ANITA JONES
Cottonwood,AZ
Summary
Experienced Revenue Cycle Specialist II with a strong background in revenue optimization, claims management, and financial analysis. Proven ability to enhance revenue streams, resolve complex billing issues, and ensure compliance in healthcare settings. Seeking an opportunity to contribute advanced skills and knowledge to drive financial excellence for a dynamic healthcare organization and prepared to bring 15+ years of related experience to a dynamic position with room for career growth. Also experienced Accounts Receivable Specialist with diligent and detail-oriented Payment Posting professional with a proven track record of accurately recording and allocating payments to patient accounts. Adept at reconciling payment data with Explanation of Benefits (EOB) and Electronic Remittance Advice (ERA) documents, ensuring precise financial records.
Overview
21
21
years of professional experience
Work History
Patient Claims Resolution Specialist II
Currance
09.2021 - 07.2023
- UB04 and DRG inpatient hospital claims
- Reached out to insurance companies via payer portals and phone to verify coverage, prior authorization, payments and denials.
- Collected information about rejected claims, charges, coding and claims follow-up including appeals.
- Understood requirements for disputes, gathered evidence to support claims and prepared customer cases to handle appeals.
- Balanced and reconciled accounts.
- ICD 10 and revenue codes.
- Remote position, work from home.
- Used programs such as Citrix, Soarian, Power Chart System.
Patient Access Representative
Northern Arizona Healthcare
10.2019 - 10.2021
- Scheduling radiology
- Insurance Verification
- Call center inbound
- Team Environment
- Customer Service Call, including patient payments
- Used Citrix and power chart.
Patient Accounts Representative/Contractor
Tru Community Care
09.2018 - 03.2019
- UB04 Hospice claims
- Reached out to insurance companies via payer portals and phone to verify coverage, prior authorization, payments and denials.
- Reviewed charges, coding and did claims follow-up including appeals
- ICD 10 and revenue codes
- Team Environment
- Customer Service Call, including patient payments
- Work with assigned insurance payers, including Kaiser, Cigna and Medicaid
- Used Smartcare System and Zirmed.
- Balanced and reconciled accounts.
Accounts Receivable Specialist/Contractor
Mental Health Partners
03.2018 - 08.2018
- Work directly with insurance for eligibility and prior authorization
- Charges, Coding and claims follow-up including appeals
- ICD 10
- Team Environment
- Customer Service Call, including patient payments
- Reached out to insurance payers, including Kaiser, Cigna and Medicaid.
- Used Smartcare System
- A/R balanced and reconciled accounts.
- Scheduling patients
Billing Analyst/Contractor
MBMS
02.2017 - 10.2017
- UB04 and DRG inpatient hospital claims
- Reached out to insurance for eligibility and prior authorization
- Charges, Coding and claims follow-up including appeals
- ICD 10 and revenue codes
- Team Environment
- Customer Service Call, including patient payments
- Worked assigned work ques
- Followed up using e-scan correspondence
- A/R Balanced and reconciled accounts.
Billing Rep II
Radiology Imaging Associates
12.2016 - 02.2017
- Reached out to insurance companies via payer portals and phone to verify coverage and prior authorization
- Charges, Coding and claims follow-up including appeals
- ICD 10 and revenue codes
- Team Environment
- Worked with assigned work ques
- HCFA claims corrections and refiling.
Billing Claims Rep II / Contract Position
SCL
08.2016 - 11.2016
- Work with UB04 and DRG inpatient hospital claims
- Reached out to insurance companies via payer portals and phone to verify coverage, prior authorization
- Charges, Coding and claims follow-up
- ICD 10 and revenue codes
- Team Environment
- Customer Service Call
- Worked with assigned work ques and e-scan correspondence
Medical Claims Follow-up
Rocky Mountain Primary Care
02.2016 - 08.2016
- Billed HCFA 1500 claims
- Reviewed Charges, Coding and claims follow-up
- ICD 10
- Team Environment
- Customer Service Call/And Scheduling
- Mail open and distribution
- Submitted electronic/paper claims documentation for timely filing
- Managed large volume of medical claims on daily basis
Document Scanning Processor
Hemophilia And Thrombosis Center
02.2015 - 11.2015
- Used digital document imaging and managed records in Singularity
- Performed Quality Assurance of team members document imaging records
- Worked with team members to maintain steady workflow of project demands
- Used knowledge of past medical terminology and experience with documents to assign records to correct classification
Client Support Specialist/Contract to Hire position
Matrix Medical Network
04.2012 - 06.2014
- Generated and reviewed system reports
- Scanned, balanced and validated quality of Health Risk Assessments
- Prepared files for delivery to external customers, including health insurance companies and patients
- Organized workload according to set priorities
- Wrote policies and procedures
Reimbursement Specialist
McKesson
09.2011 - 02.2012
- GNE overflow team for Lucentis
- Assisted Physician's office in obtaining patient insurance benefits and verifying coverage in order for patient to receive treatment of specific administered drug
- Completed outbound calls for Insurance verification
- Scanned documents into electronic files
Administrative Assistant
Desert Foothills Counseling
02.2007 - 02.2010
- Assisted Licensed Professional Counselor
- Maintained Medical Records with both physical and electronic files
- Kept client database up to date with payments and schedules
- Scheduling patients
- Restocked supplies and placed purchase orders to maintain adequate stock levels.
- Answered multi-line phone system, routing calls, delivering messages to staff and greeting visitors.
Medical Biller
Arizona Medical Providers Associates
07.2005 - 05.2007
- Managed medical billing radiology records
- Maintained and organized medical records both physically and electronically
- Used A-Life Program for billing/coding
- Performed claims processing duties (HCFA 1500 and UB04)
- Communicated with insurance providers to resolve denied claims and resubmitted.
- Verified insurance of patients to determine eligibility
- Posted payments and collections on regular basis
- Accurately entered patient demographic and billing information in billing system to enable tracking history and maintain accurate records
Medical Records/Prior Authorization Technician
Health Management Assoc./IMX Inc.
02.2002 - 02.2005
- Maintained Medical Records
- Performed claims processing duties (HCFA 1500 and UB's)
- Scanned and maintained medical records and claims documents
- Transcribed claims information and patient demographics
- Obtained Prior Authorizations for Doctor's offices and patients
- Verified eligibility and compliance with authorization requirements for service providers
- Fielded telephone inquiries on authorization details from plan members and medical staff
Education
No Degree - Business Administration
Yavapai Community College
Clarkdale, AZHigh School Diploma -
Mingus Union High School
Cottonwood, AZ05.1987
Skills
- 10 years of experience Inpatient Hospital billing on UB04 claims
- 10 years of experience in Digital Document Imaging
- 15 years of experience in Medical Records Management
- 6 months experience using database management software (Singularity)
- 1-year experience writing Policies and Procedures
- 10 years of experience in Quality Assurance of Medical Record Management
- 25 years of experience working in team setting
- 6 months experience working in University environment
- 25 years hands on Medical Billing
- 6 months experience using billing database management software (Nextgen)
- 5 years of experience using billing database management software (Epic)
- 5 years of experience using billing database management software (Citrix, Soarian)
- 20 years of experience working with Commercial, Medicare and Medicaid insurance billing
- 1 year working with Smartcare Billing System
- 4 years' experience working with Zirmed
- 2 years working with Oncology patients
- 15 years' experience with scheduling patients
- 1 year working with Hospice patients and Mental Health patients
- 20 years working accounts receivable and accounts payable
- 2 years working with Oncology patients
References
- Larry Martinez, Supervisor, Radiology Imaging Associates, 720-493-3661
- Angelina Ballesteros, Manager of Operations, HMA/IMX Inc., 928-301-6137
- Anthony Sykes, Accounts Receivable, Mental Health Partners, 720-549-1149
Timeline
Patient Claims Resolution Specialist II
Currance
09.2021 - 07.2023
Patient Access Representative
Northern Arizona Healthcare
10.2019 - 10.2021
Patient Accounts Representative/Contractor
Tru Community Care
09.2018 - 03.2019
Accounts Receivable Specialist/Contractor
Mental Health Partners
03.2018 - 08.2018
Billing Analyst/Contractor
MBMS
02.2017 - 10.2017
Billing Rep II
Radiology Imaging Associates
12.2016 - 02.2017
Billing Claims Rep II / Contract Position
SCL
08.2016 - 11.2016
Medical Claims Follow-up
Rocky Mountain Primary Care
02.2016 - 08.2016
Document Scanning Processor
Hemophilia And Thrombosis Center
02.2015 - 11.2015
Client Support Specialist/Contract to Hire position
Matrix Medical Network
04.2012 - 06.2014
Reimbursement Specialist
McKesson
09.2011 - 02.2012
Administrative Assistant
Desert Foothills Counseling
02.2007 - 02.2010
Medical Biller
Arizona Medical Providers Associates
07.2005 - 05.2007
Medical Records/Prior Authorization Technician
Health Management Assoc./IMX Inc.
02.2002 - 02.2005
No Degree - Business Administration
Yavapai Community College
High School Diploma -
Mingus Union High School
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