Charmaine N. Spriggs
Fort Washington,Md.
Summary
Dedicated professional with 30 years of experience in the field of Medical Accounts Receivable (physician and facility). Proven ability to multitask and prioritize in a fast-paced environment.
Overview
30
30
years of professional experience
Work History
Accounts Receivable Specialist II
Savista (contract) Medical Faculty Associates
Alpharetta , GA
2007.06 - 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.
Patient Accounts Insurance Specialist
Prince George’s Hospital Center
Cheverly , Maryland
2001.11 - 2007.06
- 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
1999.08 - 2001.11
- 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
Sibley Memorial Hospital
Washington DC
1999.02 - 1999.08
- Installation and Billing
- 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
Washington DC
1990.06 - 1999.02
- 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
Washington DC
1989.01 - 1990.06
- 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
Medicare via teleconferences and webinars earning. CEU’s (continue education units) - undefined
Current
Medicare Billing Certificate Program for Part B Providers - undefined
10.2012
CPAT certification (Certified Patient Accounts Technician) - undefined
05.2002
Business
Charles County Community College
06.1998
undefined
Sibley Memorial Hospital
03.1997
Hospital for Sick Children - undefined
03.1996
CPT coding class (certificate - undefined
Suitland High School
06.1988
Diploma - undefined
Professional Coder
Skills
- Summary
- 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
References
References available upon request.
Timeline
Accounts Receivable Specialist II
Savista (contract) Medical Faculty Associates
2007.06 - Current
Patient Accounts Insurance Specialist
Prince George’s Hospital Center
2001.11 - 2007.06
Customer Service Representative
Blue Cross Blue Shield of
1999.08 - 2001.11
Lifeline Assistant
Sibley Memorial Hospital
1999.02 - 1999.08
Patient Accounts Financial Representative
Sibley Memorial Hospital
1990.06 - 1999.02
Insurance Agent/Customer Service Representative
World Access Incorporated
1989.01 - 1990.06
Medicare via teleconferences and webinars earning. CEU’s (continue education units) - undefined
Medicare Billing Certificate Program for Part B Providers - undefined
CPAT certification (Certified Patient Accounts Technician) - undefined
Business
Charles County Community College
undefined
Sibley Memorial Hospital
Hospital for Sick Children - undefined
CPT coding class (certificate - undefined
Suitland High School
Diploma - undefined
Professional Coder
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