Quality Assurance Insurance

Elaine J. Elliott

*** ******* *** ■ Jonesboro, GA 30238 ■ 770-***-**** ■ *******@***.***

Selected Accomplishments

• Provide several years of experience in auditing, analyzing, processing commercial and government claims by reducing rejects and expedite outstanding accounts receivables. Strong interpersonal, oral, written and communication skills.

• Managed quality assurance by providing updated to policies and procedures in order to maintain and streamline organization effectiveness.

• Maintained and developed expertise in regulatory compliance with the State and Federal agencies and other programs such as HCFA, HIPPA, Medicare and Medicaid.

• Respond effectively to an extremely high stress/volume environment while continuing to meet department standards.

• Establishes and maintains long term customer relationships, building trust and respect by consistently meeting and exceeding expectations.

Professional Experience:

Medicaid Collections Specialist

Gentiva Home Healthcare Services, Atlanta GA

September 2007- June 2010

• Responsible for collecting Durable Medical Equipment (DME) invoices electronically.

• Process claims for the states of Texas, Georgia and Alabama on billing software, and provider’s web portal.

• Perform insurance verification, Medicaid eligibility and prior authorizations review prior to billing.

• Conduct ongoing communication with assigned branches and providers to expedite prompt payments.

• Performs A/R denial analysis to identify areas which require process improvement.

• Identifies deficiencies and or problems affecting the FSU operations which require correction and or remediation, by providing training and or education to DME staff.

Medicaid Billing/Collections Specialist

Atlanta Perinatal Associates, Atlanta GA

January 2005 - September 2007

• Collected on A/R aged report for Georgia Medicaid, WellCare, Amerigroup and PeachCare Claims.

• Communicated problem accounts and escalate as appropriate to managements and or providers.

• Responsible for resubmitting claims that denied and or in suspend status before timely filing limits ends.

• Successfully maintained a library and constantly reviewed documents, manuals, regulations relating to the financial department and Georgia Medicaid policies and procedures.

Medicare/Medicaid Patient Account Representative

Henry Medical Center, Stockbridge, GA

July 2004 - December 2004

• Temporary contract assignment with Blackstone Resources.

• Daily billing Medicare/Medicaid claims on UB92 and 1500’s.

• Handled inbound telephone calls from providers who had questions or concerns about patients benefit and accounts.

(Elaine Elliott Résumé, Continued)

Consultant Agencies with Alliance One and Jacobson Solutions

May 2000 - June 2004

Georgia & North Carolina Claims Recovery Specialist/ Insurance Collection/ Claim Examiner

• Temporary contract assignment at High Point Regional Hospital in Greenville, NC.

• Identify coding or billing problems and work effectively to correct the errors in a timely manner.

• Analyze and review the Medicare Transmission Error edit reports to expedite payments.

• Perform onsite audits for Blue Cross Blue Shield and reduce large credit balances.

Patient Admissions Rep/Insurance Collections Specialist

Alliance One Medical Coders, Ft. Lauderdale, FL

• Temporary contract assignment at Duke University Hospital in Durham, NC.

• Work with patients and guarantors to secure payment on outstanding account balances.

• Update the patient account record to identify actions taken on the account.

• Obtain pre certification and authorizations on pre admitted patients.

Medicare/Medicaid Billing Specialist & Insurance Collector

• Temporary contract assignment at Arnett Clinic in Lafayette, IN.

• Monitor insurance claims by running appropriate reports and contacting insurance companies to resolve claims that are not paid in a timely manner.

• Informed management of any account discrepancies that may cause payments to be delayed.

• Commercial follow up on high dollar accounts submitting medical records if requested.

Ambulance Billing Supervisor

LogistiCare Solutions, College Park, GA

August 1997 - April 2000

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• Reviewed ambulance claims to ensure completeness and accuracy of diagnosis codes.

• Oversee accounts receivable adjustments to resolve overpayments and payment rejections per standard operating procedures.

• Eliminated unnecessary procedures and reduce claims rejected.

Education & Certification

JohnCo Management Systems

Certified Billing and Coding Specialist (CBCS)

College Park GA

Elizabethtown Community College

Information Systems Courses

Elizabethtown, KY

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