Insurance Manager
Resume:
Deanna Scala, CPC
Phoenix, AZ 85053
602-***-**** (cell)
OBJECTIVE: Utilize my coding skills remotely to maximize the financial success of any
medical organization.
EXPERIENCE:
John C Lincoln Hospital
09/2002 to present
November 2010 to present
Specialty Coder - CPC
Abstract coding for Gastroenterologists, Neurologist, Primary Care Physicians and
Radiologists.
Work remotely, logging into computer at office.
Go to hospital and pick up face sheets from doctors
Go to medical records and make copies of progress notes.
Abstract coding for Inpatient, Outpatient, E/R, Observations.
Auditing Evaluation and Management codes.
Coding pathology reports
View CCI and LCD before assigning codes/modifiers
Submit charges to data entry staff via Microsoft Excel and Outlook.
Work with data entry for accuracy with billing and data entry problems.
Provides feedback to providers on coding related problems.
August 2010 to November 2010
Patient Account Representative Lead/Supervisor
Train new billing staff
Assisted in the interview process
Given feedback on 30 day, 60 day and 90 day for new staff.
See job description below.
July 2008 to August 2010
Patient Account Representative
Responsible for the daily deposit, posting of office and hospital charges, posting mail
payments, work denied EOB in timely manner, submit claims electronically, send paper
claims (HCFA-1500) to primary insurance, review electronic reports to make sure claims
went through, if not then review and resolved problem.
Identify coding errors when posting charges
Appeal on bundled charges that denied in error
Close Credit Card at end of day.
Call insurance companies to check status of claims, appeals and eligibility.
Work denials; identify the problem and work with patient and insurance to resolve.
Send patients statements weekly.
Call and collect payments on patient accounts over 60 days.
Answer phone calls from patient, providers or insurance companies.
Collect payments from patients in office.
Assist Front Office with scheduling appointments, if we need to obtain referrals for various
situations that arise.
Professionally interact with providers, patients and co-workers.
Assist the procedure scheduler with problems that arise with insurance companies.
Balance and close the previous day and send to corporate office.
Conducts all business in a professional manner maintaining respect for individuals at all
times.
Obstertrix Medial Group
04/2007 - 07/2008
Patient Account Specialist Float
Training new staff on GPMS and Master Database.
Assisted in the interview process.
Given feedback on 30, 60 and 90 day for new staff.
Assisted in performance review.
Educating staff on policy and procedures.
Assist Regional Manager with any additional projects.
Assume job responsibilities of employees with long-term absences, while maintaining my
current workload.
Assisted in referral department as needed
Work denials; identify the problem and work with patient and insurance to resolve.
Working with payers on three different specialties (over 100 physicians) regarding
underpayments of specific procedure codes.
Creating monthly reports using Microsoft Excel.
Identifying trends with payers.
Researching credentialing status of providers with specific payers.
Assisted in Provider Enrollment department, setting up providers with insurance companies
using CAQH.
Writing formal appeals to payers for payment.
Gathered and worked reports on electronic rejections to identify problems.
Send payer updates to corporate office to implement changes on HCFA and electronic
formatting.
Contact payers for claim status and reimbursement to decrease A/R over 90.
Contact patients for updates on insurance, home addresses as well as payments.
Post payments and adjustments receive from lock box
Conducts all business in a professional manner maintaining respect for individuals at all
times.
AOS
04/2006 - 04/2007
Payment Poster
Used Excel and Word for tracking of payment problems with payors for monthly meeting
with A/R department.
Posting daily deposits to a split screen using computer software called NextGen.
Balance the day and send a report via email to manager to balance the month.
Posting ERA's through Navicare to NextGen.
Posting patient as well as insurance payments, when there is a credit, reviewing the account
to make sure balance in correct bucket.
Making sure payment is posted to correct CPT code per EOB. Posting zero pays and making
sure proper notes in system for AR department when reviewing the account.
Conducts all business in a professional manner maintaining respect for individuals at all
times.
John C Lincoln Hospital
9/2002- 04/2006
April 2005 to April 2006
Patient Account Representative:
Worked for two Primary Care Physicians, a Nurse Practitioner and two Neurologists using
PCN, Meditech.
Responsible for the daily deposit, posting charges from the day before, posting mail
payments, work denied EOB in timely manner, submit claims electronically, send paper
claims to primary insurance, review electronic reports to make sure claims went through,
if not then review and resolved problem.
Identify coding errors when posting charges
Appeal on bundled charges that denied in error
Send patients statements weekly.
Call and collect payments on patient's accounts over 60 days.
Collect payments from patients in office.
Professionally interact with patients whom have a balance in a private room.
Balance and close the previous day and send to corporate office.
Conducts all business in a professional manner maintaining respect for individuals at all
times.
July 2004 to April 2005
AHCCCS/Medicare Biller
Review and release UB-92 to go electronically or paper to insurance company, using Premis.
The accounts are in a que on the computer, Meditech, which I review and resolve daily. In
doing my accounts, I found a trend with the insurance company, which resolved in our
favor.
Answer phones, verify eligibility using Medifax, view EOB's in a computer software
program.
Review the DDE daily for denied claims, secondary payers and if patient was enrolled in a
risk plan and/or hospice.
Identify coding errors when posting charges
Appeal on bundled charges that denied in error
Resolve third party payers.
Correspond with other departments via email to resolve problem accounts.
Deal with patients, as well as insurance companies, to resolve high dollar balances.
Conducts all business in a professional manner maintaining respect for individuals at all
times.
September 2002 to July 2004
Patient Account Representative:
Work with three different primary care physician practices, which include 14 doctors.
Review and resolve zero pay EOB's from various insurance plans using a windows based
computer.
Identify coding errors when posting charges
Appeal on bundled charges that denied in error
Send patient's letters explaining to them their portion and asking for payment.
Run credit card payments taken by phone, send receipts to patients and close the credit card
machine at end of day.
My accounts are three percent or lower in the 90 day time frame.
Conducts all business in a professional manner maintaining respect for individuals at all
times.
SYSTEMS:
3M CODER
EPIC
PCN
MEDITECH
GPMS
NEXTGEN
WORD
EXCEL
OUTLOOK
MEDICAL MANAGER
KRONOS
ORACLE
EDUCATION:
2010 - CPC
5/1994
Southwestern College, Phoenix, AZ
General Studies
5/1992
Paradise Valley Community College, Phoenix, AZ
General Studies.
5/1991
Horizon High School, Phoenix, AZ
CERTIFICATION/PROFESSIONAL MEMBERSHIPS:
MEMBER OF GLENDALE CODERS AND AMERICAN ACADEMY OF
PROFESSIONAL CODERS
2012 TRESUSUER FOR GLENDALE AAPC CHAPTER
References Available Upon Request
Contact this candidate