Summary
Overview
Work History
Education
Skills
Timeline
Generic

CHERYL E. ROGERS

Plainfield,NJ

Summary

OBJECTIVE: To secure a responsible position with an established company, that will utilize my strong billing & collection skills as well as my over 30 plus years of outstanding customer service experience while providing excellent growth opportunities.

PROFILE: Highly capable, dedicated, and a dependable individual. With over twenty-seven yrs. of experience in the healthcare field. I can easily adapt to change while excepting new and challenging responsibilities. Intricate knowledge of medical billing, collections, customer service, follow-up & claims processing with a strong knowledge of ICD 10 codes. Knowledge of Medicare, Medicaid, EPO, PPO, HMO, PIP, Personal Injury, Disability claims, Dental, Pharmacy, Teladoc & EyeMed Billing. A working knowledge of Microsoft office, Microsoft Word, Excel, V-lookup, PowerPoint, Sales force, Skype, Teams, Zoom, SharePoint's, Salesforce, Sales Cloud, Avaya & all general office equipment. The ability to work third and secondary insurance claims effectively given the company a quick cash turnaround. The ability to meet or exceed department productivity requirements. Ability to understand and implement internal control concepts and perform root cause analysis to solve complex problems. Exercise discretion, good judgment, and strong attention to detail, courtesy, tact, and patience. Ability to work independently and meet multiple deadlines. High ethical standards and values with ability to handle confidential / sensitive issues and information with the highest degree responsibility. Experience handling Personal Health Information (PHI) in a professional manner. Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.

Overview

32
32
years of professional experience

Work History

Resolution/Case Installation Specialist

Emblem Health
08.2018 - Current
  • Focus on prompt and accurate responses to internal departments and vendors to ensure seamless resolution.
  • Ensure that all renewal paperwork is signed, and any renewal notification is issued timely.
  • Resolve issues and inquiries from sales and underwriting that may arise during the group's renewal period.
  • Conduct in-depth research of escalated issues and identifies root cause analysis.
  • Ensure productivity & accuracy of auditors meet or exceed department standards.
  • Identify opportunities while partnering with other departments to minimize reoccurring issues with new customers.
  • Conducts full audits on over 100 groups during Open Enrollment to ensure all renewing groups (large/small) are renewed properly within a timely manner.
  • Ensuring all member benefits are set up accurately as well as group renewal rate to create a smooth renewal process.
  • Apply analytical skills and knowledge of current auditing developments and standards to formulate appropriate solutions to problems.
  • Perform special projects as needed.

Accounts Receivable Lead

Med-Metrix/Medi
02.2013 - 05.2018
  • Respond to members incoming calls regarding billing inquiries and resolve any complaints made by members and physicians regarding their medical claims.
  • Post payments from patients & insurance refunds and adjustments
  • Run daily audit journals as well as month end reports.
  • Send insurance appeal letters for denied/underpaid or incorrectly paid medical claims.
  • Adjudicate electronic claims online through Availity.
  • Maintain daily and monthly excel report for payment, adjustments and charges.
  • Identify carriers with related denial trends and review and resolve root cause.
  • Verified discrepancies and resolved clients' billing issues
  • Prepared bills receivable, invoices, and bank deposits.

Collections Rep

Medcon Financial/Origin Health
02.2004 - 01.2013
  • Respond to all billing inquiries and complaint calls from patients, clients, physicians in a prompt and efficient manner.
  • Post payments, patient & insurance refunds, and adjustments; Run daily audit journals as well as month end reports.
  • Delivered exceptional customer service on collection calls and maintained calm and professional demeanor.
  • Accurately enter all charges/demo info with patient diagnosis, procedure codes, provider numbers & authorization
  • Review patient medical records for accuracy and make sure procedures are coded correctly per ICD 10 guidelines.
  • Send out appeal letters for denied/ incorrect/underpaid paid claim.
  • Update & Negotiate rates with insurance carriers.
  • Review and verify billing documents before recommending payment or prompt pay discounts for WC & NF carriers.
  • Maintain daily excel log sheet for payments, charges & adjustments audit all posted charges & invoice clients.
  • Correct electronic claims online through electronic claims vendors software: Zirmed & Availity
  • Maintain a clean AR by following up on all accounts from 30-120 days by running & working current excel reports.
  • Working correspondence daily; contact ins carriers regarding claim status, reviewing issues & refunds from ins/pts
  • Identify carrier with related denial trends, f/u on timely filing issues & resolve through appeals process. Keeping track of assigned accounts to identify outstanding debts; planning course of action to recover outstanding debt Heavy phone activity with customers; locating and contacting debtors regarding payment status; negotiating payoff.
  • Handling questions or complaints; investigating and resolving discrepancies for patients & doctors.
  • Establishing good relationships with customers; updating account status & demographic in database
  • Post customer payments to accounts and kept track of daily lock box total.
  • Follow-up on accounts 90 days and over via Navient.
  • Send appeals on claims not paid per contracted rate.
  • Achieved performance goals on consistent basis.

Audit Collection Coordinator

Children's Specialized Hospital
09.1999 - 01.2004
  • Coordinate all aspects of billing operations to coincide with Patient Accounts Manager and AR Manager
  • Follow up with all commercial insurance carriers as well as Medicare, Medicaid Workers Comp & No-Fault
  • Perform all aspects of collections activities directly related to Inpatient and Outpatient accounts.
  • Researched and prepared information for medical records associated with appeal process.
  • Determine weather services billed to patients is consistent with medical record documentation & HIPPA guidelines.
  • Weekly meeting with doctor, nurse, therapist & family to discuss best care path for the minor child & update new authorization.
  • Resolved issues through active listening and open-ended questioning, escalating major problems to manager.

Dedicated Service Manager

Oxford Health Plans
08.1997 - 07.1999
  • Managed over 75 plus calls per day in an high-volume call center environment from members and providers.
  • Answered all questions accurately and efficiently regarding services provided by to members through their medical plan coverage.
  • Provided benefit information to doctors, small & large group member's also authorized services per policy guidelines.
  • Resolution of medical claim issues, as well as adjudication claims online for swift reimbursement.
  • Conducted follow-up call at end of job to verify satisfaction.

Physicians Biller, Customer Service / Collection Representative

Overlook Hospital
04.1991 - 08.1997
  • All aspects of electronic (NEIC) billing as well as, hard copy billing on UB92 & 1500 forms
  • Follow-up on accounts 45-120 days
  • Maintain daily correspondence and answer in-coming calls.
  • Cash posting and adjustments & negotiate rates for swift claims resolution.
  • Billing of all commercial carriers as well as Medicare, Medicaid, Blue Cross/Blue Shield, Workmen's Comp & No-Fault claims
  • Resolve any issues with: Inpatient & Outpatient billing, anesthesia, physician, dialysis & oncology billing.
  • Maintain up to date knowledge on current policies & procedures regarding carriers.
  • Reviewing of EOB for accuracy according to the company's contractual rate payment agreement.
  • Appeal incorrectly processed claims, f/u on outstanding claim status adjudicate claims online.
  • Kept all patient information secure and confidential.

Education

Computer Programming & Operations

School of Data Programming
Union NJ
06.1986

Business Administration

Kean College of New Jersey
Union NJ
06.1985

High School Diploma -

East Orange Campus High School
East Orange NJ
06.1983

Skills

  • Data Analysis
  • Customer Service
  • Problem Solving
  • Work Independently
  • Multi Tasking
  • Self Motivated
  • Team Player
  • Excellent Oral, written & Verbal skills
  • Ability to meet deadlines
  • Perform root cause analysis to resolve complex problems

Timeline

Resolution/Case Installation Specialist

Emblem Health
08.2018 - Current

Accounts Receivable Lead

Med-Metrix/Medi
02.2013 - 05.2018

Collections Rep

Medcon Financial/Origin Health
02.2004 - 01.2013

Audit Collection Coordinator

Children's Specialized Hospital
09.1999 - 01.2004

Dedicated Service Manager

Oxford Health Plans
08.1997 - 07.1999

Physicians Biller, Customer Service / Collection Representative

Overlook Hospital
04.1991 - 08.1997

Computer Programming & Operations

School of Data Programming

Business Administration

Kean College of New Jersey

High School Diploma -

East Orange Campus High School
CHERYL E. ROGERS