• Analyze problem claims and provide resolutions.
• Communicate claim issues with revenue cycle departments.
• Billing and assistance with billing functions to assure proper submission.
• Appeals
• Time management
UMC Hospital. Washington DC JAN 2021 - July 2021
contract assignment
Claims Analyst
• Analyze claim denials and rejections.
• Credits and refunds
• Analyze credits/overpayments.
• Research account issues.
• Insurance eligibility
• Aged report resolutions
• Medical insurance correspondence
• Knowledge of all insurance products including government, Medicaid, Medicare, and self-funded groups
• Analyze problem claims and provide resolutions
• Communicate claim issues with revenue cycle departments.
• Billing and assistance with billing functions to assure proper submission.
• Appeals
• Time management
WSSC Water Co./Laurel MD September 2019- Dec. 2019 Accounting Specialist/Contract assignment
• Assume the responsibility of receiving and sorting incoming payments with attention to credibility
• Manage the status of accounts and balances and identify inconsistencies.
• Issue and post bills, receipts, and invoices.
• Check the validity of debit accounts.
• Update the accounts receivable database with new accounts or missed payments.
• Ensure all clients remain informed of their outstanding debts and deadlines.
• Provide solutions to any relative problems of clients.
• Write thorough reports on billing activity with clear and reliable data. Howard University Hospital/Washington DC March 2019 – June 2019 Revenue Cycle Specialist/Contract assignment
• Physician Insurance Analyst 4/2016- 12/3/2016
• Followed up on aged claims and appeal process.
• Corresponded with responsible payers for claim discrepancy solutions.
• Investigated payment posting for accuracy and errors, credits, and refunds.
• Accessed insurance website for applicable remits and processed claims.
• Appeals and time management.
Mindlance/USAC Washington DC Sept. 2018- Nov. 2018 Data Processing Specialist/ Contract assignment
• Responsible for processing legal documentation of appeal letters for government-funded healthcare clients/consortia.
• Analyze, organize and streamline data
• Create PDF files for client appeals.
• Technical writing
• Edit denial letters.
• Proofreading language for accuracy
• Processing of all applicable data.
• Create PDF Files
• Combine client spreadsheets into the master spreadsheet. Pathways of AZ Behavioral Health, Fredericksburg VA Healthcare Claims Analyst 4/17-2/18
• Oversees charge capture audits, ensuring services are being captured, documented, and charged.
• Performs financial/statistical analyses related to revenue cycle management.
• Manages credit balances.
• Prepares estimates for services and ensures information is delivered to the client promptly
• Implements patient-friendly billing guidelines.
• Monitors credentials of providers within the insurance carriers
• Review payer contracts for accuracy and underpayment analysis by performing audits.
• Facilitates effective relations with payers and providers related to managing care plans.
• Prepares financial reports, invoices, and presentations, reviewing for accuracy and compliance. Bartech Kaiser Permanente Rockville, MD (3 Month Temporary Assignment) Revenue Cycle Claims Analyst 1/17-4/17-Epic software
• Analyzed medical claims to determine the validity of denial/recovery options.
• Utilized McKesson and Epic software along with other insurance applications.
• Appeals and time management: appeal letters that resulted in reimbursements.
• Prepared reports by collecting and analyzing information.
• Communicated with insurance carriers, patients, attorneys, and employers to facilitate.
• Provider contract reimbursement.
• Researched and reviewed clinical policies, contracts, lessons learned, and other historical information to aid in claims recovery.
• Worked individually and within a team to identify trends from client inventories and formulate recovery resolution.
• Clearly and concisely document all actions taken to the resolution of each claim within a claim’s recovery system.
• Ensured legal compliance by following guidelines, account contract requirements, and the company's strategic business plan.
• Maintained quality service by implementing quality control procedures on an ongoing basis. INOVA Hospital Systems, Fairfax VA- Epic software
Physician Insurance Analyst 4/2016- 12/3/2016
• Followed up on aged claims, credits, and refunds.
• Corresponded with responsible payers for claim discrepancy solutions.
• Investigated payment posting for accuracy and errors.
• Accessed insurance website for applicable remits and processed claims.
• Interfaced with various departments to resolve medical claim issues.
• Utilized McKesson and Epic software along with other insurance applications.
• Performed other analyst duties as needed.
• Epic Certification
Sentara Hospital, Virginia Beach VA
Revenue Cycle Claims Analyst, Epic software 12/2016-4/2016 -
• Analyzed medical claims to determine the validity of denial/recovery options.
• Resolved claims by approving or denying documentation; calculating benefit due; composing appeal letter that results in recovery; and auditing claims.
• Prepared reports by collecting and analyzing information.
• Communicated with insurance carriers, patients, attorneys, and employers to facilitate reimbursement.
• Researched and reviewed clinical policies, contracts, lessons learned, and other historical information to aid in claims recovery.
• Worked individually and within a team to identify trends from client inventories and formulate recovery resolution.
• Clearly and concisely document all actions taken to the resolution of each claim within a claim’s recovery system
• Ensure legal compliance by following guidelines, account contract requirements, and the company's strategic business plan.
• Maintained quality service by implementing quality control procedures on an ongoing basis.
• Software application- Epic
The Resource Group, Towson MD
Billing Manager 4/2015-9/2015
• Monitored billing activities, performance management, production standards, and quality of services.
• Provided technical assistance to the leadership team to initiate billing to all appropriate payer types including Medicare, Medicaid, MCOs, and Commercial Insurers.
• Coordinated and maintained communication with other divisions, and agencies to resolve problems or discrepancies and foster process improvements in processing claims and billing
• Provided responsive, high-quality service to agency employees, representatives of outside agencies, and members of the public by providing accurate, complete, and up-to-date information, in a courteous, efficient, and timely manner.
• Analyzed data for bill presentation based on technical and compliance requirements and reviewed claims for quality and compliance. Prepared and supervised the preparation of, and analyzed pre-billing and pre-closing processes and bill presentation to ensure quality, accuracy, and compliance with governmental regulations.
Quadrant/South Riding Medical Group/ temp assignments 1/13-7/14 Claims Analyst
• Analyze claim denials and rejections.
• Analyze credits/overpayments.
• Research account issues.
• Insurance eligibility
• Aged report resolutions
• Medical insurance correspondence
• Knowledge of all insurance products including government, Medicaid, Medicare, and self-funded groups
• Analyze problem claims and provide resolutions.
• Communicate claim issues with revenue cycle departments.
• Billing and assistance with billing functions to assure proper submission.
• Credits
• Refunds
• Appeals
• Time management
Dr. Leo Carter M.D. Newport News, VA
Office Manager 9/2007-12/2012
• Managed an ENT/Allergy office with a staff of nine employees.
• Set new guidelines and protocols for office procedures and policy.
• Trained staff to be more efficient in the medical administration field.
• Trained staff in billing, A/R, collections, and all other duties about the set job descriptions.
• Interfaced with Electronic Payer to edit failed claims.
• Handled claim discrepancies with insurance carriers such as Medicare, Medicaid, Tricare, Workers Comp, Commercial carriers, and Self- Funded Groups
• Increased co-pay revenue by 85% in five months and collected 70% of monies due on aged claims.
• Followed State and Federal Guidelines about OSHA, Fire Safety, HIPPA, and Labor Laws
• Responsible for the hiring and disciplinary actions of all employees
• Analyzed problem claims and provided resolutions.
• Loading of all Provider demographic information into the Database
• Worked on Customer and Provider services inquiry logs.
• Interpreted healthcare benefit products.
• Assisted with pended claims due to provider inquiries.
• Administered government contracts
Other Employment History
Claims Analyst/ Amerigroup, United Healthcare, BC/BS, Integrated Behavioral Care, Integrated Behavioral Care/Claims Manager.
Innovation Health/Claims processer.
Dell, Jacobson Solutions/Consultant assignments with various insurance carriers. Caremark, Advanced PCS, Hartford Insurance Group, and AIG.
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