Medical Insurance

Alinda Franklin **** Auburn Drive

Beaumont, Texas77705

512-***-**** Cell 409-***-**** Home OBJECTIVE: To obtain a long term and challenging position with a reputable and progressive company that is dedicated to the advancement of their employees and customers that are being served.

Work Experience:

Health Screener-Onsite Health Diagnostics-(PRN)10/2011-Present,AustinTexas

Onsite Health Diagnostic system of early detection diagnostics is a proven process that can be tailored to each employers specific needs. Through analysis and comprehensive test guide we can give employers the power to create a program that is completely customized to fit their needs.

Providing health screens for participating companies for their employees checking blood pressure, height, weight ,body mass index, cholesterol (LDL and HDL),cholesterol ratio, glucose via finger stick.

Patient Account Rep.-STAT Medical Staffing(TEMP Assignment)02/2011- 05/2011,San Antonio,Texas.

Dealing with insurances, such as Blue Cross, Aetna,Humana,United Healthcare,Cigna, and Tricare Insurance,Medicare and Medicaid. Working knowledge of ICD-9 and CPT coding,experience in claims resolutions. Billing and appealing of charges for outpatient Oncology procedures.Account receiveables,preparing daily A/R reports.Correction of all charges that are billed out.Also handle charges that are paid below fee schedule requirements according to the facilities contract with the insurance companies.Appealing of claims that are denied due to insufficient medical documentation, such as no Authorizations or Pre-Certifications and Notifications from insurance companies.Coordinate with the referring Physicians office to make sure all documentations are in place prior to the procedure taking place.Handling of incoming and outgoing calls from patients and the insurance companies as required.$10,500.00

Patient Account Rep./Team Lead-Austin Radiological Association 8/2006- 11/2010, Austin,Texas Dealing with Medicaid and Medicare insurances. Private insurances such as Blue Cross, Workers Comp, Aetna, Humana, United Healthcare , Cigna, and Tricare Insurance. Working knowledge of ICD-9 and CPT coding, experience in claims resolutions using HCFA 1500 . Billing and appealing of charges for outpatients/inpatients charges. Account receivables/Account Payables - preparing daily A/R,A/P reports working on special assigned projects, complies data, and preparing reports .Team Lead of 6 members which is required on a daily basis to report all accounts that are past 120 days without a resolution from the insurance to immediate Team Leader overseeing the current status of patient accounts and assisting in identifying and resolving billing and processing problems. Assist with entering charges and payment posting -performing coding and error resolutions, communicating with internal and external staff. Distribute work when a team member is out due to illness or vacation .Assist Supervisor with hiring new employees. Also handle charges that are paid below fee schedule requirements according to the facilities contract with the insurance companies. Appealing of claims that are denied due to insufficient medical documentation. Handling of incoming and outgoing calls from patients and the insurance companies as required.$29,900.00 yr.

Accounting Assistant 1/2005 – 6/2006 Ascension Health Care Systems(Seton), Austin, Texas § Medical lab billing.Handling lab billing for all of Seton entire network. Dealing with Medicaid and Medicare insurances. Private insurances, such as Blue Cross, Aetna, Humana and Tricare Insurance. Working knowledge of ICD-9 and CPT coding,experience in claims resolutions. Billing of lab charges for inpatients and outpatient to CPL and Lab Cor.Handling SSI UB-92 inpatient and outpatient charges.Account Receiveables,preparing daily A/R reports to be discuss in meetings.Correction of all charges which are billed out and payed, below fee schedule requirements.Handling all incoming and outgoing calls. 27,500.00 yr.

Medical Insurance Billing/Temp.Employment 7/2004 - 1/2005 Sensory Specialist of America, Austin, Texas § Worked on Claim Gear software. Worked with Georgia Medicare/Medicaid and commercial insurance plans. EOB posting and collections. Posted charges and ran AR reports daily. Patient contact by phone. Performed Medical procedure authorizations for billing purposes.Kept up daily reports for the physicians as required.Checked on all payments recieved by the insurance companies to insure proper reimbursements were recieved according to the fee schedules. Claims appealing with proper documentation for the procedure that was performed.Make sure paperwork is kept up-to-date and filed.Perform other duties as assigned.11,500.00 yr.

Medical Billing/ Collector (Temp Employment) 1/2004 - 5/2004 Health Specialist Staffing, Austin, Texas § Handling all government insurance claims.Medicaid,Medicare,Superior And Seton Chip.Electronic billing and appealing of claims that paid and denied.Verify coverage and the line items billed by the physicians are payable by the insurance company.Checking on the referrals for the line items.Verify payable procedure code for proper reimbursement.Appealing claims with medical records as proper documentation for the procedure done. Help the physicians to maintain accurate diagnosis on the claims are payable by the insurance company.Continous customer service with the physicians,their team members and the patients. $27,500.00 yr.

Claims Analyst II/ Researcher 6/2001 - 12/2003 National Heritage Insurance Co, Austin, Texas § Prior authorizations for surgical procedures,verify eligibility,medical claims billing/appealing.R&S report balancing and collections. Handling all incoming calls concerning paid and denied claims by the physicians office staff.Research problem claims when physician office staff are unable to understand the denial code that was given.Return calls on all researched accounts. $27,500.00yr.

HIM Coordinator 05/1998- 5/2001 Heart Hospital of Austin, Austin, Texas §Responsible for maintaining health information, accurately sorting and filing medical records and documents in medical charts.Validates requests and authorizations for release of medical information according to established procedures • Excellent organizational skills.Answered all incoming calls, fax medical records, gather all discarded records, and assist director with problem solving.$23,350.00 yr.

Medical Assistant 02/1995-04/1998 Family Medical Clinic,Austin ,Texas- Patient assessments including vital signs, mini-mental assessments, assisting with diagnostic procedures, recording data for medical records, skills and ability to triage patient problems appropriately, including phone triage & out-patient treatment. Obtaining & inputting accurate information for patient records, providing patient follow-up regarding prescriptions, referrals, diagnostic testing, patient check In and check Out as needed, patient/family education through literature & community service recommendations.

EDUCATION: 6/1992 Lamar University- Beaumont, Texas § Bachelor's Degree § Degree in Elementary Education

01/1995Allied Health Careers- Austin, Texas-Certified Medical Assistant and Phlebotomist

SKILLS: Microsoft Windows 0.7 ,Power Point, EXCEL, Medic, Group Cast Billing System, Medi Soft ,Centricity, MARS, eClinicals Work , Navi Net, Availity

REFERENCES:

Jae Sanchez 512-***-**** –Supervisor

Kathy Humphries 512-***-****-Director of Billing Dept.

Burnett Howard 512-***-****-Admin Executive

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