Data Entry Customer Service

Tiffany Funk

Aurora, CO *****

*************@*****.***

720-***-****

Professional Summary

To obtain a position that will utilize my expertise and skills and that will allow room for growth and movement with opportunities to learn and grow not only in knowledge but as a person. Willing to relocate to: Denver, CO

Authorized to work in the US for any employer

Work Experience

Insurance Support Specialist

Med-El Corporation-Remote, CO

April 2024 to Present

Primary Responsibilities:

Provide direct insurance support for customers, patients, and medical professionals on behalf of and for Spanish and English-speaking customers.

Answer calls from physician offices, hospitals, and patients using exemplary customer service skills. Accurately enter required information into computer databases and other insurance related data entry to ensure proper and timely billing of claims.

Follow established procedures for submitting authorization and/or verification of eligibility for all requested items, as well as determine member benefit coverage for requested items. Call patients and/or providers back with information regarding authorization and any funds due Maintain patient confidentiality as defined by state, federal and company regulations. Establish effective rapport and maintain cooperative working relationships with other employees, professional support service staff, customers, clients, patients, families and physicians or other healthcare providers.

Actively support departmental and corporate strategic plans and ensure successful implementation. Responsible to assist accounts receivable staff in researching unpaid claims related to eligibility, prior authorization and other verification related denials. Perform day to day administrative functions and general office duties related to the reimbursement department.

Practices confidentiality and privacy protocols in accordance with company policies and HIPAA requirements

Exercises problem-solving and conflict resolution skills when handling patient complaints and follows company procedures when handling complaints as needed. Medical Billing Specialist

Welter Healthcare-Arvada, CO

September 2023 to March 2024

CO(Remote)

· Mental/Physical Health, SUD, Dispensation Medical Billing for Tribal Clinic in CA

· Insurance verification including Medicare, Medicaid(Medi-Cal) & MCO’s, Managed Care Plans, Commercial insurances.

· Verification of provider information on claims including but no limited to NPI, Taxonomy, Primary Diagnosis Codes.

· Claim Analysis and Reporting

· Large check payment posting including adjustments, write-offs, and balance transfers for Medicare, Medicaid, Managed Care Plans, Commercial Insurances.

· Accounts Receivables.

· Reporting of claims processing

· Share of Cost reporting with County via DHCS website

· Work claims rejections and errors and correcting for re-submission.

· Claim Appeals

Data Entry Clerk - Temp

Professional Home Health Care-Longmont, CO

July 2023 to August 2023

· New Client Intakes for skilled nursing, physical therapy, occupational therapy, speech therapy, personal care aides (home health aides) entering into Healthcare Advisor.

· Insurance verification including Medicare, Medicaid, Managed Care Plans, Commercial insurances.

· Data entry of demographics, providers, referrals, clinicians, diagnosis codes, and medication lists

· Entering clients into a 3rd party provider site for therapists if needed.

· Entering certification periods

· Transcribing OASIS discharge and reevaluation reports.

· Pulling EVV reports and verifying information and working EVV backlog reports.

· Pull Visit notes and Oasis reports from 3rd party site, verifying and closing corresponding EVV records in CellTrak.

· Entering start of care delay and face to face orders. Payroll Specialist Temp

Ledgent/Roth Staffing – For US Nursing/Fastaff-Remote August 2022 to March 2023

· Phone Customer Service

· Payroll Document Processing including Federal W4’s, Direct deposit information, and State Payroll forms for various states, to include entering the proper municipality localities for states with locality requirements.

· Providing customer service for various states during Job actions in states like California, Michigan, New York, and Oregon.

· Help in processing daily pay in required states during job actions.

· Weekly timesheet processing for New York client.

· Analyzing and processing of Kronos times entry weekly.

· Processing payroll corrections daily.

· Research and analyze any issues in pay from nurses including benefits, taxes, FLSA, 401K, bonuses, non-taxable pay.

· Securely emailing documents to nurses – ie: 2022 W2 & Paycheck stubs.

· Meet all deadline requirements for responsibilities and projects by staying organized and prioritizing my tasks.

Admin. Assistant/ Billing Specialist

Soul Dogs, Inc.-Remote

January 2022 to May 2022

· Serve as internal consultant and subject matter expert on billing project engagements and Therap.

· Identify and recommend client business process improvements.

· Facilitate and manage software development life cycle activities (Therap), such as requirement sessions.

· Communicate and/or translate business challenges.

· Serve as liaison between various stakeholder groups and other third-party vendors.

· Demonstrate and further develop an understanding of the Medicaid market, which includes understanding Medicaid programs and service delivery by participating in training courses, online learning, or through learning from more experienced colleagues.

· Accounts Payable - reviewed invoices for term correctness based on client contracts and submitted to Executive Director for payment.

· Developing relationships with state clients, health plans and/or vendors to compare products, services and technical too.

· Contribute to project work plans, and other formal project management deliverables relative to project initiatives.

· Contract Analysis - review external vendor and managed care organization contracts, state plans, federal waivers, and other documents (e.g., policies, manuals) to ensure compliance with regulatory requirements and contract standards or to develop best practice contract requirements for a client.

· Clinical Analysis - review and analyze encounter, claims, utilization, performance measure, and other data to look for trends and patterns and to inform clinical recommendations.

· Generates weekly billing data and sends professional claims to each funding source through Therap including Medicaid Waiver billing and Medicaid billing.

· Generates weekly caseload-based reports for director audit purposes; upload reports into SDI Income sheet.

· Collaborates with directors regarding any errors found in the billing process and to resolve any back billing situations.

· Performs audits on denied claims and identifies, documents, resolves and/or escalates issues to the appropriate level.

CBO Specialist

InterDent-Remote

November 2021 to December 2021

· Researching and reconciling A/R accounts for all government and commercial payors

· Resolving past due patient accounts

· Proving required documentation to insurance companies based on ERA Remittance or and/or denied EOB’s.

· Communication with all dental offices to find such required information.

· Use all Open Dental, EZDental, NEA/FastAttach, clearinghouses, government, and commercial website use.

· Communication with insurance companies to resolve payment issues. Insurance & Billing Specialist

Cascade Oral & Facial Surgery-Lake Oswego, OR

October 2021 to October 2021

· Verify Insurance benefits/coverage for patients prior to their appointments.

· Provide patients accurate cost estimates based on their insurance coverage.

· Billing/coding

· Submitting claims

· Claims follow up.

· Research and resolve insurance billing issues.

· Receives and sort incoming payments and posts payments in a timely manner.

· Handles complex coordination of benefits for patients with more than one type of insurance.

· Prior authorization processing

Insurance Specialist

Infinity Rehab, Inc.-Remote

March 2021 to July 2021

· Insurance verification - verify benefits with Medicare and verify eligibility with commercial and HMO insurances via phone and internet.

· Insurance authorization - contact insurance companies for pre-authorization.

· Establish and maintain accounting practices to ensure accurate and reliable data necessary for business operations including Accounts Receivable, Accounts Payable and General Ledger.

· Sets up patient accounts in billing software program.

· Accounts Receivable - Collections as needed, private pay and insurance.

· General Office: Filing, faxing, and mailing, attending team meetings, and other duties as needed.

· Assists with preparation of financial related materials as needed.

· Assists with other activities as directed by supervisor or Executive Team.

· Assists with back up entering of charges/billing into billing software program. Insurance Follow-Up Specialist

HealthCare Outsourcing Network-Remote

September 2020 to January 2021

· Analyzing insurance payments and denials, looking for reasons for shirts pays and denials and figuring out why there is an amount still outstanding.

· Calling insurance companies or sending needed documents required from the insurance company to close and receive payment on the claim using the EMR in our customer’s EPIC system, contacting customer is needed information is not in the patient record, contacting the patient is the information needed can be obtained from the patient or is needed directly from the patient to the insurance company.

· Analyzing the payment record if there is an outstanding balance that does not match the EOB(s) on file and figuring out if there is an error in posting or in payment and getting that error resolved. Sr. Advisor II, Transaction Processing

Concentrix-Remote

July 2018 to April 2020

· Analyzing CMS 1500 claims for payment for Arizona Medicaid program to include doctor office, surgery, maternity, OT/PT/ST for pediatric and adults, in and outpatient, radiology, pathology, anesthesiology, skilled nursing and others when needed.

· Checking for COB of other insurance, checking files for proper prior authorizations required for processing, making sure all necessary elements are in place prior to authorizing a payment, processing required claims through McKesson for proper processing including reduction of payment and denial due to bundling, checking patent history to confirm allowable and max procedures, checking images in two systems to verify patient information, and needed information such as anesthesiology times.

· Verifying ICD-10-CM diagnostic codes and modifiers for proper processing Reimbursement Specialist

Bioscrip,Inc.-Aurora, CO

November 2017 to July 2018

· Processing Home Infusion claims in CPR+ for commercial, Medicaid, Medicare, and patient pay for all types of home infusion billing, including Chemo, Chelation, Enteral, IVIG, SCIG, Hydration, Anti-Emetic, and other therapies for most states across the US

· Processed Credit/Rebills.

· Completed Collections projects.

· Worked on Medicare claims across the US as well.

· Printed and sent secondary claims as needed.

· Looked for all required documentation for each insurance as required including DIF’s, AOB’s ABNs, and more as determined but insurance type regulations. If documentation was not there or was out of date, the claim was placed on hold.

· Created CMN’s including initial and revised.

· Worked on the held report for Medicare.

· Released older claims when documentation was presented, and claims could be released.

· Scanned documentation into an MRO electronic documentation system and organized into date and type folders.

· ICD-10-CM coding and diagnoses verification for proper reimbursement and processing.

· Verifying EDI submissions and correcting any errors. HR & Billing Director

Authentic Home Care Inc.-Aurora, CO

May 2017 to November 2017

· Weekly Medicaid billing including Adult Day Care Services and HCBS and IHSS professional claims.

· Analysis and reconciliation of all insurance payments and research and follow-up for any non-payment items.

· Primary Insurance UB-04 claims/1500 claim submissions.

· PAR submissions for Medicaid for Long Term Home Health Pre-authorizations and In Home Services Support – Adult.

· EMR system integration from paper records to Cashe and training of all office employees.

· Collect and audit employee charting per pay period per Medicaid regulations.

· Process payroll through Wells Fargo for over 90 employees, both bi-weekly and monthly, including any garnishments and child support processing.

· Created billing tracking system prior to EMR system.

· Coding for 485’s and Adult Assessment tools if needed.

· Doctor DORA verification and NPI verification.

· OIG Exclusion verifications.

· DORA verification for employee’s licenses.

· Run background checks prior to employment.

· ICD-10-CM diagnosis coding for submission of PAR to state of Colorado Owner

Special Angel, LLC-Aurora, CO

October 2015 to February 2017

· Weekly Medicaid billing Primary Insurance UB-04 claims/1500 claim submissions.

· 485 reviews for proper codes and tracking for Pre-Authorization submissions.

· PAR submissions for Medicaid for Long Term Home Health Pre-authorizations and In Home Services Support.

· EMR system integration from paper records twice.

· Created training manuals for new system charting for CNA’s.

· Collected and audited CNA charting weekly per Medicaid regulations.

· Reported CNA hours weekly for payroll.

· Created billing tracking system prior to EMR system.

· Insurance claim denials and reprocessing.

· Coding for 485’s and Pediatric Assessment tools if needed.

· Doctor DORA verification and NPI verification.

· ICD-10-CM/ICD-9-CM diagnosis coding for PAR approval and CPT coding for proper claim submission Parent CNA

All For Kid’s Home Health-Denver, CO

October 2015 to November 2016

· 24/7 CNA tasks for my special needs son

Parent CNA

Evergreen Home HealthCare-Aurora, CO

September 2014 to October 2015

· 24/7 CNA tasks for my special needs son

Sales Coordinator

Marubeni-Itochu Steel America, Inc-Nashville, TN

October 2006 to April 2011

· Purchase Orders.

· Created and tracked monthly steel orders from raw material to steel coil processing – utilizing vlookup and many other formulas.

· Price negations with new customers.

· Tracked all shipments of customer orders.

· Created sales reports monthly.

· Prepared sales meeting notes and presentations.

Office Manager

Comfort Dental-Aurora, CO

May 2011 to February 2002

· Billing for all insurances.

· Credentialing for all providers.

· Scheduling of all providers and employees.

· Insurance denials.

· Accounts Receivables.

· Processing of all Insurances payments and patient payments.

· Calculating patient treatment plans.

· Patient check-in and out.

· Proper ICD-9-CM CPT coding for proper reimbursement on procedures and visits.

· Applications for becoming In Network providers for all Dentists in the practice.

· Fees/Rates tracking and negotiation.

· Payment posting for insurance checks and patient payments.

· Research patient refunds

· Front Office Employee Scheduling

Education

Associate's Degree in Health Information Technology DeVry University

July 2015

Associate's Degree in Allied Health

Cambridge College

June 2001

High school diploma or GED

Skills

• Care plans

• Excel

• Transcription

• Cash application

• Math (10+ years)

• Recruiting

• Home health

• Patient interaction

• AS400

• Construction Billing and Invoicing (2 years)

• Writing skills

• CPT coding

• Data entry

• McKesson

• Live chat

• Revenue cycle management

• Proofreading

• Human resources

• Accounting

• AdvancedMD

• Google Docs

• EZ Dent

• Windows

• Nursing

• Adobe Acrobat

• Customer support (10+ years)

• CPR

• Behavioral health

• Marketing

• Clerical experience

• POS

• OSHA

• Customer relationship management

• Construction

• Medical transportation experience

• SharePoint

• Sales

• Medical scheduling

• ICD-9

• Word

• Cerner

• Time management (10+ years)

• General ledger accounting

• Long term care

• Basic math

• Financial management

• Front desk

• Data analysis skills

• Team management (3 years)

• Typing

• Medical Terminology (10+ years)

• HIPAA

• Epic

• PowerPoint

• HCPCS (3 years)

• Information management

• Medical office management

• Order entry

• Medical coding (8 years)

• Pediatrics

• Kronos

• EHR systems

• EMR systems

• ICD-10

• Telehealth

• Accounting software

• Analysis skills

• Project management

• Anatomy Knowledge

• Microsoft Access

• Outpatient

• Supervising experience (2 years)

• Test-driven development

• 50 wpm & 10 key

• Accounts payable

• Pivot tables

• Customer service

• Root cause analysis

• ADP

• EDI

• Computer operation

• Research

• Dentrix

• ERP systems

• Medical office experience

• Managed care

• CPR+

• Contracts

• Cost Accounting Standards

• Full Cycle Revenue Management

• Payment processing (7 years)

• Leadership

• Bank reconciliation

• Account analysis

• Healthcare management

• Cash Posting

• Search engines

• Quickbooks

• Innovation

• Organizational skills

• Communication skills

• Accounts receivable

• Administrative experience

• ICD coding

• PeopleSoft

• Software troubleshooting

• Open Dental

• Office management (3 years)

• Payroll

• Accounts Receivables - Construction

• Schedule management

• Account reconciliation

• Microsoft Excel (10+ years)

• Negotiation

• Dental terminology

• Google Suite

• Microsoft Office (10+ years)

• DME

• Dental clinic

• Medical billing

• Document management

• Insurance verification

• eClinicalWorks

• Auditing

• Physiology knowledge

• Documentation review

• Pricing

• Medicare

• Microsoft Outlook

• Databases

• Caregiving

• Ob/Gyn

• Workday

• Home & community care

• Medical records

Languages

• English

Certifications and Licenses

Certified Medical Assistant

Driver's License

RHIT

CNA

State Tested Nursing Assistant

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