Medical Billing Patient Care

Carol McGruder

Upper Marlboro, MD ****** 240-***-***** ******@*****.***

SUMMARY

I am a seasoned medical billing and patient care expert with over 20 years’ experience in managed care resolution, customer health, commercial and physician care. Successful track record of generating new business with managed care professionals, marketing medical account strategies, and solutions to existing and potential clients in real-time and within individual budget constraints. Proven ability to recruit, retain, and motivate operational and medical personnel at all staff levels. Advanced patient account management and marketing communication skills in the private sector.

CORE COMPETENCIES

Project Management

Medical Billing

Claims Management

Collections

Customer Service

Account Management

Document Control

Quality Assurance

Client Relations

Technical Skills: Microsoft Office (Word, Excel, PowerPoint, Outlook, Cerner Implementation

PROFESSIONAL EXPERIENCE

Children’s National Hospital, Washington, D.C, 2005 – Present

Credit Collections Representative

- Receive denial correspondence from insurance companies via email or payment posting process.

When claims are not being paid, maybe electronic or paper format, evaluate the type of denial using

codes and prioritize the number of claims.

- Proactively follow up on submitted claims to determine payment issues through telephone or web contact

in a timely manner.

- Manage a large volume of denials to maximize reimbursement

- Administer and maintain company financial documentation and generate correspondence concerning claims and appeal process.

- Research reason for denial and collect more information and documentation, review system records to identify source of denial and health Information to collect necessary information and documents referral and authorizations for the appeal process.

- Review demographics, insurance and charge entries to assure correct input and system compliance

- Monitor error trends to determine if it’s a staff or system issue and I report to the Management.

- Perform Special projects that are given for follow up with the insurance

- Continuously validate and verify information needed for decision making or documentation

- May follow-up with parent if insurance has paid the patient, and for any other information needed to have The claim processed and paid.

- Prioritize work to facilitate payment of higher account balances.

- Identify and report trends in denial and appeal claims, inform manager, and work closely to identify appeal and follow–up strategy for getting the claims processed and paid.

- Assist co-coworkers when they need help

- And recommend adjustments for write-offs over my limit to the manager as appropriate and attach documentation needed for processing the adjustments.

List of references upon request.

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