Summary
Overview
Work History
Education
Skills
Timeline
Generic

Catherine Wallace

Dorchester,MA

Summary


Competent Third Party Specialist with 10 years of experience in handling wide variety of medical billing tasks. Sophisticated and hardworking individual with excellent analytical and multitasking abilities. Coordinates with insurance companies and expedites claims processes.

Overview

9
9
years of professional experience

Work History

Third Party Specialist

Beth Israel Deaconess Medical Center
Boston , MA
2019.08 - Current

Communicated with insurance providers to resolve denied claims and resubmitted.

  • Precisely evaluated and verified benefits and eligibility.
  • Precisely completed appropriate claims paperwork, documentation and system entry.
  • Determined prior authorizations for medication and outpatient procedures.
  • Communicated effectively and extensively with other departments to resolve claims issues.
  • Located errors and promptly refiled rejected claims.
  • Prepared billing correspondence and maintained database to organize billing information.
  • Filed and updated patient information and medical records.
  • Delivered timely and accurate charge submissions.
  • Prevented financial delinquencies by working closely with managers to resolve billing issues before becoming unmanageable.
  • Gathered information from multiple sources to simplify billing and organize accounts.
  • Examined patients' insurance coverage, deductibles, insurance carrier payments and remaining balances not covered under policies when applicable.
  • Researched CPT and ICD-9 coding discrepancies for compliance and reimbursement accuracy.

Assistant Client Manager

Plexus Management Group
Westwood , Ma
2016.02 - 2019.04
  • Request and process medical records from hospital contacts
  • Follow up on concurrency irregularities.
  • Oversee client service representatives, assisting with and resolving any escalated issues.
  • Responsible for providing weekly reports on team metrics.
  • Review accounts with collection agencies.
  • Coordinate patient requests and status updates.
  • Resolve issues with third party groups, Expecteds, Dictionary, and Ajuba assist clients and patients.

Client Service Associate

Plexus Management Group
Westwood , MA
2012.Aug - 2016.Feb
  • Manage the anesthesia claim submission process to Medicare, Medicaid, and commercial payers.
  • Responsible for sending Electronic Data Interchange (EDI) transactions to GE Centricity, including corrections and re-spooling as necessary.
  • Balanced billing to secondary and tertiary insurance with correct primary insurance.
  • Processed and posted credit card payments taken by phone.
  • Answered patient calls and assisted with overall concerns.
  • Managed delinquent accounts including collections.

Education

High School Diploma -

Mount Saint Joseph's Academy
Brighton, MA
05.1990

Skills

  • Data Entry
  • Problem Solving
  • Insurance Billing
  • Verbal and Written Communication
  • Information Classification
  • Treatment Documentation
  • Medical Billing Processing
  • Time Management
  • Attention to Detail
  • Hospital Inpatient and Outpatient Records
  • Medical Terminology
  • Coding Error Resolution
  • Demographics Information
  • Patient Information Verification

Timeline

Third Party Specialist

Beth Israel Deaconess Medical Center
2019.08 - Current

Assistant Client Manager

Plexus Management Group
2016.02 - 2019.04

Client Service Associate

Plexus Management Group
2012.Aug - 2016.Feb

High School Diploma -

Mount Saint Joseph's Academy
Catherine Wallace