Gwendolyn Mays-Franklin
Healthcare
Ocean Springs,MS
Summary
As my resume below shows, I have over ten years of experience in hospital revenue, work denials, accounts receivable, and a variety of other revenue account duties. I take ownership of an account from the being to close. The knowledge I obtain in leadership and diversity allow me to be utilize though out the billing cycle. I have worked closely with the Director of Revenue, team leaders, and managers of different departments in healthcare allow me experience in coding, payment posting and follow up. While it has been years since I managed a healthcare office, I have the skills to manage and operate a location, department or team.
Overview
21
21
years of professional experience
1
1
Certification
Work History
Revenue Cycle Specialist Remote
Enable comp LLC
Franklin, TN
01.2022 - Current
- Third party collections for out of state Medicaid for all states
- Follow up on full and partial denial claims
- Correcting registration errors, obtaining authorization for hospital service
- Writing appeals for denial claim from medical necessity, timely filing and coding
- Correcting medical claim errors for billing
Epic Analyst/ Hospital Biller
Singing River Hospital
Pascagoula, MS
01.2021 - 12.2022
- Managing all aspects of Medicaid claims to bill
- Completed monthly billing reports for the department and individual physicians as assigned
- Writing denial arguments utilizing their research skills along with the knowledge of billing
- Managed audit-related issues as well
- Making decisions regarding billing accuracy and the need to re-bill, follow-up, and/or identify actions for prevention on an ongoing basis
- Performed duties to be by procedures and policies, accreditation organization, and governing guidance and publications for health care employees
Hospital Medical Biller
Memorial Hospital
Gulfport, MS
01.2015 - 12.2021
- Billing and processing Institutional claims with an emphasis on Medicare, Medicaid, Commercial Insurance, Work Comp, and Third-Party claim submission
- Knowledgeable experience in CPT, ICD-9, and ICD 10CM, ICD 10 coding claims
- Knowledgeable in primary and secondary insurance billing and claims processing, review validation verifies changes for accuracy
- Proficient in Microsoft word and excel, CMS guidelines policy, and regulations
- Revenue cycle for ambulatory, physical base billing, and institutional claims
Office Manager
Herron Pediatrics
Atlanta, GA
01.2004 - 12.2019
- Manage a pediatric office with a small staff and medical students
- Insurance verification, referrals to outpatient service and specialists, copying and recording medical records, also obtaining authorization for medication as well as medical treatment
- Immunization inventory for Georgia Immunization Registry System
- Insurance billing for Medicaid and commercial insurance for private practice service
- Accounts receivable
- Collections and reimbursements
- Supervise interns and new medical graduate students and manage the day-to-day office duties
- Billing follow-up on denials and appeals of any claim
Medical Biller/AR Follow-up
Southern Crescent Staffing
Atlanta, GA
01.2013 - 12.2014
- Team leader for revenue team including billers, coders, and third-party collecting
- Billed for holistic therapy and treatment for multiple providers, which practice internal medicine
- Payer verification for treatment and preauthorization benefits for compound medication as well as office visits
- Appeal medical claims that were underpaid or denied per contract
- Internal auditor for coding claims per compliance as well as RAC
- Billing third-party claims for auto insurance, workers' compensation, and itemized billing
- Crediting new physicians for commercial, and government payers as well as updating for CAHAB
- Provider auditor for medical claims
- Epic Hyperspace 2015 billing system software
- Remote Biller for client Phoenix Medical Group
- In Greenway Medical System
Hospital Biller
Mobile Infirmary Medical Center
Mobile, AL
01.2011 - 12.2012
- Medicare inpatient and outpatient hospital billing
- A/R revenue cycle follow-up
- Reviewing and correcting billing charges
- Following up on claim issues modifier conflict
Hospital Biller/ AR Follow Up
Provident Hospital
Mobile, AL
01.2010 - 12.2011
- Registration team leader for clerks, maintain for staff trauma 1 emergency room
- Medical billing of inpatient and ambulatory claim
- Follow up on denial claims and appeal claims for failed medical necessity or coding issues
- Insurance verification for emergency room visits
- Emergency room registration clerk, outpatient service registration clerk, bed board coordinator, team leader for night shift
Patient Account Rep
Saint Joseph Hospital
Atlanta, GA
01.2009 - 12.2010
- Insurance verification
- Precertification and authorization for scheduled and unscheduled services
- Verification of insurance for all patients
- Obtaining referrals for CT, PET Chemo, and another radiology service
- Audit coding for billing
- Utilization care team for chem therapy service
Education
Master of Public Health - Concentration in Community Health Leadership
The University of Phoenix
12.2022
BA - Business Health Science Administration
University of Phoenix
Phoenix, AZ11-2020
Medical Billing/Coding -
Northwest College
Pomona, CA12.2001
Skills
- Microsoft Office Suite
- Epic Hyperspace 2021(HB Hospital Analysts)
- Centricity
- E-Clinical Medical Software
- Cerner Revenue Cycle
- Claims processing proficiency
- Medical billing expertise
- Patient registration
- Professionalism and ethics
- Insurance verification
- Managing records
- Insurance collaboration
- Medical billing
- Analyzing claims
- Records coordination
- Revenue cycle management
- Analytical problem solving
- Claims review
- Coordinating documents
- Verifying insurance
- Accounts receivable management
- HIPAA compliance
- Denial management
Certification
Epic Certification
Timeline
Revenue Cycle Specialist Remote
Enable comp LLC
01.2022 - Current
Epic Analyst/ Hospital Biller
Singing River Hospital
01.2021 - 12.2022
Hospital Medical Biller
Memorial Hospital
01.2015 - 12.2021
Medical Biller/AR Follow-up
Southern Crescent Staffing
01.2013 - 12.2014
Hospital Biller
Mobile Infirmary Medical Center
01.2011 - 12.2012
Hospital Biller/ AR Follow Up
Provident Hospital
01.2010 - 12.2011
Patient Account Rep
Saint Joseph Hospital
01.2009 - 12.2010
Office Manager
Herron Pediatrics
01.2004 - 12.2019
Master of Public Health - Concentration in Community Health Leadership
The University of Phoenix
BA - Business Health Science Administration
University of Phoenix
Medical Billing/Coding -
Northwest College
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