April Smith
Orangevale,CA
Summary
Eighteen years of experience processing, billing and collecting private and government insurance claims. Dependable, hardworking, detail oriented, quick learning, committed to providing the highest level of service.
Overview
22
22
years of professional experience
Work History
Pediatrics Rural Health Clinic Biller/Collections
Marshall Medical Center
Diamond Springs, CA
05.2018 - 07.2024
- Reviewed each encounter for medical necessity and type of service
- Maintained patient information ensure up to date and accurrate
- Dispute/Appeal claims that were denied incorrectly in a timely manner
- Verified patients’ coverage and eligibility.
- Reviewed patient charts to better understand health histories, diagnoses, and treatments.
- Interacted with physicians and other healthcare staff to ask questions regarding patient services.
- Communicated with insurance companies to research and resolved coding discrepancies.
- Trained and mentored newly hired billers.
- Adhered to established standards to safeguard patients' health information.
- Analyzed complex Explanation of Benefits forms to verify correct billing of insurance carriers.
- Delivered timely and accurate charge submissions.
- Monitored outstanding invoices and performed collections duties.
MEDICARE/WORKERS’ COMPENSATION COLLECTIONS
ROGER B. STEPHENS M.D.
01.2014 - 01.2018
- Work directly with insurance company, provider, and patient to get a claim paid
- Reviewing and appealing unpaid and denied claims
- Verify patients’ insurance coverage
- Ensure all claims are paid per contract and in a timely manner
- Contact adjusters to resolve payment issues
- Answering patients’ billing questions.
Lead Medi-Cal Biller / Collections
River City Pharmacy
Sacramento, CA
01.2011 - 01.2014
- Handle confidential patient files and medical records on a daily basis
- Review patient information to determine why claims weren't paid
- Research denied claims
- Collection calling and billing out claims to insurance companies
- Updating billing information
- Compiles and tracks the outstanding balances owed
- Assist in the training of new employees
- Help in the coordination of projects and goals
- Answer questions from billers daily.
Claims Processor Lead- Manual Pricing
Acs
West Sacramento, CA
01.2010 - 01.2011
- Examine claims for several DCC’s
- Met or exceeded corporate standards for number and quality of claims processed per hour
- Determine payment status for Medi-Cal
- Responsible for coordination of the daily work flow activities of the Suspense Claim Examiners
- Provide quality assurance checks and verification support for the team
- Assist the Suspense Supervisor in monitoring workflow of the Unit
- Verify the work of others for accuracy and completeness.
Office Administrator
G&R AUTO BODYAND PAINT
Sacramento, CA
01.2008 - 01.2010
- Office Administrator- Front line in all customer orientated tasks, from beginning to end
- Consisting of, setting up initial appointment, updating customer on vehicle status and follow up after pick up
- Insurance Claims Processing – Photographing of vehicles, documenting of specific damage pertaining to insured’s claim and making all necessary calls to gather and verify each customer’s insurance information
- Accounts Payable.
Claims Processor
ELECTRONIC DATA SYSTEMS
Sacramento, CA
01.2005 - 01.2007
- Examine claims for durable medical equipment
- Determine payment status for Medi-Cal.
Claims Processor
BLUE SHIELD OF CALIFORNIA
01.2003 - 01.2005
- Process medical claims to assure prompt payment
- Met or exceeded corporate standards for number and quality of claims processed per hour.
Education
Billing And Coding
Heald College
Rancho CordovaSkills
- EPIC
- CPR
- All Meds
- Centricity
- Microsoft Office
- Word
- Excel
- Outlook
- Internet Explorer
- Regulatory Compliance
- Dispute Resolution
- Payment tracking
- Insurance company billing
- Insurance billing procedures
- Reimbursement processing
- Month-end closing procedures
- Collection practices
References
References upon request
Timeline
Pediatrics Rural Health Clinic Biller/Collections
Marshall Medical Center
05.2018 - 07.2024
MEDICARE/WORKERS’ COMPENSATION COLLECTIONS
ROGER B. STEPHENS M.D.
01.2014 - 01.2018
Lead Medi-Cal Biller / Collections
River City Pharmacy
01.2011 - 01.2014
Claims Processor Lead- Manual Pricing
Acs
01.2010 - 01.2011
Office Administrator
G&R AUTO BODYAND PAINT
01.2008 - 01.2010
Claims Processor
ELECTRONIC DATA SYSTEMS
01.2005 - 01.2007
Claims Processor
BLUE SHIELD OF CALIFORNIA
01.2003 - 01.2005
Billing And Coding
Heald College