Dorothy Mitchell

**** ****** ****, *******, ** **125

901-***-****(H) 901-***-****(C)

disnb2@r.postjobfree.com

Professional Experience

SPHERION (Accredo) Memphis, TN 2010 -2011

Claims Processor

Followed established procedures, billed patient insurance, and other third-party carriers.

Answered inquiries regarding patient accounts while abiding by HIPPA Guidelines.

Contacted insurance companies to inquire on payment, denial and to verify if patient re-enrolled.

Billed, credited and processed invoices.

Posted payments and billed patient Co-Pay.

Obtained information to meet billing standards established by payer (i.e., Certificates/Statements of Medical Necessity (CMN), Prior Approvals, etc.)

Collect outstanding balances through telephone and written communications

Transcript collection letter to patient on delinquent account and possible insurance suspension

Provide follow up on identified issues and discrepancies

Maintain and generate delinquent accounts and other collection measurements.

Professional Experience

MidSouth Pain Treatment Center 2009-2010 Office Clerk

Performed medical office duties including: Verified insurance, answered phones Medical records requests, scheduled patient appointments and referrals, registered patients and entered all billing

Professional Experience

AMERIGROUP (formerly Memphis Managed Care) Memphis, TN 2001-2008

Billing Representative Specialist

Provided doctors and provider/members information concerning professional and institutional medical insurance claims including: OB/GYN payments or denials, appeals, pre-certs, Prior Authorization, Reimbursement on Medicare, Medicaid and Commercial Insurance.

Retail – Responsible for store opening and closing, maintained daily cash count, completed bank deposits, customer service cashier, stock and inventory

Handled denials by correcting codes

DME billing

Appeals, Appeals Coding, Billing, Physicians, Co-Pay Assistance, Claims Research, Patient Assistance.

Scheduled transportation for patient doctor's visits.

Assisted members in locating Home Health Agencies.

Updated Members' Medical Eligibility Benefit Status with Medicare and Medicaid.

Received incoming calls on Customer-Service Provider Line regarding health insurance.

Supported doctor provider staff with answers to complex insurance claims and payments.

Adept at aggressive trouble-shooting and diligent problem-solver.

Provided appropriate procedures and guidelines to TLC (Amerigroup, Memphis Managed Healthcare to providers and members). Entered data regarding patient information and phone notes to claim adjudicator. Posted items to patient accounts

EDUCATION AND TRAINING

Diploma, Hamilton High School, Memphis, TN

Introduction-To-Computer, Messick Vocational- Certificate

10-Key Data Entry, Sheffield Vocational

Secretarial Development Training, Sheffield Vocational

Business Management @ Accounting, Trezevant Vocational

Skills

Data Entry 10 Key

Microsoft Applications Internet/Intranet

Word Perfect Excel

Claims Adjudication Medical Biller Diagnosis Codes

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