Accounts Receivable Customer Service
Resume:
Ayelet Nachum
**** ******** ****** *** *****
Philadelphia, Pa 19111
******.******@*****.***
Skills & Qualifications
Customer Service Experience 7+ years and management field
* ****s’ experience with Claim Processing, billing as accounts Receivable & ICD 10
Excellent leadership Skills, Motivated, Attention to Detail, Organized & Detail Orientated, Independent worker, Punctual and Reliable Solid Problem-Solving Skills, Decision making skills and strong verbal written and communication skills
Citrix, Relay, PA Medicaid Portal and CMS Portal, Tower Health
AdvantX, Zirmed Outlook Express, Jiva, Macess, Facets, Windows, Navinet, Emdeon, NEXTGEN
Experience
Credence Home Care Caretaker 08/18/2018-Current
Meal preparation & Feeding assistance
Monitoring Clients Diet, Medication Reminders
Appointments for Clients, Attend Appoints and assist with Transportation
Help with Getting in or Out of Bed; Safety Supervision Bathing and Showering Assistance; Assistance with Toileting – Take patients on errands as needed
Physicians Endoscopy Billing Representative 07/24/2017-05/08/2018
Responsible for DDEC and Communicate w/The centers Front Desk regarding issues with the center and patient concerns and any billing issues. Billing Claims on Daily Basis
Log Payments from Insurance company through Zirmed as well as post EOB’S- Submit Adjustment on patient accounts as well as refund patient CC when no Patient responsibility.
Accounts Receivable Follow up, work with all insurance portals to receive claims details such as rejection and payments. Submit Appeals and Medical Records and communication with Provider rep from insurance companies for claims issues.
Communicate with Manager regarding payer and account issues in a timely manner
Monitor accounts for other opportunities to collect payments at time of service (i.e. co-pays, deductibles and coinsurance)
Enter all appropriate comments in software system clearly and concisely for tracking documentation. Responsible for working with patients on Phone Calls timely. Working aging reports through Advantx. Run different reports in AdvantX when needed to run the Center appropriate.
Fresenius Vascular Care Accounts Receivable Rep 06/09/2016-01/06/2017
Ensures that all charges billed on behalf of FVC centers are paid accurately and billed correct.
Reviews the updated denial management log listing accounts that are denied, underpaid or overpaid. Researches the account listed in billing application, reviews the Explanation of Benefits (EOB) that specifies how the insurance carrier processed the claim and the reason for denial or incorrect reimbursement.
Resubmitting corrected claim due to internal billing error, requesting claim reprocessing for insurance reprocessing error, submitting/resubmitting primary EOB, correcting patient demographic and/or insurance information, correcting Coordination of Benefits (COB) information, submitting appeal for missing authorization, and/or submitting appeals for medical necessity.
Correcting COB information, requesting claim reprocessing per contract and surgical procedure reimbursement policies for insurance reprocessing errors, submitting/resubmitting primary EOB, requesting takeback or future claim offsets to resolve overpayments, preparing internal refund request with all EOBs, providing explanations for overpayment and any pertinent supporting documentation.
AmeriHealth Caritas Provider Claims Services 03/18/2013-11/13/2015
Responsible for responding in a timely, professional, and courteous manner to all provider needs. Handling provider calls or correspondence regarding benefits, eligibility, and other provider issues.
Reviews and adjudicates claims online based on provider and health plan contractual agreements and claims processing guidelines.
Handle and resolve claim inquire, complaints and appeals received by the providers
Resolve all assigned claim reconsiderations requests through MACESS.
Investigate and facilitate timely resolution on suspense conditions using MACESS service forms within 48 hours of receipts. Demonstrates solid knowledge if Provider Service/Claim Systems, functions, and team process.
Central Wholesalers Senior CSR 10/13/2010-01/18/2013
Receive, allocate and release all orders that are current or on back order Verify MS shops, print MSDS Sheets & Assist with new Hires.
Initiate or cancel sales orders and obtain details of complaints/discrepancies via telephone, fax, e-mail, or internet. Process kitchen cabinet quotes as well as regular merchandise quotes
CSR – Key punch orders, Eta's, and check availability. & communicate with buyers regarding products that are due in. Key Punch Cabinet and Countertop Orders, delivery and product issues as well release backorders.
David Bridal Corporate Trainer/SR CSR/Lead 05/200*-**-****
Key punched new orders, changes to existing orders, price adjustments, and checked availability on styles and colors pertaining to bridal gowns etc.
Answered incoming calls from stores and the West Coast Regional manager regarding customer issues. Assisted co-workers with difficult store concerns; responded to priority emails and priority comments with timely and accurate information
Provided detailed documentation on customer situations; Created manuals on all the procedures for the call center
Education
University of Phoenix Business/HR Associate Degree 2012
Computer Learning CTR ITSP Diploma 1998: Northeast High School Business Management High School Diploma 1997
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