Pharmacy Billing & Collections Specialist

Carolyn D. Armstrong

* ********* *****

Newark, DE 19702 302-***-**** (H)

302-***-**** (C)

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

OBJECTIVE

To secure a challenging position that requires strong leadership, relationship building, and excellent communication skills to surpass company objectives and customer expectations.

Qualifications

A goal oriented, take charge professional with over 15 years of diverse experience in positions of increasing responsibility, known for open-door management style that leads to cohesive teams and increased productivity.

EXPERIENCE

May 2021-Current Grane Supply, INC LLC Pittsburgh, PA

Pharmacy Billing & Reconciliation Specialist

•Generate Invoices

•Post charges and payments to accounts; individual patients, group homes, nursing homes, and Independent Patient Accounts

•Generate Monthly Billing Statements

•Answer calls for billing questions regarding account errors or clarification. Issue credits or correct charges accordingly

•Charge credit cards for designated accounts on a monthly basis, post payments and mail receipts

•Monitor all accounts for errors and past due payments, call insurance companies when needed

•Reconcile all EOB’s each month as they are received

•Make sure EOB’s are completed in time for the Bank review

•Be sure that we are collecting ail revenue due

•Bring to Supervisor’s attention any discrepancies over $1,000.00

•Generate Monthly Aging Reports

•Monitor, make phone calls to track down payments accordingly

•Forward accounts to collections when needed

•Maintain collection accounts, solve problems with other billing issues

•Bill all claims to the appropriate insurance companies and make sure they are processed in a timely and accurate manner

•Check all forms for accuracy of information, completion of all questions, diagnosis codes and procedure codes and signatures of patients

•Contact Physician’s office for any information needed for patients, such as a Certificate of Medical Necessity (CMN), diagnosis codes, and current insurance information

May 2017-May 2021 Elwyn Specialty Care-Biomatrix Garnet Valley, PA

Pharmacy Billing & Reconciliation Specialist

•Generate Invoices

•Post charges and payments to accounts; individual patients, group homes, nursing homes, and Independent Patient Accounts

•Generate Monthly Billing Statements

•Answer calls for billing questions regarding account errors or clarification. Issue credits or correct charges accordingly

•Charge credit cards for designated accounts on a monthly basis, post payments and mail receipts

•Monitor all accounts for errors and past due payments, call insurance companies when needed

•Reconcile all EOB’s each month as they are received

•Make sure EOB’s are completed in time for the Bank review

•Be sure that we are collecting ail revenue due

•Bring to Supervisor’s attention any discrepancies over $1,000.00

•Generate Monthly Aging Reports

•Monitor, make phone calls to track down payments accordingly

•Forward accounts to collections when needed

•Maintain collection accounts, solve problems with other billing issues

•Bill all claims to the appropriate insurance companies and make sure they are processed in a timely and accurate manner

•Check all forms for accuracy of information, completion of all questions, diagnosis codes and procedure codes and signatures of patients

•Contact Physician’s office for any information needed for patients, such as a Certificate of Medical Necessity (CMN), diagnosis codes, and current insurance information

2008-January 2017 New Castle RX, LLC. New Castle, DE

Pharmacy Billing & Reconciliation Specialist

•Ability to communicate effectively with coworkers, residents, facilities, responsible parties (Family Members), and the general public

•Perform functions of computer/data processor

•Maintain patient confidentiality

•Answer phone messages on voicemail

•Read and respond to emails

•Enter census and work no known payer report from previous day

•Collection calls, monitor and collect accounts receivable report delinquent accounts to General Manager

•Key remittance and post cash to appropriate charge accounts. Records payments posted to monthly cash breakdown spreadsheet

Billing Coordinator

•Review and generate facility statements (interim/monthly) accurately, timely, and completely

•Assist in identification and resolution of billing discrepancies, ensure prompt communication to ail appropriate parties

•Review and analyze end-of-day reports (audit action, manual variance, write-offs, etc...) for accuracy

•Facilitate new account set-up including, but not limited to, patient information and miscellaneous facility charges to ensure Pharmacy can process prescriptions

•Process changes received from facility staff or responsible parties to ensure accurate and timely billing

•Monitor residents in Medicaid Pending status and execute timely changes to secure financial responsibility

•Work closely with PharMerica Collections Associates to verify insurance information ^and if appropriate, rebill charges to appropriate payer

•Work electronic claims log to resolve rejections

•Fax prior authorizations notifications to the appropriate facility contracts

•Do a bank deposit twice a week. Record deposits made to monthly cash deposit log. Balance cash receipts posted to QS-1 deposits made

•Filing

•Update prior authorization spreadsheet and email to appropriate facility distribution list

•Review the interim statement report for each facility to review house stock charge accounts for "99999" charge account and fix accordingly

•Work all facility daily census activity reports

•Tie out cash deposited to cash posted in QS-1

•Generate statements for facilities by the end of the month

•Enter medical records and consulting charges by the 15*" of each month

•Run primary and secondary monthly revenue reports and post all charges to their corresponding charge accounts

•Check ail interim statements for homes against monthly census reports sent by the facilities

•Generate all remaining statements

Send all month end documentation to the corporate office

August 2005-Janaury 2006 Vision Quest Wilmington, DE

Medical Billing Supervisor

•Manage the efforts of 3 Medical Billing Representatives for the collection of current or delinquent accounts on behalf of Medicaid

•Coordinate PA Medicaid conversion to begin billing ail problem youth to Medicaid

•Processed reconciliation of month end statistics to home office in Tucson, Arizona

May 1998-May 2005 Hospital Billing & Collection Services Newcastle, DE

Accounts Receivable Supervisor

•Manage the efforts of 24 Representatives for the collection of current or delinquent receivables on behalf of member hospitals

•Develop strategies to maximize account coverage

•Ensure compliance with HIPPA standards in billing and collections

•Hire, motivate, retain, and evaluate staff

•Develop and maintain relationships with ail other reimbursement departments

< Develop production and quality standards, lead quality improvement initiatives

•Review and improve billing process to ensure customer satisfaction and timely receipt of insurance payments

•Conduct system and account audits to ensure validity and accuracy of data and system measurements

•Assist in identification and resolution of specific carrier problems or system issues

Maintain and update reporting systems, databases and process required system reports

May 1996-1998 Collection Support Quality Coordinator

•Work to optimize efficiencies between Collection Support Representatives and Liaison Staff to minimize time to complete rebills, itemized bills, and other work between facilities

•Coordinate efforts to balance new business and cash file transmissions on a daily basis

•Organize office operations and procedures to provide efficient completion of the following tasks. Batch Cash Error Report, interim Late Charge Entry, On-Line Cash, Audits, Credit Balances, Mail Return, and annual companion rating for all hospitals within the cooperative

•Copy and distribute ail Reports for Account Representatives to Supervisor

•Track employee attendance and lateness for Supervisor

•Compile and maintain data to measure departmental and individual productivity

•Train Collection Support Representatives on system in adherence to company policies and procedures

•Formulate procedures for systematic retention, protection, retrieval, transfer, and disposal of records

•Identify and report ail system problems

•Coordinate with other Quality Coordinator's to ensure appropriate support is provided as defined in policies

•Conduct quality audits to ensure compliance to hospital requirements, as well as State and Federal regulations

May 1994-May 1996 Ancillary Service Analyst

•Review and reconcile ail Bad Debt related member Weekly Audit, Credit Balances, Edit/Reject Cash Reports, which include the legal portions of all reports

•Communicate with member hospitals to resolve any outstanding issues related to their Audit, Credit Balance accounts or any Cash related issues, may be asked to make on-site visits to the member hospital to assist in resolving audit/cash report related issues

•Ensure all monthly invoicing is completed and forwarded to the Finance Department in a timely Fashion

•Serve as a resource to the Bad Debt Management Staff with issues related to cash postings and. audit related issues and or legal related posting issues

•Devise and maintain systems to derive the maximum benefit at the lowest cost for Metro Net and legal processes, as assigned

•Interface with all vendors who provide services associated with assigned processes

•Act as support representative for the entire Ancillary Services Unit and Bad Debt area as it relates to cash, legal, or skip trace issues

•Research and analyze all legal reports in reconciling them with both the HBCS system and the member system

•Required to assist with training employees, addressing complaints, and resolving problems

•Effectively relay to HBCS Senior Management the level of member satisfaction with the audit and cash related issues

February 1992-March 1994 Patient Accounts Representative

•Responsible for customer service and collections of Bad Debt accounts

SKILLS

May 1989-1991 Goldey Beacom College

Studied courses towards a Degree in Business Administration May 1999 Truth Bible Institute

OTHER

Certified Discipleship Facilitator

September 2004 Christian Research & Development

Certified Biblical Counselor

References

Adrienne Indellini 302-***-****

Mrs. Anne Parrish 267-***-****

Regina McGowan 484-***-****

Marge Hercker 610-***-****

Dr. Raymisha Sudler 302-***-****

February 2006-July 2008 PharMerica Newark, DE

Microsoft Word Access Software FACS System Xactimed System Point Click System Sage Financial

April 2010 University

Associates of Arts Degree in

Microsoft Excel Crystal Software Shared Medical System Keane QS-1 Billing System

EDUCATION

Ashford

Administration-Cum Laude

Microsoft PowerPoint Contact Medical System Magic-Meditech System First Coast Meditech Framework

Clinton, Iowa

Wilmington, DE

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