Denise Brown
Dacula,GA
Summary
I am currently seeking a highly skilled and qualified professional position in an environment where I can utilize my current education, along with gaining additional knowledge. Experienced professional in managed care, medical claims, and medical collections with 13+ years of experience, including Workers Compensation, DME, Hospital Collection and Research, PCP Collections, and Laboratory Collections. Skilled in collaborating with commercial and managed care payers such as Blue Cross, Aetna, United Health Care, Medicaid, and Medicare and Medicare Advantage. I am known for attention to detail and exceptional customer service. Proficient in Allscripts, Nextgen, Centricity, EPIC, OnBase, Quadax, Mesta Med, AS 400, Facets, Xifin, Eprimis, 3MGroup, EClinicalWorks, and other applications. Specialized expertise in ICD-10 codes for Medical Collections and Billing. Maintaining confidentiality with HIPAA regulations and client policies.
Overview
17
17
years of professional experience
Work History
SR. Denial Management Medical Collector
Southeast Medical Group
07.2022 - Current
- Oversaw the insurance collection process that included payment posting, payment validation, denial, and resolution of delinquent Medicare accounts.
- Review the aging A/R to be resolved.
- Send Medical Records to payers, filing reconsiderations and appeals.
- Communicating with 3rd party payers such as Multiplan, MARS, and Zelis regarding OON claim negotiations.
- Contacting insurance payers to collect on outstanding accounts receivable.
- Research and resolve underpaid balances on Medicare insurance claims.
- Proficient in dealing with various providers, including Medicaid, Medicare, Aetna, and Blue Cross Blue Shield.
- Navigating through various payer systems for accurate resolution of claims.
- Ensure timely follow-up on all appeals.
- Developed strategic appeal letters to ensure timely overturn appeals.
- Corrected front-end edits from the clearing house to ensure timely submission of a clean claim.
- Open communication with various payers, either verbal, chat, to follow up on overdue appeals or claim status that is unattainable via the payer portal.
- Effectively resolve complex issues, including payment research, payment recoupments.
- Reviewed UB04 information for correct claim errors.
- Print and submit each CMS 1500 claim with all required attachments.
- Effectively communicate issues to management, including payer, system, or escalated account issues, as well as develop solutions.
SR. Denial Management Medical Collector
Southeast Medical Group
07.2022 - Current
- Oversaw the insurance collection process that included payment posting, payment validation, denial, and resolution of delinquent Medicare accounts.
- Review the aging A/R to be resolved.
- Send Medical Records to payers, filing reconsiderations and appeals.
- Communicating with 3rd party payers such as Multiplan, MARS, and Zelis regarding OON claim negotiations.
- Contacting insurance payers to collect on outstanding accounts receivable.
- Research and resolve underpaid balances on Medicare insurance claims.
- Proficient in dealing with various providers, including Medicaid, Medicare, Aetna, and Blue Cross Blue Shield.
- Navigating through various payer systems for accurate resolution of claims.
- Ensure timely follow-up on all appeals.
- Developed strategic appeal letters to ensure timely overturn appeals.
- Corrected front-end edits from the clearing house to ensure timely submission of a clean claim.
- Open communication with various payers, either verbal, chat, to follow up on overdue appeals or claim status that is unattainable via the payer portal.
- Effectively resolve complex issues, including payment research, payment recoupments.
- Reviewed UB04 information for correct claim errors.
- Print and submit each CMS 1500 claim with all required attachments.
- Effectively communicate issues to management, including payer, system, or escalated account issues, as well as develop solutions.
Accounts Receivable Collector
DME/ARC
03.2021 - 07.2022
- Worked all current and past due A/R.
- Collect all unpaid CPT codes that were not paid per the contracted rate.
- Responsible for AR greater than 90 days, cash collections compared to goal, and denial recovery rate.
- Performed insurance collection activities.
- Bill patient responsibility as in coinsurance, deductibles, and copays.
- Contact insurance companies to request reconsideration and follow up on appeals.
- Monitored all delinquent accounts and managed collection activities.
- Submitted Primary and Medical Necessity appeals.
- Submitted request on missed pre-cert claims.
- Submitted corrected claims as needed.
- Made Posting Corrections as needed.
Accounts Receivable Collector
DME/ARC
03.2021 - 07.2022
- Worked all current and past due A/R.
- Collect all unpaid CPT codes that were not paid per the contracted rate.
- Responsible for AR greater than 90 days, cash collections compared to goal, and denial recovery rate.
- Performed insurance collection activities.
- Bill patient responsibility as in coinsurance, deductibles, and copays.
- Contact insurance companies to request reconsideration and follow up on appeals.
- Monitored all delinquent accounts and managed collection activities.
- Submitted Primary and Medical Necessity appeals.
- Submitted request on missed pre-cert claims.
- Submitted corrected claims as needed.
- Made Posting Corrections as needed.
Accounts Receivable Collector
IKS Health Care
11.2019 - 02.2021
- Collect on all past A/R for commercial and government claims.
- Responsible for reducing the A/R by accurately and thoroughly working assigned accounts in accordance with established policy and procedures.
- Review all EOB's to ensure proper reimbursement, which also includes underpayments and overpayments.
- Pulled reports to work aging A/R to ensure we meet all appeal timely filing guidelines.
- Submitted Medical Records that are being requested by the insurance company, as well as proof of medical necessity.
- Submitted appeals which included valid, timely filing, Medical Necessity, and various other denials that the insurance has denied the claim for.
Accounts Receivable Collector
IKS Health Care
11.2019 - 02.2021
- Collect on all past A/R for commercial and government claims.
- Responsible for reducing the A/R by accurately and thoroughly working assigned accounts in accordance with established policy and procedures.
- Review all EOB's to ensure proper reimbursement, which also includes underpayments and overpayments.
- Pulled reports to work aging A/R to ensure we meet all appeal timely filing guidelines.
- Submitted Medical Records that are being requested by the insurance company, as well as proof of medical necessity.
- Submitted appeals which included valid, timely filing, Medical Necessity, and various other denials that the insurance has denied the claim for.
Insurance Collector
M-power
10.2018 - 11.2019
- Company Overview: Intraoperative Neuromonitoring
- Daily contact with various insurance companies to follow up on the status of submitted appeals, which included reconsiderations, level 1-3 appeals, and requests for Medical Reviews.
- Performed Insurance Collection functions.
- Submitted Medical Records that are being requested by the insurance company, as well as proof of medical necessity.
- Submitted appeals which included valid, timely filing, Medical Necessity, and various other denials that the insurance has denied the claim for.
- Added adjustments as needed, which included Contractual Adjustments.
- Billed Patient responsibility, which includes the patient's coinsurance, deductible, and any other patient liability.
- Reviewed all payments to ensure they have been paid correctly according to the contract.
- Intraoperative Neuromonitoring
Insurance Collector
M-power
10.2018 - 11.2019
- Company Overview: Intraoperative Neuromonitoring
- Daily contact with various insurance companies to follow up on the status of submitted appeals, which included reconsiderations, level 1-3 appeals, and requests for Medical Reviews.
- Performed Insurance Collection functions.
- Submitted Medical Records that are being requested by the insurance company, as well as proof of medical necessity.
- Submitted appeals which included valid, timely filing, Medical Necessity, and various other denials that the insurance has denied the claim for.
- Added adjustments as needed, which included Contractual Adjustments.
- Billed Patient responsibility, which includes the patient's coinsurance, deductible, and any other patient liability.
- Reviewed all payments to ensure they have been paid correctly according to the contract.
- Intraoperative Neuromonitoring
Hospital Medical Collections Representative 2
X-Tend Health Care, a Navient Company
11.2015 - 10.2018
- Review all EOB's to determine if and how a claim is paid correctly.
- Submitted medical records are requested by the insurance company or to prove Medical Necessity to ensure proper payment for all services rendered.
- Called patients to collect needed information that is being requested from the insurance company such as correct id numbers, coordination of benefits, or sending additional requested information.
- Perform adjustments on accounts to ensure the correct contractual adjustment was made.
- Call various insurance companies to ensure timely and proper payment of each claim worked.
- Ensure all accounts are resolved to make each account the goal to be zero after the correct resolution has been applied.
- Assist new employees with help in navigating the system and how to collect claims.
- Responsible for investigating refunds and recoupments which included the duties of appealing and contesting any money that has been taken incorrectly by the insurance company.
Hospital Medical Collections Representative 2
X-Tend Health Care, a Navient Company
11.2015 - 10.2018
- Review all EOB's to determine if and how a claim is paid correctly.
- Submitted medical records are requested by the insurance company or to prove Medical Necessity to ensure proper payment for all services rendered.
- Called patients to collect needed information that is being requested from the insurance company such as correct id numbers, coordination of benefits, or sending additional requested information.
- Perform adjustments on accounts to ensure the correct contractual adjustment was made.
- Call various insurance companies to ensure timely and proper payment of each claim worked.
- Ensure all accounts are resolved to make each account the goal to be zero after the correct resolution has been applied.
- Assist new employees with help in navigating the system and how to collect claims.
- Responsible for investigating refunds and recoupments which included the duties of appealing and contesting any money that has been taken incorrectly by the insurance company.
Laboratory and Molecular Billing/Collection A/R Representative II
Caris Life Sciences
01.2012 - 01.2015
- Review and prepare claims for manual and electronic billing submission.
- Identify upfront billing errors for corrections and resubmit claims to various insurance carriers.
- Provide all necessary documentation required to expedite payments, which includes authorizations and referrals.
- Processed insurance and patient correspondence, which included patient responsibility payments.
- Complete refunds and adjustments on accounts as required to resolve balances.
- Review past due and current A/R for all payers to collect 100% of the allowable amount.
- Daily follow-up on collections of patient payments and from all commercials, workers' compensation, and government payers.
- All payments under provide itemized bills, medical records, and any additional information to the insurance to ensure the billed claim will be paid per the contracted rate.
- Trained each team member to work with various players and was readily available to answer any questions.
- Formatted a medical necessary appeal strategy to allow claims to be processed per the medical policy.
Laboratory and Molecular Billing/Collection A/R Representative II
Caris Life Sciences
01.2012 - 01.2015
- Review and prepare claims for manual and electronic billing submission.
- Identify upfront billing errors for corrections and resubmit claims to various insurance carriers.
- Provide all necessary documentation required to expedite payments, which includes authorizations and referrals.
- Processed insurance and patient correspondence, which included patient responsibility payments.
- Complete refunds and adjustments on accounts as required to resolve balances.
- Review past due and current A/R for all payers to collect 100% of the allowable amount.
- Daily follow-up on collections of patient payments and from all commercials, workers' compensation, and government payers.
- All payments under provide itemized bills, medical records, and any additional information to the insurance to ensure the billed claim will be paid per the contracted rate.
- Trained each team member to work with various players and was readily available to answer any questions.
- Formatted a medical necessary appeal strategy to allow claims to be processed per the medical policy.
Medical Claims Analyst I
Aetna Health Insurance
01.2009 - 01.2012
- Process Inpatient, Outpatient, and Appeals with the limits of $50,000 and under.
- Analyze and approve routine claims that cannot be auto-adjudicated.
- Apply Medical Necessity guidelines to determine coverage, complete eligibility verification and identify discrepancies and apply all cost containment measurements to assist in the claim adjudication process.
- Utilize all applicable system functions available to ensure accurate and timely claim processing service, including Claim Check.
Medical Claims Analyst I
Aetna Health Insurance
01.2009 - 01.2012
- Process Inpatient, Outpatient, and Appeals with the limits of $50,000 and under.
- Analyze and approve routine claims that cannot be auto-adjudicated.
- Apply Medical Necessity guidelines to determine coverage, complete eligibility verification and identify discrepancies and apply all cost containment measurements to assist in the claim adjudication process.
- Utilize all applicable system functions available to ensure accurate and timely claim processing service, including Claim Check.
Education
High School Diploma - undefined
Antioch High School
Nashville, TNHealth Care Management
Independence University
Skills
- Revenue Cycle Management
- A/R Collections
- Billing cycle management
- Medical collection
- Insurance collection
- Financial account oversight
- Revenue growth strategies
- Denied Claims Processing
- Microsoft Word
- Microsoft Excel
- Microsoft PowerPoint
- Microsoft Outlook
- Medicaid
- Medicare
- All Commercial Payers
- Workers Compensation
Summary
I am currently seeking a highly skilled and qualified professional position in an environment where I can utilize my current education, along with gaining additional knowledge., Experienced professional in managed care, medical claims, and medical collections with 13+ years of experience, including Workers Compensation, DME, Hospital Collection and Research, PCP Collections, and Laboratory Collections., Skilled in collaborating with commercial and managed care payers such as Blue Cross, Aetna, United Health Care, Medicaid, and Medicare and Medicare Advantage., Known for attention to detail and exceptional customer service., Proficient in Allscripts, Nextgen, Centricity, EPIC, OnBase, Quadax, Mesta Med, AS 400, Facets, Xifin, Eprimis, 3MGroup, EClinicalWorks, and other applications., Specialized expertise in ICD-10 codes for Medical Collections and Billing., Maintaining confidentiality with HIPAA regulations and client policies.
Timeline
SR. Denial Management Medical Collector
Southeast Medical Group
07.2022 - Current
SR. Denial Management Medical Collector
Southeast Medical Group
07.2022 - Current
Accounts Receivable Collector
DME/ARC
03.2021 - 07.2022
Accounts Receivable Collector
DME/ARC
03.2021 - 07.2022
Accounts Receivable Collector
IKS Health Care
11.2019 - 02.2021
Accounts Receivable Collector
IKS Health Care
11.2019 - 02.2021
Insurance Collector
M-power
10.2018 - 11.2019
Insurance Collector
M-power
10.2018 - 11.2019
Hospital Medical Collections Representative 2
X-Tend Health Care, a Navient Company
11.2015 - 10.2018
Hospital Medical Collections Representative 2
X-Tend Health Care, a Navient Company
11.2015 - 10.2018
Laboratory and Molecular Billing/Collection A/R Representative II
Caris Life Sciences
01.2012 - 01.2015
Laboratory and Molecular Billing/Collection A/R Representative II
Caris Life Sciences
01.2012 - 01.2015
Medical Claims Analyst I
Aetna Health Insurance
01.2009 - 01.2012
Medical Claims Analyst I
Aetna Health Insurance
01.2009 - 01.2012
High School Diploma - undefined
Antioch High School
Health Care Management
Independence University