Ariel Jefferson
St Louis,MO
Summary
Authorized to work in the US for any employer Competent Accounts Receivable Specialist bringing six years of experience carrying out all accounts receivable functions in high volume environments. Proficient in tracking payments, resolving billing issues and preparing account statements. Recognized as dedicated professional driven to meet team targets and enhance bottom-line performance.
Overview
8
8
years of professional experience
1
1
Certification
Work History
Medical Billing Representative
HealthCare Support Staffing
02.2023 - Current
- Hospital billing
- Assisting callers with billing concerns on hospital accounts
- Notate each account accordingly
- Follow up on hospital account with insurance company
- Assist with uploading legal documents
- Post payments to patients accounts
- Accept payments when patient calls in wanting to pay
- Works on EPIC daily
- Create spreadsheets for patient accounts
- Working with unclean claims and contracts
- Works with commercial, third party insurance,Medicare part A & B, also Medicaid
- Accounts Payable
- Evaluated patients' financial status and established appropriate payment plans.
- Diligently filed and followed up on third party claims.
- Promptly sent out and posted all medical claims.
- Actively maintained current working knowledge of CPT and ICD-9 coding principles, government regulation, protocols and third party requirements regarding billing.
- Researched CPT and ICD-9 coding discrepancies for compliance and reimbursement accuracy.
- Posted and adjusted payments from insurance companies.
- Precisely completed appropriate claims paperwork, documentation and system entry.
- Performed billing and coding procedures for ambulance, emergency room, impatient, and outpatient services.
- Managed collections claims for unpaid bills against estates of debtors.
- Reviewed and resolved claim issues captured in TES/CLAIMS edits and clearing house.
- Pre-certified medical and radiology procedures, surgeries and echocardiograms.
- Maintained and updated collections tracking spreadsheet to help organize payment information.
- Verified insurance of patients to determine eligibility.
- Communicated with insurance providers to resolve denied claims and resubmitted.
Accounts Receivable Specialist
BioTAB Healthcare
05.2022 - 01.2023
- Processes billing to patients and third party insurance companies
- Maintains supporting documentation files and current patient addresses
- Researches and responds by telephone and / or in writing to patient inquiries regarding billing issues and problems
- Monitors submitted claims; follows up on unpaid claims, and initiates dialogue with insurance companies
- Resubmits claims to insurance companies as necessary
- May receive and receipt cash items and third party reimbursements
- Posts and reconciles payments to patient ledgers
- Balances daily batches and reports
- Maintains patient demographic information and data collection systems
- Participates in development of organization procedures and update of forms and manuals
- Performs a variety of general clerical duties, including telephone reception, mail distribution, and other routine functions
- Answers questions from patients, clerical staff and insurance companies
- Identifies and resolves patient billing complaints
- Evaluates patient's financial status and establishes budget payment plans
- Follows and reports status of delinquent accounts
- Reviews accounts for possible assignment to collections and makes recommendations to the Billing
- Team Leader; also prepares information for the collection agency
- Performs various collection actions including contacting patients by phone, correcting and resubmitting claims to third party payers
- Works in conjunction with the reception to ensure clean billing
- Performs miscellaneous job-related duties as assigned
- Participates in educational activities and attends monthly staff meetings
- Maintains strictest confidentiality; adheres to all HIPAA guidelines/regulations
- Assists in development and communication of SOP for key areas to improve accuracy and understanding of processes
- Works on Salesforce, Excel, FastTrack, ACT, EPIC and care tracker
- Work with TRICARE, HUMANA, UHC, AMBETTER, BCBS, Etc
- Works with Medicare part A&B and also Medicaid
- Typing data
- Payment posting
- API, EMR, EHR
- Accounts Payable
- Creating invoices through quick books, SAP, people soft
- Reviewing accounts to see make sure a check is ready to be sent to company
- Unclean claims
- Unclean contracts
- Prior
- Followed up overdue payments and payment plans from clients to establish good cash flow.
- Monitored accounts to verify compliance with payment terms and schedules.
- Utilized Microsoft Excel, QuickBooks and Oracle software to manage invoices and payments.
- Submitted cash and check deposits and generated cash receipts to record money received.
- Reviewed accounts on monthly basis to assess aging and pursue collection of funds.
- Developed and maintained positive relationships with clients to maximize collections.
- Generated monthly accounts receivable reports to submit developments for management review.
- Reconciled accounts receivable ledger to verify payments and resolve variances.
- Negotiated payment arrangements with customers to establish timely receipt of payments.
- Contacted clients with past due accounts to formulate payment plans and discuss restructuring options.
- Identified, researched, and resolved billing variances to maintain system accuracy and currency.
- Prepared financial statements to provide results of operations, financial position and cash flow.
- Prepared and mailed invoices to customers, processed payments, and documented account updates.
Prior Authorization Specialist/ A/R Rep
Metro Cardiovascular
11.2019 - 05.2022
- Answer incoming calls for new and existing authorizations
- Document the appropriate systems and ensure high quality and accurate information is provided to callers
- Process authorizations and customer services requests in a timely and professional manner
- Researches and communicates information regarding member eligibility, provider status and authorization inquires to caller while maintaining confidentiality
- Resolves customer complaints or concerns as the first line of contact
- Make problem resolution and triage decisions not requiring clinical judgement
- Assist callers with understanding what clinical information is required
- Accounts Payable
- Communicate appeal and denial language to providers and members when appropriate
- Processes withdrawals and other case status changes as needed
- Processes fax attachments in between calls
- Demonstrate effective problem solving skills
- Maintain member and provider confidentiality
- Maneuver through various computer platforms/screens while verifying variety of information
- Assist appeal department with faxes and notify patients and provider in writing there appeal decision
- Assist billing department in processing electronic claims though the system
- Converting information from excel spreadsheets
- Billing for DME
- Claims
- Appeals
- Reworking Claims
- Handling batches
- Dealing with Medicare & Medicaid
- Quick books
- Documentation review
- Worked on V-Look up
- Processed new medication and refill requests for authorization.
- Resolved patient billing inquiries and other issues efficiently.
- Maintained patient confidentiality and safeguarded medical records to avoid information breaches.
- Tracked referral submission during facilitation of prior authorization issuance.
- Obtained and logged accurate patient insurance and demographic information for use by insurance providers and medical personnel.
- Communicated pertinent information to client's prescribing provider to facilitate quality service.
- Prepared and distributed denial letters, detailing reasons for denial and possible appeal measures.
- Triaged unscheduled and emergency authorizations, directing submissions to appropriate personnel for rapid response.
- Created and maintained spreadsheets detailing medical procedures and insurance denials and approvals.
- Processed patients lacking coverage for planned procedures.
- Authorized surgical requests in accordance with applicable plan guidelines.
- Collected and processed patient liability statements prior to service.
- Responded to inquiries from healthcare providers regarding prior authorization requests.
- Input all patient data regarding claims and prior authorizations into system accurately.
- Reached out to insurance carriers to obtain prior authorization for testing and procedures.
- Analyzed medical records and other documents to determine approval of requests for authorization.
- Reviewed appeals for prior authorization requests and communicated with payers to resolve issues.
- Evaluated clinical criteria for approval or denial of services requiring pre-authorization.
Elementary Education Teacher
Adams Elementary
02.2017 - 08.2021
- Designed daily lesson plans customized to student needs.
- Built positive relationships with parents to involve families in educational process.
- Assessed student learning progress and comprehension with routine tests and standardized examinations.
- Established and enforced rules of behavior to drive social development and maintain positive interactions.
- Implemented classroom management improvements to enhance class morale and engagement.
- Planned lessons according to district standards to cover requirements and prepare for standardized tests.
- Kept classroom clean, organized, and safe for students and visitors.
- Organized classroom supplies and decorated walls to create fun, nurturing settings, and meet learning needs.
- Boosted individual perseverance and resilience by setting challenging goals and providing realistic support.
- Drove student learning by establishing clear classroom plans and group objectives, as well as actionable strategies to achieve each goal.
- Taught students subject-specific material, learning strategies, and social skills.
- Helped students develop self-esteem and life skills by fostering healthy conflict-resolution, critical thinking, and communication.
- Developed learning objectives for each subject area to quantify learning and set benchmarks.
- Assessed student progress by administering tests and evaluating results.
CUSTOMER SERVICE REPRESENTIVE
AT&T
01.2016 - 10.2020
- Resolve customer complaints via phone, email, mail, or social media
- Use telephones to reach out to customers and verify account information
- Greet customers warmly and ascertain problem or reason for calling
- Cancel or upgrade accounts
- Assist with placement of orders, refunds, or exchanges
- Sold items to customers
- Met a certain amount of calls
- Create spreadsheets to track important customer information and orders
- Transfer data from hard copy to a digital database
- Update customer information in a database
- Organize existing data in a spreadsheet
- Verify outdated data and make any necessary changes to records.
Education
BACHELOR OF SCIENCE - Psychology
UNIVERSITY OF PHOENIX
Phoenix, AZ05.2027
High School Diploma -
AFFTON HIGH SCHOOL
St Louis, MO05.2017
Skills
- TIME MANAGEMENT
- CSR
- Customer Support
- Microsoft Office (4 years)
- Excel (4 years)
- Outlook (4 years)
- Organizational Skills
- Accounts receivable
- Accounts payable
- Bookkeeping
- QuickBooks
- PeopleSoft
- Public accounting
- SOX
- Financial concepts
- Payroll
- Documentation Review
- EMR Systems
- A/R follow up (5 years)
- ICD-10
- Medical Billing
- APIs
- Epic
- Office Management
- Curriculum Development
- SAP
- Financial Report Writing
- Assessments
- Customer Focus & Orientation — Proficient
- Responding to customer situations with sensitivity
- Full results: Proficient
- Customer Focus & Orientation — Highly Proficient
- August 2020
- Responding to customer situations with sensitivity
- Full results: Highly Proficient
- Indeed Assessments provides skills tests that are not indicative of a license or certification, or continued
- Development in any professional field
- Additional Information
- Skills & Abilities
- COMMUNICATION
- Patience
- Attentiveness
- Ability to use positive language
- Time Management Skills
- Calming Presence
- Ability to handle surprises
- Willingness to Learn
- HIPAA Compliance
- Access Software
- Operations Support
- Creating Treatment Plans
- Benefits Verifications
- Revenue Operations
- Regulatory Compliance
- Time Management
- Billing Codes
- CMS-1500 Billing Forms
- Correct Errors
- Work Coordination
- Adding, Calculating and Billing Machines
- Data Security Procedures
- Scientific Calculators
- Maintain Records
- Error Revision
- System Updates
- ICD-10 Coding
- Accounts Receivable Management
- Prepare Statements
- Invoice Processing
- Dictation and Transcription
- Desktop Publishing
- A/P and A/R Expertise
- Customer Service
- Critical Thinking
- Verbal and Written Communication
Certification
- CPC - Certified Professional Coder
Timeline
Medical Billing Representative
HealthCare Support Staffing
02.2023 - Current
Accounts Receivable Specialist
BioTAB Healthcare
05.2022 - 01.2023
Prior Authorization Specialist/ A/R Rep
Metro Cardiovascular
11.2019 - 05.2022
Elementary Education Teacher
Adams Elementary
02.2017 - 08.2021
CUSTOMER SERVICE REPRESENTIVE
AT&T
01.2016 - 10.2020
BACHELOR OF SCIENCE - Psychology
UNIVERSITY OF PHOENIX
High School Diploma -
AFFTON HIGH SCHOOL
- CPC - Certified Professional Coder
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