Crystal Clark
Pittsburgh,PA
Summary
Experienced Account Representative II with over25 years of experience in the medical billing field. Accurate and detail-oriented with knowledge of benefits, eligibility and appeals practices, and HCPC coding. Productive and diligent with passion for resolving discrepancies through attention to detail and creative problem-solving. Passionate about perpetuating Chartwell's values through impeccable work ethic and drive. Seeking to obtain an advanced position to help team achieve company goals as a team lead.
Overview
32
32
years of professional experience
1
1
Certification
Work History
Account Representative II
Chartwell PA/CarepathRx
07.1991 - Current
- Collaborated with other departments to address customer needs and service requests.
- Processed client payments and updated accounts.
- Analyzed accounts for delinquencies and other ongoing issues.
- Confidently and adeptly handled claim denials and/or appeals.
- Precisely evaluated and verified benefits and eligibility.
- Diligently filed and followed up on third party claims.
- Actively maintained current working knowledge of CPT and ICD-9 coding principles, government regulation, protocols and third party requirements regarding billing.
- Posted and adjusted payments from insurance companies.
- Researched CPT and ICD-9 coding discrepancies for compliance and reimbursement accuracy.
- Reviewed and resolved claim issues captured in claims edits and clearing house.
- Maintained and updated collections tracking spreadsheet to help organize payment information.
- Verified insurance of patients to determine eligibility.
- Communicated with insurance providers to resolve denied claims and resubmitted.
- Analyzed complex Explanation of Benefits forms to verify correct billing of insurance carriers.
- Prepared billing statements for patients and verified correct diagnostic coding.
- Collected payments and applied to patient accounts.
- Reviewed patient records, identified medical codes, and created invoices for billing purposes.
- Posted payments and collections on regular basis.
- Generated reports and analyzed trends to maximize reimbursement and reduce claim denials.
- Responded to customer concerns and questions on daily basis.
- Audited and corrected billing and posting documents for accuracy.
- Handled account payments and provided information regarding outstanding balances.
- Monitored outstanding invoices and performed collections duties.
- Collaborated with customers to resolve disputes.
- Utilized various software programs to process customer payments.
- Processed payment via telephone and in person with focus on accuracy and efficiency.
- Generated monthly billing and posting reports for management review.
- Generated accounts payable reports for management review to aid in financial and business decision making.
Skills
- Microsoft Word and Excel
- Multitasking and Organization
- HIPAA Compliance Certification
- Medicare Policy and Procedure Guidelines
- ICD-9 and HCPC Coding
- Teamwork and Collaboration
- Claims Processing
- Accounts Reconciliation
- Billing and Collection Procedures in
Government, Commercial and Private Insurance
Certification
- Community College of Allegheny County - Accounting Fundamentals I & II 2021
Timeline
Account Representative II
Chartwell PA/CarepathRx
07.1991 - Current
- Community College of Allegheny County - Accounting Fundamentals I & II 2021
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