- United States of America
- February 9, 2015
HealthCare Management Solutions, LLC., Fairmont, WV 26554, 2/11/2013-Present
Primary Coder, Medical Records Analyst, Certified Coding Specialist
Responsible for Physician based inpatient, outpatient and office visits medical chart audits to assure that ICD codes billed are appropriate and supported by documentation in the medical record. Verifies that all coding / documentation combinations are compliant with CMS regulations. Experience creating powerpoint presentations for educational purposes. Experience with RADV, HCC, Federal and State regulations, analyzes, enters and manipulates databases, reviewing Coding Clinics, maintains a confidential work environment. Detail oriented and quality-focused. Knowledge of encoding databases.
Healthcare Support Technologies, Beaver Falls, PA 15010, 1/16/2013-2/9/2013
Medical Billing Specialist
Medical Billing Specialist, responsible for posting all payments and adjustments from electronic and paper Insurance Explanation of benefits and patient payments. Billing secondary claims to all insurance companies, researching and resolving denied claims, documenting all activity as completely as possible. Managing delinquent patient balance accounts to be sent to collections. Making outbound follow-up calls to insurance companies and patients documenting all activity as completely as possible. Balancing posted payments, per physician, per payment batch daily. Working with several specialty physician offices such as, Neurology, Rheumatology, Psychiatric, Chiropractic and General Practice. Resolving any billing issue the physician office might have. Answering a multiline phone and transferring the call to the billing specialist responsible for the physician group.
CCS Medical / Medical Express Depot, Wexford, PA 15090, 1/25/2010-9/15/2011
Accounts Receivable Representative- Insulin Pump / Pump Supplies
Accounts Receivable Representative for a Chronic Care Company. Responsible for claims resolution on delinquent insurance accounts to achieve maximum collections from all sources. Initiated appeals and ensured all required documentation be submitted in the appeals process. Responsible for claims resolution for Tricare-North, South, Triwest, Tricare for Life and ChampVA for all the CCS Medical entities. UMPC, Highmark and Blues Plans, Medicare Replacement policies and Secondary private insurance companies for the Pittsburgh entity Medical Express Depot. Researched denials, resubmitted claims, making outbound calls to insurance companies and documenting all activity as completely as possible. Achieved productivity goals based on accounts touched, dollars collected and aging period.
Accredo Therapeutics, Inc. – Warrendale, PA 15086, 1/16/2006-2/9/2009
Senior Clearance Specialist, Patient Account Representative
Senior Clearance Specialist for a Specialty Pharmaceutical National Distribution Center
Verified patient prescription benefits with insurance companies and discussed the outcome with the patient. Obtained prior authorizations from Physicians or their office staff and negotiate rates with insurance companies. Filed electronic billing for pharmacy claims, verified co-pay amounts to be billed to patient pay with the patient prior to shipment of the medications. Assisted patients with the transaction of Medicare Part D. Provided outstanding customer service.
Adecco Temp Agency, Cranberry Township, PA 16066, 06/2005-1/16/2006
Senior Clearance Specialist
Responsible for timely and accurate verification of patient prescription benefits. Obtained authorization for services and negotiates contracts with insurance companies. Filed electronic billing for pharmacy claims. Backed up other Senior Clearance Specialists with the Medicare Replacement Drug Demonstration program. Assisted the Administrative assistant with Welcome packets and Summary of Benefit mailings.
Black Hills Surgery Center, LLP, Rapid City, South Dakota 57701, 6/2002-2/2004
Patient Account Representative
Responsible for timely and accurate follow up on patient accounts that have an outstanding balance, setting up payment plans and credit card payments. Post insurance payments and adjustments. Billing to secondary insurance such as, Medicare, Medicaid, Indian Health Services, Champus, Tricare Prime, DEERS and ChampVA. Assisted collection agencies and Attorneys with bankruptcies Sent weekly and monthly statements. Assisted Controller with specialty monthly reports. Covered reception desk for vacations and breaks. Worked with multiline phone system. Backed up other collection specialist with various other duties.