SKILLS:

• SMS, Med iSOFT, Medical Manager, Cisco Finesse, QuickBooks, Outlook, Lync
• CPT, ICD - 9 Codes, Billing/Posting, SAP, Phreesia EMR, AS400 Systems, Citrix. PeopleSoft
• Microsoft Office XP
• Alpha and Numeric Filings
• Switchboard Operator, Multi Line Phone System
• Data Entry 10,000 ksph
• 44-45 wpm

PROFESSIONAL EXPERIENCE:

Confidential

Account Receivable/Cash Application

Responsibilities:

• Apply cash remittances, consisting of lockbox deposits, credit cards, and Confidential / wires, accurately and in a timely manner
• Perform cash reconciliation on disputed applications, as necessary.
• Post customer remittances and research unapplied cash in a timely and efficient manner.
• Processed returned payments
• Verify EOB s
• Processing of lockbox uploads
• Audits patient accounts for insurance or personal over payments.
• Ensures appropriate authorization and signing of checks
• Monitors and acts on Refund or Credit reports as needed.
• Interact with EMR and other IT systems for claims research, recoups, refunds, reprocessing and collections

Confidential, Atlanta, Georgia

Account Receivable/Cash Application

Responsibilities:

• Apply cash remittances, consisting of lockbox deposits, credit cards, and Confidential / wires, accurately and in a timely manner
• Perform cash reconciliation on disputed applications, as necessary.
• Post customer remittances and research unapplied cash in a timely and efficient manner.
• Processed returned payments
• Pulling of daily data from bank portals for payment processing
• Processing of lockbox uploads
• Audits patient accounts for insurance or personal over payments.
• Ensures appropriate authorization and signing of checks
• Monitors and acts on Refund or Credit reports as needed.
• Receive prepared refund packets from on - site refund staff for review and distribution to payer analyst to review and approve.

Confidential, Atlanta, Georgia

Senior Care Associate

Responsibilities:

• Accurately create and document assessments, notes and reviews in the case management system
• Facilitate the request for prior authorization information of inpatient and outpatient services, ensuring timely and accurate responses in compliance with state and federal guidelines
• Prepare approval/denial letters and meet regulatory turnaround times Facilitate Confidential Meetings
• Manage the fax boxes and submit pertinent information to the nurse pre\-auth team, UM leadership team and the medical directors in a timely manner
• Prepared Discharge Reports and Calls
• Prepared Admissions, Transportation/Ambulance rides to providers.
• Case Management Profiles

Confidential, Atlanta, Georgia

Call Center Leader

Responsibilities:

• Monitor service levels of the team to ensure that client service standards are being maintained.
• Oversees work for the service center team.
• Conducts quality evaluations with Service Representatives.
• Responds to escalated calls from client's plan members.
• Conducts research to identify solutions to client issues.
• Leads internal training sessions to help develop Service Representatives.
• Provides feedback to Call Center Manager regarding Service Representatives; participates in performance management for the team.
• Provides feedback to management regarding status and effect of outstanding issues.
• Manages the relationship between clients, administrators, insurance providers, and analysts.
• Prepares reports on Call Center metrics.
• Participates in internal and external meetings.
• Peer review of documentation regarding client memberships.
• Manages multiple priorities simultaneously in a fast paced environment.
• Devises ways to continuously improve team operations and performance.
• Assists with special projects and other tasks, as required.

Confidential, Doraville, Georgia

Merchant Account Services Rep

Responsibilities:

• Responsible for first level support of technical problem resolutions on point-of-sale activation of financial card holders.
• Respond to high volume in-bound calls from merchant (store) sales representatives/customers who sell the company's products.
• Communicate via telephonic and email correspondence to/from tech support to the fraud department for vendors, account managers, and store owners.
• Activate and Reactivate financial cards
• Strong analytical and problem solving skills; able to develop and use structured approaches to identify root causes and recommend resolutions; can present results in a meaningful term.
• Understand, utilize and adhere to SnapPay/MIO desktop application, Payment Manager, and proper navigation of.
• Works with internal business partners to ensure that any new enhancements or issues are developed and addressed appropriately.
• Tracks client financial and other performance vs. plan figures. Identify key issues (product/platform, financial, regulatory, or other) affecting performance and works with Regional Sales Manager to actively manage outcomes

Confidential, Atlanta, Georgia

Front Desk Registrar

Responsibilities:

• Collected personal and medical data from the patient or the family of the patient.
• Initiated medical records written and electronically.
• Collected personal data as well as payment information and verified health insurance coverage.
• Utilized knowledge of medical terminology on a daily bases as a liaison between the hospital patients as well as outside medical clinics and laboratory facilities.
• Compiled and recorded patients information from notes of doctors and nurses.

Confidential, Atlanta, Georgia

Dermatology Clinic/Clerk

Responsibilities:

• Handled clerical tasks at the nurse's station of the intensive care unit of hospital floor.
• Created records of new patients and regularly update patient records from chart.
• Recorded measurements of vital signs such as temperature and respiration rates along with any notes from doctors and nurses.
• Recorded diagnoses and treatments on insurance and medical forms also processed discharge forms.
• Arranged, and transported patient transfers to other wards.
• Scheduled surgeries/patient care plans
• Responsible for processing patient's claim Verified patient's insurance coverage through online and telephonic contact.
• Pulled denial report and resubmitted billable claims.
• Also responsible for filing appeals and specialized in Medicare and Managed Care follow-ups.
• Managed 7-10 employees to assure that all office duties/rules are completed.
• Referrals and pre-certifications