I have over 20 years experience in AR Revenue Cycle.
I have worked with Medicare/Medicaid, Commercial payers, and HMO's in different positions by contacting the payers on delinquent accounts to assist in getting claims processed and paid in a timely manner. As a Denials Coordinator, I identified trending claim denials and their root causes and reported them back to Manager as well as corresponding departments. I have a solid ability in developing objectives and strategies to settle claims. Excellent skills compiling, categorizing, and auditing information to process claims.
Responsible for billing Medicare and Medicare Advantage insurance plans and assuring billing guidelines stay current for all hospital based physician billing. Perform miscellaneous clerical duties. Collaborate with different departments in order to resolve potential denials of claims. Maintain claim edits with Clearing House to insure clean claim rates. Maintain departmental productivity goals.
Responsible for pulling denial information in from dashboard and analyzing data and distributing findings to responsible departments. Maintain a caseload and monitor day to day compliance of appeal decision time frames. Reports trending denials to management to eliminate denials. Maintaining denial percentage below 5% for all hospital and ambulatory locations.
Responsible for collection of accounts. I worked Medicare, Medicaid, Medicaid CMO's, and Commercial payers. I worked assigned claims daily. Mailed insurance claims that were not transmitted electronically. Made telephone inquiries to insurance carriers to collect delinquent claims. Updated patients insurance as needed. Answered all correspondence that was received from payers. Submitted medical records when requested.