Carly Walls
Saint Helens,OR
Summary
Professional medical billing specialist with over 20 years of comprehensive knowledge in insurance billing processes and regulations. Skilled in claims management, policy analysis, account receivables, authorizations and customer service. Strong focus on team collaboration, adaptability, and achieving results. Reliable with expertise in navigating complex billing software and resolving discrepancies efficiently.
Overview
18
18
years of professional experience
Work History
Financial Counselor-Collections
Rebound Orthopedics
06.2023 - Current
- Managed patient billing inquiries and resolved discrepancies efficiently.
- Contacted patients after insurance was calculated to obtain payments.
- Responded to patient, family, and external payer inquiries including outsourced third party collection agency.
- Reconciled patient accounts through proper primary and secondary billing, money movement and resolving discrepancies to enhance collection efficiency.
- Developed and maintained strong relationships with patients, ensuring clear communication regarding payment options.
- Managed patient accounts to ensure timely collections and minimize outstanding balances.
- Offer self-pay platform options for self-pay patients and assist in setting up those plans, including negotiating payment plans.
- Identify patients who may have financial hardships and evaluate eligibility for financial assistance programs.
- Identified and resolved insurance billing and statement discrepancies.
AR Billing Specialist
Rebound Orthopedics
05.2022 - 05.2023
- Processed accounts receivable transactions efficiently, ensuring accurate billing and timely follow-up.
- Collaborated with healthcare providers to resolve billing discrepancies and enhance patient satisfaction.
- Enhanced billing accuracy by diligently reviewing and correcting discrepancies in patient accounts.
- Expedited the resolution of complex claims by working closely with healthcare providers, patients, and insurance companies.
- Identified trends in billing issues by analyzing claim denials and implementing corrective actions to prevent future occurrences.
- Maintained strong relationships with insurance providers through effective communication to ensure timely reimbursement for services rendered.
- Optimized revenue generation by accurately applying appropriate adjustments, write-offs, and refunds as needed.
- Collaborated with the coding department to ensure accurate charge capture for all services rendered, minimizing claim denials due to coding errors.
- Sustained a high level of professionalism when dealing with sensitive financial matters, upholding patient confidentiality and adhering to HIPAA guidelines.
- Collaborated with healthcare providers to gather necessary documentation for appeal submissions.
- Analyzed denial claims to identify patterns and root causes, improving resolution rate.
- Maintained knowledge of insurance coverage benefit levels, eligibility systems and verification processes.
Lead Accounting Specialist
CODA, Inc.
05.2017 - 08.2017
- Provide training assistance to new and existing staff.
- Train on all client service billing and collection activities.
- Prepare and submit error free claims to various insurance companies.
- Contact insurance companies to get authorization for patient services as necessary.
- Prepare adjustments and rebills.
- Post and file EOBs as received.
- Respond to patient and colleagues questions promptly and efficiently.
- Resolve billing issues by discussing contract with third-party payer, explaining insurance contract with patient and negotiating settlement.
- Maintain patient and invoice files by entering and adjusting rate.
- Enter date accurately and efficiently into posting, charge inputs and authorizations.
- Provide billing information by collecting, analyzing and summarizing third-party billings, accounts pending, and late charges data and trends.
- Verify that CPT, HCPCS and ICD-9 codes submitted to third-party payers are an accurate representation of the medical services rendered.
- Research any discrepancies noted prior to charge entry to ensure accuracy.
- Notifying the Billing Manager of any regulatory and compliance issues relating to inaccuracies or aberrant billing patterns discovered during the billing process.
Billing Specialist
CODA, Inc.
04.2014 - 08.2017
- Facilitate timely and accurate pre-bill audit of billing system transactions for mental health, residential/detox and outpatient chemical dependency programs and services .
- Managed end-to-end billing cycle, including invoicing and payment processing.
- Contact insurance companies to get authorization for patient services as necessary.
- Identify and resolve patient billing complaints.
- Prepare, audit and transmit patient billing.
- Prepare adjustments and rebills pertaining to EOB denials and insurance changes.
- Post EOB's and claim denials in an accurate and timely manner.
- Respond to patient and colleague questions promptly and efficiently.
- Provide billing information by collecting, analyzing, and summarizing third-party billings, accounts pending, and late charges data and trends.
- Verify that CPT, HCPCS and ICD-10 codes submitted to third-party payers are an accurate representation of the medical services rendered.
- Notify billing management of any regulatory or compliance issues relating to abnormal or inaccurate billing patterns discovered during pre-audit and billing process.
Billing & Registration Specialist
University Medical Group
09.2011 - 12.2013
- Processing transactions on customer accounts, including account set-up, registration, insurance set-up/verification, problem resolution and auditing transaction activity.
- Communicating directly with customers, UMG staff, and third-party contacts (departments and insurance companies) to ensure timely and accurate processing of professional billing charges to commercial, individual, Medicare and Medicaid health plans.
- Interpreting and inputting referrals and pre-authorizations for prior, current and future health services.
- Analyzing and researching insurance programs for claim information, and to facilitate customer account transactions with use of OneHealthport, Availity and other various insurance websites.
- Charge entering batches, review of clinical and physician charges, verifying insurance and determining filing order as well as reading and interpreting chart notes in Epic.
Membership & Account Specialist
Providence Health & Services
07.2008 - 10.2010
- Responsible for the first line of communications with existing and potential members, providers, and employers.
- Responsible for providing detailed benefit, eligibility, and premium information on a broad portfolio of products, assist members in selecting primary care physicians, assist members in the appropriate use of clinics services and health plans, provide eligibility to members, providers, and employers, respond to claims inquiries, and resolve members issues or concerns.
- To initiate and facilitate member, provider, and employer phone calls to the Providence provider entities, pharmacy department, employer groups, sales and producers in an efficient manner.
- To reconcile monthly commercial group premiums, identify discrepancies and enforce delinquency and collection policies.
- This position also includes processing receipts for refunds, write-off's, payment reversals, general A/R and processing contract renewals.
Education
Diploma -
Franklin High
Portland, OR01.2000
Skills
- Accounts receivable management
- Detail-oriented analysis
- Fast Typing, Data-Entry and 10-Key by touch
- Excellent verbal, written, interpersonal and customer service skills
- Working knowledge of Microsoft Word, Excel, Outlook, Facets, Epic, Avatar and MedEvolve
- Vast knowledge of insurance policies and practices including Medicare, medicaid and commercial insurance
- Patient counseling and support
- Insurance verification including utilization of external payer websites
- Accurate and timely payment posting
- Efficient claim processing and management
Timeline
Financial Counselor-Collections
Rebound Orthopedics
06.2023 - Current
AR Billing Specialist
Rebound Orthopedics
05.2022 - 05.2023
Lead Accounting Specialist
CODA, Inc.
05.2017 - 08.2017
Billing Specialist
CODA, Inc.
04.2014 - 08.2017
Billing & Registration Specialist
University Medical Group
09.2011 - 12.2013
Membership & Account Specialist
Providence Health & Services
07.2008 - 10.2010
Diploma -
Franklin High