Billing Manager
Resume:
SANDRA D. STEINKOENIG
GRANITE CITY IL 62040
************@*****.***
SUMMARY OF QUALIFICATIONS
Brief Summary:
Results-Oriented Medical Claims Processing, Billing and Customer Service Skills
Good working knowledge of medical claims processing and billing
Good working knowledge of medical terminology
Good working knowledge of CPT, ICD-9, HCPCS, DRG and Revenue Codes
Good working knowledge of Medicare CCI edits
Good data entry skills resulting in 10,000 kpm
Answers the phone in a professional and courteous manner
Ability to multi-task
Ability to solve problems
Ability to learn new software programs
Friendly, outgoing personality, and a team player
PROFESSIONAL EXPERIENCE
Firstsource-Belleville Illinois 10/2009-Present
Account Resolution Specialist
Worked patient accounts for three different clients to get the balance to zero
Contacted insurance companies to investigate payment details
Billed UB-04 claims to Commercial, Medicaid, Workers’ Compensation, and Third Party Liability insurances, Type of Claims included Inpatient and Outpatient claims
Billed CMS-1500 claims to Commercial, Medicaid, Workers’ Compensation, and Third Party Liability Insurances, Type of claims include Radiology, Physical Therapy, Emergency Room, Surgery, Pathology and Laboratory Services
Appealed claims
Checked payment against contracts
Checked payment against the IL Work Comp State Fee Schedule
Examined EOB/EORs
Posting payments and adjustments
Verified patient eligiblilty
Utilized Xactimed, Emdeon, SSI, Meditech, IDX, FACS , Rehab Toolkit billing systems
Healthcare Financial Resources-St. Louis, Missouri 04/2009-09/2009
Third Party Account Representative
Worked patient accounts, which included mini account to high dollar account, to get the balance to zero
Contacted insurance companies to investigate payment details
Billed UB-04 claims to commercial insurance and supplement Medicare and Medicaid insurance companies, Type of claims included Outpatient and Inpatient claims with services including Surgery, Physical Therapy, Speech Therapy, Observation, Emergency Room
Appealed UB-04 claims
Investigate claims processing by researching contracts and determining if claim was processed according to contract
Contacted patients regarding additional information that may be needed for processing of clam via phone and written communication
Resolved credit balances by checking contractual agreements and determining coordination of benefits
Utilized MedCollex software system
Essence Healthcare-St. Louis, Missouri 10/2008-04/2009
Customer Service/Claims Processor
Processed Medicare UB-04 and CMS-1500 claims by direct keying and electronic claims processing. Type of claims included Ambulance claims, Pain Management, Emergency Room, Physical Therapy, Occupational Therapy, Surgery
Quoted benefits to providers
Quoted eligibility to providers
Answered benefit questions for members and providers
Resolved referrals and authorizations issues by matching to the correct claim
Resolved duplicate claims issues
Responsible for transplant claims via working with third party administrators
Utilized FACETS and Trizetto software
Coventry Healthcare-St. Louis, Missouri 03/2003-08/2008
Auditor I, II, III, Quality Assurance Auditor
Auditor I-Processed work comp claims for all 50 states. Utilized fee schedule for the fee schedule states to ensure proper payment of claims. Processing included UB-04 and CMS-1500 claims.
Auditor II-Team Lead for a group of five people. Responsibilities included auditing work, feedback on errors found, and monthly evaluations. Also responsible for special projects that required thorough research, analyzing, troubleshooting of incorrect processed claims.
Quality Assurance Auditor-Responsible for auditing claims for all clients. Type of claims being audited were DME, Home Health, UB-04, Physical Therapy, Occupational Therapy, Surgery, and a variety of other claims. Responsible for keeping track of errors found and reporting information to the manager.
Auditor III-Processed appeals, responsible for special queues on that were problem claims and needed to be fixed to completion, responsible for PPO queues which required working bills that went to this queue to completion and sometimes calling various PPO networks to get information, responsible for state reporting, answered client/provider questions, responsible for refund requests
Utilized Ingenix/PowerTrak software programs
EDUCATION
Diploma in Medical Coding and Billing, Sanford Brown College-Granite City, Illinois
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