Charmaine Spriggs
Accounts Receivable Specialist
Fort Washington,Md.
Summary
To obtain a challenge in a fast-paced environment where my skills and experience can be utilized to their fullest potential.
Overview
35
35
years of professional experience
Work History
Accounts Receivable Specialist II
Savista(contract)Medical Faculty Associates (GWUH)
Alpharetta, GA
06.2007 - Current
- Effectively follow up and research on Medicare, Carefirst Blue Cross Blue Shield, other government and commercial payers to collect payment for patient accounts for all divisions (Anesthesia, Dermatology, EM, Neurology, OB/GYN, Ophthalmology, Pathology, Psychiatry, Surgery, Urology, Podiatry, Gastroenterology, Radiology, and Cardiology)
- Determine accuracy for All payer payments, contractual obligation, and other adjustments
- Make sure all diagnose codes, procedure codes, HCPCS codes are correct according to the type of service for accurate reimbursement
- Appeal All payers due to discrepancies for payment and denial reasons
- Proficient knowledge and use of Epic and IDX (patient accounting system), Knowledge Source, Availity RealMed
- And InstantMed (Eligibility and claim status), Touchworks, Allscripts (accessing and reviewing medical documents)
- I also have access to and knowledge of Payer websites.
- Implemented new accounting processes to decrease spending and work flow downtime.
- Trained new team members on company policies, software systems, and effective accounts receivable practices for seamless integration into the role.
- Ensured the accuracy of customer records in internal systems by updating contact information, payment terms, and other relevant data as needed.
- Enhanced cash flow by ensuring timely invoicing, payment application, and account reconciliation.
- Managed complex problem-solving for upper management in order to complete projects on-time and within budget.
- Optimized revenue recovery efforts by utilizing negotiation skills in resolving complex issues related to past due invoices or disputed charges.
- Reconciled accounts receivable ledger to verify payments and resolve variances.
- Reduced outstanding accounts receivable balances by diligently following up on overdue payments.
- Participated in cross-functional initiatives designed to improve overall financial operations within the company, sharing accounts receivable expertise for broader organizational success.
Patient Accounts Insurance Specialist
Prince George's Hospital Center
11.2001 - 06.2007
- Effectively bill follow up, refund and determine appropriate action for Medicare accounts
- Determine accuracy for Medicare payments and discounts
- Make sure all diagnoses, procedure codes, CPT codes ECT
- Is correct according to the type of service
- Organize Medicare statistics and updates
- Answer questions relating to Medicare procedures and policies via phone or in person.
Customer Service Representative
Blue Cross Blue Shield of Washington DC
08.1999 - 11.2001
- Answering incoming calls from brokers, Group Administrators and subscribers, seeking assistance in claim and billing matters
- Assessed claim and benefit information
- Analyzed and made determination regarding adequacy of claims (diagnoses, procedure, allowed amounts and preauthorization numbers, etc.)
- Sent claims back to claims processor for adjustments as needed
- Claims were from dental, medical, vision and prescription drug providers
- Troubleshoot problems with subscribers benefit file and have them updated
- Issue cards, update names and address files
- Quote rates based on age, medical condition and deductible amounts for open enrollment, new non-group and conversion policies
- Explained in detail health insurance policy benefits
- Direct subscribers to the correct customer's service center as necessary.
Lifeline Assistant- Installation and Billing
Sibley Memorial Hospital
02.1999 - 08.1999
- Responsible for all Lifeline installation procedures
- Performs data entry billing and collection functions
- Maintains financial records and prepares monthly accounting reports
- Responsible for all clerical duties and all interactions with clients/patients
- Drove throughout the Region to patients home to install Lifeline Systems
- Educate clients/patients on how the system works.
Patient Accounts Financial Representative
Sibley Memorial Hospital
06.1990 - 02.1999
- Billed, follow up, refund and determined appropriate action for Medicare, Blue Cross, Commercial, Workers Compensation and Medicaid Insurance
- Managed and organized information by written correspondence and by telephone
- Customer service with patients by answering questions and setting up payment plans
- Review 700 accounts monthly making sure payments are posted accurately
- Claims from dental, medical, vision and prescription drug providers.
Insurance Agent/Customer Service Representative
World Access Incorporated
01.1989 - 06.1990
- Directed Blue Cross customers to international hospitals, assisting Capital Care members to correct facilities and talking to them about medical problems and conditions
- Explained MasterCard and Visa benefits, helping credit card clients with collision damage insurance, sending out appraisers and selling card members travel insurance.
Education
A Member of American Academy of Professional Coder
Continue Education Through LinkedIn Learning
Skills
- Exceptional Medical Billing skills
- A vast knowledge of diagnoses, procedure, CPT codes and hcpc codes
- Excellent communicator, fast learner and skilled problem solver
- Strong data entry skills: MS Word, Excel, Internet
- Exceptional customer service skills
- Attention to Detail
- Microsoft Office
- Payment Negotiations
- Investigative research
- Codes reviewing
- Accounts Receivable
- Microsoft Excel
- Financial research
- Data inputting
Additional Information
A member of American Academy of Professional Coder-Since August 2010, Continuous education on LinkedIn My Learning
Education Credentials
- 10/2012, Medicare Billing Certificate Program for Part B Providers
- 08/2010, A member of the American Academy of Professional Coders (AAPC)
- 05/2002, Continuing education with Medicare via teleconferences and webinars earning. CEU's (continue education units)
- 05/2002, CPAT certification (Certified Patient Accounts Technician)
- 09/1997, Charles County Community College Laplata, Maryland Majoring in Business
- 03/1997, Sibley Memorial Hospital Washington DC Medical Terminology
- 03/1996, Hospital for Sick Children Washington DC CPT coding class (certificate)
- 09/1984, Suitland High School Suitland Maryland Diploma
References
References available upon request.
Timeline
Accounts Receivable Specialist II
Savista(contract)Medical Faculty Associates (GWUH)
06.2007 - Current
Patient Accounts Insurance Specialist
Prince George's Hospital Center
11.2001 - 06.2007
Customer Service Representative
Blue Cross Blue Shield of Washington DC
08.1999 - 11.2001
Lifeline Assistant- Installation and Billing
Sibley Memorial Hospital
02.1999 - 08.1999
Patient Accounts Financial Representative
Sibley Memorial Hospital
06.1990 - 02.1999
Insurance Agent/Customer Service Representative
World Access Incorporated
01.1989 - 06.1990
A Member of American Academy of Professional Coder
Continue Education Through LinkedIn Learning