DARLENE FOX
Kregesville,PA
Summary
Dedicated professional with extensive experience in medical billing and collections, complemented by a strong background in customer service. Known for exceptional interpersonal skills and a passion for fostering positive interactions in a collaborative environment. Proven ability to leverage industry knowledge to enhance operational efficiency and deliver outstanding service. Committed to driving success through dedication and expertise.
Overview
37
37
years of professional experience
Work History
Medical Biller and Collector
Philadelphia Pain Practice
11.2021 - 02.2026
- Oversaw billing processes to ensure accurate submission of claims and timely reimbursements.
- Mentored junior staff on coding practices and compliance regulations for optimal accuracy in billing.
- Implemented process improvements that enhanced efficiency in claim resolution and reduced denials.
- Analyzed billing discrepancies to identify root causes and develop corrective action plans.
- Led training sessions for staff on updates to medical coding standards and billing software functionality.
- Verified insurance of patients to determine eligibility.
- Communicated with insurance providers to resolve denied claims and resubmitted.
- Collected payments and applied to patient accounts.
- Posted payments and collections on regular basis.
- Reduced claim denials by meticulously reviewing patient insurance information and coding practices.
- Delivered timely and accurate charge submissions.
- Analyzed complex Explanation of Benefits forms to verify correct billing of insurance carriers.
- Worked on URO's for Worker Comp patients
- Worked on Peer Reviews for MVA patients
- Filed Fee Reviews on the WCAIS website for unpaid bills for Worker comp patients
- Spoke with attorneys to negioatate a fair settlement on patients accounts
Medical Collections Specialist
Healthbridge Chiropractic and Rehabilitation
03.2020 - 06.2022
- Managed patient account inquiries and resolved billing discrepancies.
- Streamlined collections processes to enhance recovery rates.
- Collaborated with healthcare providers to ensure accurate claim submissions.
- Trained junior staff on best practices in medical collections procedures.
- Conducted comprehensive audits of patient accounts periodically, identifying discrepancies requiring correction or further investigation.
- Worked on URO's for Worker Comp patients
- Worked on Peer Reviews for MVA patients
- File Fee Reviews on the WCAIS website for unpaid medical bills
- Enhanced revenue recovery through diligent follow-up on delinquent accounts.
- Corrected, completed and processed claims for multiple payer codes.
- Processed billing calls and answered questions from patients and third-party carriers.
- Processed online and paper appeal submissions and refund requests.
Medical Billing Supervisor
Tri County Pain Management
10.2009 - 03.2020
- Overseen the billing department of 7 employees that did the billing and collections for 14 offices
- Set up patient accounts in the computer.
- Obtain the insurance for the patient accounts
- Spoke with adjusters at Auto Insurance Carriers and Workers Comp Carriers for payments
- Ran weekly and monthly reports
- Timely management of unpaid claims, denials, aging reports and clearinghouse reports
- Correct claim errors-monitors and managed the follow up on unpaid claims
- Initiated charge entries and appeals and posted payments
- Handle Peer Reviews
- Handle URO's
- File Fee Reviews
- Negotiated settlement agreements with attorney for the outstanding balances
- Trained new employees
Cashier // Part Time
Suds Beer Store
06.2004 - 02.2014
- Worked the register
- Stocked Shelves
Billing Supervisor
Dr Stephen Ficchi DO
02.2005 - 06.2008
- Set up patient accounts in the computer.
- Obtain the insurance for the patient accounts
- Spoke with adjusters at Auto Insurance Carriers and Workers Comp Carriers for payments
- Timely management of unpaid claims, denials, aging reports and clearinghouse reports
- Correct claim errors-monitors and managed the follow up on unpaid claims
- Negotiated settlement agreements with attorney for the outstanding balances
- Trained new employees
Customer Service Representative
LYON WORKSPACE PRODUCTS
04.1989 - 03.2003
- Answered phones
- Entered orders in the computer
- Processed orders
- Packaged UPS and Fedex Orders
- Prepared labels for the shipments that were going on the truck.
- Checked on orders in production and advised the customers of the delivery schedules
- Trained New Employees
- Worked up quotes for the orders
- Handled customer questions, quotes and complaints
Education
Certificate - Medical Billing & Coding
Sanford Brown
Trevose, PA12-2007
High School Diploma - General Studies
J.W. Hallahan High School
06-1982
Skills
- Healthcare billing
- Healthcare collections
- Healthcare administration experience
- Medical Coding
- Workers' compensation expertise
- Clerical Experience
- Patient intake coordinator
- Office experience
- Detail-oriented data management
- Medical Scheduling
- HIPAA
- Professional phone communication
- Claims processing
- Insurance claims processing
- Management of electronic claims
- HIPAA compliance
- Insurance verification
- Billing and collection procedures
- Patient billing
- CPT knowledge
- Customer service
- Insurance claims processing
- Data entry
- Denial management
- CMS-1500 billing forms
- Timely payment processing
- ICD-10
- Patient account analysis
Timeline
Medical Biller and Collector
Philadelphia Pain Practice
11.2021 - 02.2026
Medical Collections Specialist
Healthbridge Chiropractic and Rehabilitation
03.2020 - 06.2022
Medical Billing Supervisor
Tri County Pain Management
10.2009 - 03.2020
Billing Supervisor
Dr Stephen Ficchi DO
02.2005 - 06.2008
Cashier // Part Time
Suds Beer Store
06.2004 - 02.2014
Customer Service Representative
LYON WORKSPACE PRODUCTS
04.1989 - 03.2003
High School Diploma - General Studies
J.W. Hallahan High School
Certificate - Medical Billing & Coding
Sanford Brown