Remote Member Support Coordinator Candidate with Healthcare Experience

J O E Y R O U S E R

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

Contact Not 346-***-****

PROFESSIONAL SUMMARY

Career experience consists of 9 years in the Healthcare Billing, Coding & Reimbursements Industry. Broad experience adhering to HIPPA Guidelines, CMS edits, and Texas Prompt pay Laws. Proficient in office administration interacting with patients and physicians in a professional and timely manner. SKILLS

Excellent communication and

customer service skills. Quick learner,

listener and team player. Knowledge

of HCPCS Codes, EM Codes, ICD-9 &

ICD- Codes and CPT Codes modifiers.

Programs Centricity; Cmeds1; Med

Solutions; EDILIVE; Elligence; RIS

Electronic Claims Submission Availity;

All Scripts; Access Net; Novitas;

Surgical Notes; AdvantX EPIC and

MyChart

EXPERIENCE

Fulfillment Team Member, Amazon, Aug 2023 Current, Dallas, TX Marked containers with labeling and stocked shelves to organize products. Pulled merchandise from stock to load onto pallets. Moved orders to and from packing and shipping areas to facilitate fulfillment. Trained and mentored new order pickers to improve productivity, accuracy, and safety practices.

Apparel & Sales Associate, Goodwill Industries of, Jan 2020 Jul 2023, Houston, TX Provide satisfaction and professional customer services to customers Meet daily quota and inventory control

Elevate complaints to management

Checked hanging racks and shelving regularly to locate misplaced items. Coding & Billing /Team Lead, Texas Managerial Medical Services, Sep 2014 Jun 2018, Houston, TX

Managed Medical Billing, Coding and Reimbursement of claims, for several facilities that specializes in Nuclear Medicine, Sleep Studies, Physical Therapy, and Chiropractic back pain

Lead team and advised, trained and mentor ship as needed JR

Verified patients' insurance and eligibility for Medicare Replacements plans, commercial plans and workers comp claims

Obtained prior authorization for HMO plans, and referrals for outpatient procedures Reviewed and interpreted Physician progress reports prior to billing Filed claims electronically through Availity for in and out of Network providers and make necessary corrections for any claims rejected by the clearinghouse Followed up with insurance carriers for claim status 15 business days after claim is submitted

Kept up with updates from CMS, referenced LCD and NCD edits Post eft's and eob's from online web portals

Post payments, apply adjustments, transfer funds to patient's copay or deductible amounts

Bill secondary, and tertiary carriers if apply

Audited claims to identify trends and tactics insurance carriers use to decrease revenue

Contacted patients to offer settlement amount before forwarding to outside collections

Maintained and improved knowledge of policies, procedures and skills through participation in conferences, team meetings, departmental training, and computer-based training.

Medical Billing & Coding Specialist, Brown Medical & St. Michael's Surgery Centers, Jun 2013 Aug 2014, Houston, TX

Hospital billing and coding

CPT and HCPCS coding

Billing Micro vascular orthopedic and carpal tunnel claims to Medicare and insurance providers on UB-92 and CMS-1500 Forms, via electronic claims submission clearinghouse programs

Knowledgeable of Medicare DRG, reasonable and customary amounts Followed up on claims billed to insurance carriers within 15 business days of submission, via online web portals or by phone, to insure prompt reimbursements Reviewed and researched paid claims to assure reimbursement amounts are not below the contractual expected amount

Negotiated and approved payment for third party proposal agreements Verified patient's benefits, and eligibility

Assisted patients with questions about billing and account analysis. Medical Insurance Reimbursement Specialist, Excel Diagnostics Oncology Centers, Jun 2009 Jun 2013, Houston, TX

Audit commercial claims for high end Neuroendocrine imaging facilities Renegotiated and resubmit claims paid below the expected Medicare allowed amount

Audit in network and out of network claims

Recognized trends and denial codes

Submit claims for litigation with supporting documentation when flagged by insurance providers

Submit reconsiderations for first and second level appeals to insurance providers Type here]

EDUCATION

Bachelor of Science, Healthcare Administration

University of Phoenix Houston, TX

Certification - Medical Insurance Billing & Coding National Institution of Technology Houston, TX

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