Chanel T. Green
Lincoln,CA
Summary
Energetic Recreational Supervisor known for high productivity and efficient task completion. Specialize in program development, team leadership, and operational management. Excel in communication, adaptability, and problem-solving to enhance recreational programs and services. Committed to providing engaging and safe environments for community recreation. Positive and upbeat activity leader skilled at working with people of all skill levels to fully participate in programs. Record of success directing safe and fun events. Well-versed in recreation. Accurate professional performs all aspects of medical billing, including coding, charge entry, transmission, correction, and resubmission. Brings several years of experience in working hand-in-hand with back office to validate proper information for claims processing. Detail-oriented and helpful professional with expertise in resolving billing issues and reviewing claim denials. Go-getter Representative works closely with business development professionals to meet objectives and achieve revenue goals. Engages consumers and business leads to educate in products and services offered. Generates new business opportunities using proven processes to prospect business leads and close new accounts.
Overview
24
24
years of professional experience
Work History
Games Area Manager
UC Davis
Davis, CA
05.2024 - Current
- Manage a team of over 30 student staff in a university setting in a bowling alley, billiard, and gaming facility
- Book lane reservations for schools and organizations for full facility rentals and event or private rentals
- Assist in developing, implementing, and evaluating recreational programs for target populations
- Provide excellent customer service while building rapport with my team and current and future customers and organizations
- Assist on marketing and promoting a large complex program with the goal of generating revenue
- Assist in maintaining and analyzing financial data and adhere to budgets and deadlines
- Utilize my Interpersonal skills to establish and maintain effective working relationships with vendors and clients both on and off campus
- Run weekly team meetings to go over agenda items and how to team build and build morale to continue a functioning successful work environment.
Principal Access Rep, Representative
UC Davis Medical Center
Rancho Cordova, CA
12.2023 - 05.2024
- Directly responsible for activities related to the completion of registration, securing sponsorship and completion of applications for County, State and Federal funding programs successfully
- Activities required in this position are reception, registration, insurance verification, payor notification, authorization verification, securing sponsorship, educating patients or family members on various programs like Medi-Cal, Medicare, County Medically Indigent Services, Victims of Violent Crime, and other financial assistance linkages
- Making appropriate referrals and notifications, collecting payments, co-pays, and deductibles, and assuring all avenues of reimbursement or assistance are pursued to guarantee payment for uninsured/under insured patients
- Communicate with physicians, insurance companies, government payers, health system representatives, and patients, to verify eligibility and benefits, obtain authorizations, register patients, provide financial counseling, obtain sponsorships for unsecured accounts, and provide liaison with referring physicians within the hospital
- Representatives support both inpatient and outpatient services
- Assist in prepping the pre authorizations and connecting with the Providers/Provider offices so that we can schedule the patients for approved and appropriate appointments with the medical facility for in or outpatient services and surgeries.
Ambulance Biller
Trauma Life Care
Carmichael, CA
08.2023 - 12.2023
- Billed for ambulance transport services for multiple payors on behalf of patients
- Worked through different internal software and web portals to be able to pull past due balances and have the claims rebilled, and resubmitted rejected claims to the primary and secondary insurances
- Calculated dollar amount and services per mile and submitted for payment on HCFA 1500 and UB04 claim forms
- Worked with commercial payors and Medi-Cal to ensure correct billing and to determine if benefits were covered at 100% through HMO plans or had coinsurances through PPO or OON plans
- Ran eligibility and benefit information and reached out to patients regarding collection bills as needed or insurance update information.
Follow Up Specialist
Robert Half & Assoc | Adventist Health
Roseville, CA
11.2022 - 07.2023
- Insurance Follow-up
- Contact the payors for A/R claims or collections status via payer websites, Availity, or direct call to the hospitals
- Check claim status to determine if the claim was paid, denied, or in process
- Ensure claims were paid, payments were posted, and if needed send a work item up to cash posting to trace the check or EFT payment
- If the claims were denied, research the reasoning through medical records, itemized bill, and EOB to determine if an appeal was necessary to file within the timely filing limits
- Rebill the claims if there was a correction needed like CPT code was rejected or wrong address or anything that was inaccurate causing the claim to deny
- Calculated the contractual adjustment per expected reimbursement VCO tool to make sure we were paid at the contractual rate
- If there was a remaining balance on the account after the claim was paid, if the charges were not valid it will be contractually written off
- Meet standard of 45 claims a day working high dollar down and 10k plus and made sure the claims were cleared out by Friday
- Posted insurance and personal payments to the correct account and calculated, verified, and posted contractual adjustments to the correct patient and thoroughly documented the account with clear and concise notes
- Worked on special projects to clear out the high dollar claims for Blue Cross/Blue Shield
- Pulled medical records to be faxed over to the payers along with additional documentation when needed
- Worked with commercial payers, government, Medi-Cal, and private sector.
Regulatory Operations Specialist
United Health Group/Dignity Health/Optum 360
Rancho Cordova, CA
10.2017 - 08.2021
- Responsible for the full revenue cycle for the Dignity health system
- Responsible for all follow up on insurance claims to Medicare, Medi-Cal, and commercial insurance
- Analyzing and auditing hospital accounts to see which ones need to go out for a rebill and reprocess claims for payment in a timely manner
- Working high dollar claims to low dollar claims in multiple hospital and regions
- Working GMCP Medi-Cal ambulance claims and billing claims
- Electronic billing of all commercial, HMO and managed care carriers
- Quickly identified and resolved medical billing, coding, and insurance discrepancies
- Maintained and updated all files including insurance companies, diagnosis, procedure, fees/profiles
- Corrected and resubmitted claims denied by insurance company
- Coding of inpatient and outpatient procedures from operative reports by using ICD 10 and CPT codes and applying modifiers when needed
- Billed out Veterans Administration and Tri Care claims and attached medical records, and itemized bills and other correspondence to be sent off certified mail according to the various medical fee guidelines
- Processed high dollar stop loss claims for individual hospitals as priority, as well as review rebills, rebill requests, and return billing tasks.
Claims Examiner I
Kelly Services, Health Net Federal Services
Folsom, CA
08.2016 - 07.2017
- In a production driven environment, I process medical claims for veterans
- Maintain claim files, such as records of settled claims and an inventory of claims requiring detailed analysis
- Verify and analyze data used in settling claims to ensure that claims are valid and that settlements are made according to company practices and procedures for the veterans
- Processed under a new structure called Vertexing, where a group of us constructed the process from the ground up working on hospital claims, (UB) and Professional claims, (HCFA), and rejected claims to be manually keyed and returned to the provider
- Work on a numbers system to maintain our inventory pushing claims out within a 72-hour window with Heavy Data entry and 10 key.
Senior Billing Test Claim Specialist
CVS Coram Healthcare
Rancho Cordova, CA
10.2015 - 02.2016
- Processed test claims as they come in manually or electronically from various hospitals and healthcare organizations for home infusion therapies
- We processed the claims in a timely manner to gain contractual agreements for the various therapies
- Processed claims for various pharmaceutical treatments for short- and long-term patients, (I.E.) antibiotic IV therapies for pain management and control, or specified diseases, claims are to be approved and payable before authorization post hospital stay to transition to home care
- Processed claims for Medicare, Medicaid, Part A and B and commercial
- Input usual and customary, ingredient cost, and gross amounts into claims for billing
- Knowledgeable in CE200, HCN, and SALESFORCE
Installation and Membership
Aerotek Staffing Agency, Blue Shield of California
El Dorado Hills, CA
07.2014 - 12.2014
- Processed various electronic requests that came from the members of small and large medical groups regarding their patients
- Enrolled and cancelled members and their dependents into either HMO, or PPO plans with optional dental and life insurance
- Worked in RUMBA RTMS systems, and FACETS
- Issued ID cards and HIPPA letters
- Worked with member services, enrollment, and premium billing to resolve member complaints regarding their enrollment
- Medical billing and payments
Customer Service
Health Net, Inc
Rancho Cordova, CA
09.2012 - 01.2014
- Inbound call center with an average of 100 calls a day
- Answered multiple phone calls for Medicare members that needed benefits and eligibility questions answered
- Checked formulary information pharmaceutical benefits and coverage information to see if certain drugs were covered or excluded under Medicare allowable
- Sent out literature at the member’s request regarding ID cards, un-enrollment forms, and EFT to have automatic bank drafts
- Processed appeals and grievances cases/member inquiries/complaints into information systems and prepared documentation for further review
- Requested and obtained enrollment history, claims history and/or invoices as appropriate to assist with research
- Assured timeliness and appropriateness of all case resolutions according to state, federal, and company guidelines and maintaining HIPPA
- Collaborated with other departments and States to address root causes of member dissatisfaction
- Assisted with Medicare denial and appeals processing
- Medical billing and payments
Customer Service Representative
Delta Dental of California, Select Staffing
Rancho Cordova, CA
03.2010 - 10.2010
- Inbound dental insurance call center averaging 80-100 calls daily
- Verified benefits and eligibility for the providers and members regarding benefit amounts, annual and lifetime maximums, deductibles, and coinsurance
- Took claims calls regarding dental billing and recouping funds for the patients and providers if necessary
- Received and resolved member inquiries related to claims
- Elevated cases to the appropriate committee and or management per protocol
- Coordinated workflow between departments and interface with internal and external resources
- Processed billing and payments.
Billing Specialist/Floater
First Data TASQ Technology, Kelly Staffing
Rancho Cordova, CA
09.2009 - 03.2010
- Data entry position typed over 10k keystrokes per minute
- Learned multiple functions of the entire department to assist those that were overloaded with work
- Ran reports from web reporting, inventory receiving reports, on hand inventory reports, and order merchant inquiries
- Processed customer reporting for invoicing detail and exporting reports
- Calculated freight charges and equipment order amounts when pricing was inaccurate
- Processed credit and debit memos on shipment orders that were refunded or incorrectly priced
- Created and or maintained statistics and reporting
- Act as a liaison between the members and their merchant
- Assisted with interdepartmental issues to help coordinate problem solving in an efficient and timely manner
- Coordinated workflow between departments and interface with internal and external resources.
Customer Service Representative
Verizon Wireless
Rancho Cordova, CA
03.2006 - 08.2008
- Reason for Leaving: Personal
- Handled 100 plus calls with 5-minute average for busy inbound wireless call center
- Assisted customers with new services, upgrades, adding lines, win-backs, and wanting to add or delete features
- Assisted in the retention queue for customers who were irate and wanted to change carriers
- Offered solutions to maintain customers.
Vendor Services Representative
Bank of America
Rancho Cordova, CA
05.2004 - 03.2006
- Reason for Leaving: Department closure
- I specialized in 10- key, over 9k keystrokes
- Processed 400+ deeds daily and called clients to close loans and obtain borrower’s authorization
- Processed LPI and title of deeds of trust, and prepared documents to be shipped via fed-ex.
Installation and Membership
Blue Shield of California
El Dorado Hills, California
03.2003 - 05.2004
- Accounting and Finance-Group data entry
- Reason for Leaving: Personal
- Activated, built, and cancelled medical groups per company request
- Processed enrollment for small and large medical groups for their employees
- Processed book-keeping for the employees and maintained medical records and group information on RUMBA systems
- Also did light filing and activated ID cards and life insurance for the subscribers
- I processed medical billing and claims
- Medical billing and payments regarding coinsurance, copayments, ingredient costs, cap payoffs
Medicare Prescription Drug Plan Customer Service
Health Net of California
Rancho Cordova, California
02.2000 - 09.2003
- Provider Services
- Inbound call centers take an average of 80-100 calls daily with 10 keys over 9,000 keystrokes
- Verified benefits and eligibility to members and providers and processed payments for medical claims
- Worked with multiple IDC-9 CODES
- And CPT CODES and ensured accuracy for correct and timely claims processing
- Processed Medi-Cal, Medicare part A and B claims as well as member claims
- Worked with enrollment, member services, provider services, and premium billing to resolve member complaints/inquiries to regulatory agencies and or plan partners
- Maintained confidentiality and complied with HIPPA guidelines, and fraud and abuse prevention detection policies and procedures
- Maintained and established positive work relationships with coworkers, clients, members, providers, and customers.
Skills
- Rec Activity Supervision
- Policy Implementation
- Staff Scheduling
- Conflict Resolution and problem-Solving
- Relationship Building
- Time management abilities
- Self Motivation
- Analytical Skills
- Coaching and Mentoring
- Professional Demeanor
- Team Collaboration
- Excellent Communication
- Active Listening
Medical skills and software expertise
- Proficient in Epic, RUMBA, CITRIX, CERNER, NEX CEN and medial billing software
- Medical Terminology
- Knowledge of Pharmaceutical Medication
- Medical coding and billing
- Claims processing for Medicare, Medicaid, Commercial Plans, Part A&B plans
- Medical Group Verification and Eligibility
- 23 years of Medical Health Insurance billing and collections
- Knowledgeable of Medicare, Medi-Cal, Commercial payers, Government programs, Workman’s Comp
- Authorization and diagnosis code verification
- Appeal claims denials
- Billable claim determination, corrections, and submissions
- Insurance claim preparation and submission
- Answered patient questions and advised them on their insurance coverage and benefits
- Established repayment plans and arrangements with delinquent patients
- Contacted insurance billing departments to address and correct billing errors and omissions
- Accounts Receivable and Payable skills
- Ability to work in a high-pressure environment
- Proficient in 10 key and data entry
- Administrative and clerical skills
References
References available upon request.
Timeline
Games Area Manager
UC Davis
05.2024 - Current
Principal Access Rep, Representative
UC Davis Medical Center
12.2023 - 05.2024
Ambulance Biller
Trauma Life Care
08.2023 - 12.2023
Follow Up Specialist
Robert Half & Assoc | Adventist Health
11.2022 - 07.2023
Regulatory Operations Specialist
United Health Group/Dignity Health/Optum 360
10.2017 - 08.2021
Claims Examiner I
Kelly Services, Health Net Federal Services
08.2016 - 07.2017
Senior Billing Test Claim Specialist
CVS Coram Healthcare
10.2015 - 02.2016
Installation and Membership
Aerotek Staffing Agency, Blue Shield of California
07.2014 - 12.2014
Customer Service
Health Net, Inc
09.2012 - 01.2014
Customer Service Representative
Delta Dental of California, Select Staffing
03.2010 - 10.2010
Billing Specialist/Floater
First Data TASQ Technology, Kelly Staffing
09.2009 - 03.2010
Customer Service Representative
Verizon Wireless
03.2006 - 08.2008
Vendor Services Representative
Bank of America
05.2004 - 03.2006
Installation and Membership
Blue Shield of California
03.2003 - 05.2004
Medicare Prescription Drug Plan Customer Service
Health Net of California
02.2000 - 09.2003
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