OBJECTIVE:

A position in claims accounting and processing, medical billing/collections

PROFILE:

• Healthcare administration claims, accounting.
• Testing new national system implementation of Epic Tapestry
• Experience with Customer service, referrals processing
• Super User experience with Tapestry claims processing

SYSTEMS:

SMS BLUE CARD

HMS MEDICARE

AS400 MEDICAID

CAP MEDI - CAL

XCELYS ALL THIRD PARTY INSURANCES

MACESS

QCARE

MEDITECH

MISYS

CAS

RPMS

HBOC-STAR

FACETS 2.96 & 4.11

WGS 2.0

NPS

Epic Tapestry

Health Connect

EMPLOYMENT HISTORY:

Confidential, Denver, CO

Responsibilities:

• CQR Review, verify Tapestry claims processed per contract and benefit configuration
• Perform User Acceptance Testing for Hawaii, North West, Mid
• Atlantic & Colorado regions for Tapestry AP
• CQR Review, verify Tapestry claims processed per contract and benefit configuration
• Process returned checks to reprocess claim to correct vendor and patient/member accounts
• Benefits and provider configuration testing for Xcelys
• Benefits and provider configuration testing for Xcelys
• Process, price and verify claims eligibility
• Process claims in Xcelys
• Employee development and training
• Process, price and verify claims eligibility
• Process claims in Xcelys
• Employee development and training
• Process referral/authorization requests for Colorado Region members/providers
• Benefit plan interpretation, working with the nurses and physician for additional authorization allowances or denials.
• Self - Funded referrals for Denver/Boulder region

Claims Member Services Rep.

Confidential

Responsibilities:

• Provide Customer Service for claims customer service claims reprocessing
• Team lead for team for 6 months.
• Customer Service reports

Confidential, Chicago, IL

Medical Business Office Consultant/Benefits Coder

Responsibilities:

• Provide Customer Service skills
• Adjusted/reviewed claims pending with NPS codes and corrected processing using NPS/EEC
• Reviewed denied claims to determine medical necessity Created spreadsheets for reports.
• Team Lead for 2.5 months, generated payroll and attendance reports on a weekly basis, peer reviews, monthly reports.

Confidential, Arlington, TX

Medical Business Office Consultant/Benefits Coder

Responsibilities:

• Processed medical claims
• Reviewed claims pended with specific error codes.
• Assisted customers regarding covered/eligible benefits, claim denial of healthcare claims of healthcare claims or eligible benefits.
• Created CSR’s for all new accounts and benefit changes.
• Worked with SMS systems and MISYS
• Managed 6 member team for project in Washington, DC, payroll, end of month revenue reports to include collections received from team calls, projected revenues reports for 6 months.

Confidential, Miller, SD

Billing Manager

Responsibilities:

• Provide data entry support and medical billing for IHS contracts.
• Focus on timely submission of Medicare/Medicaid billing for these contracts auditing all claims before sending to insurances
• Using medical terminology and CPT coding practices before sending to all insurance carriers.
• Travel for consulting on these billing contracts
• Project Manager Onsite for 2 months included billing, electronic claim filing, training business office protocols for billing, collections and posting payments to accounts.
• Trained staff in billing procedures and protocol.
• Help plan the project proposals and implementing staffing needs.
• Worked with RPMS systems.

Confidential, Eagle Butte, SD

Healthcare Consultant

Responsibilities:

• Provide medical billing expertise and follow-up collections for Account Receivables.
• Implemented procedures for continuing billing for the Business Office
• Trained personnel for billing and collections
• Audited all claims before sending out to all insurance carriers, with emphasis on setting standards of practice for the Business Office.
• Used medical terminology and CPT coding
• Customer Services reports, account receivable reports, end of month reports
• Set up electronic billing guidelines, account receivable criteria.
• Reported to the Administration with all implemented tasks accomplished.
• Worked with RPMS system for Indian Health Services hospital.
• Project Manager on this project for 2.5 months.

Confidential, Hurst, TX

Business Office Consultant//Benefits Coder

Responsibilities:

• Adjusted/reviewed claims pending with NPS codes and corrected processing using NPS/EEC
• Reviewed denied claims to determine medical necessity based on hospital policy for processing claims
• Created spreadsheets for reports
• Created test grids for benefit coding
• Created CSR’s for all new accounts and benefit changes

Confidential, Portland, OR

Front Office Service Specialist

Responsibilities:

• Provide supervisory expertise for reception, medical records for 11 months.
• Trained front office receptionists for patient access to clinic, answering phones, appointment setting.
• Computer data entry on RPMS.
• Referrals for patients with Medicaid and Medicare for 2 years.
• Coordinated with Physicians and their schedules for clinic appointments.
• Medical Records Coordinator.
• Front Office supervisor for 2 years.

Confidential, Portland, OR

Credentialing Assistant/Credentialing Coordinator

Responsibilities:

• Credential new medical staff applications.
• Re-credential existing medical staff every 2 years.
• Data entry, staff verifications from other facilities.
• Knowledge of JAHCO/NCQA policies.