Denise Lundy
Coatesville,Pennsylvania
Summary
To obtain and secure a position in the Medical/Healthcare Claims industry, whereas, I may utilize my medical billing, problem solving and decision-making skills to achieve success and growth within the organization. Furthermore, effectively utilize my professional and leadership skills to move the organization towards organizational goals. Committed job seeker with a history of meeting company needs with consistent and organized practices. Skilled in working under pressure and adapting to new situations and challenges to best enhance the organizational brand.
Overview
30
30
years of professional experience
Work History
Accounts Receivable Rep/Collection Customer Service Representative
Azura Vascular Care- Full Time
Malvern, PA
11.2014 - Current
- Responsible for collecting, posting and managing account payments
- Responsible for submitting claims and following up with insurance companies
- Essential functions of the position include the following: Upload claims from Emdeon
- BILL out claims, work rejection in Emdeon
- Run Aging Report, Month End Close Report, Billing Report; Obtain authorization when claims are denied for no authorization; Obtain contract from insurance payor so claim can be paid at the correct rate
- Answer patient calls on a live phone system
- Call Insurance to f/u on denied claims
- Working Waystar Address rejection.
- Investigated and resolved discrepancies on customer accounts.
- Provided support in the resolution of escalated complaints.
- Researched customer requests by accessing internal databases.
- Protected and preserved confidentiality and integrity of information to comply with HIPAA guidelines.
- Arranged debt repayment or established schedules for repayment based on customer's financial situation.
- Answered incoming calls from customers regarding collections inquiries.
- Initiated outbound calls to customers with delinquent accounts.
- Provided customer service to resolve issues related to overdue accounts.
- Identified opportunities for process improvement within the department.
- Contacted insurance companies to check status of claim payments.
- Assisted customers with understanding their payment options.
- Performed administrative functions for assigned accounts, recorded address changes and purged records.
- Reviewed open accounts for collection and skip trace efforts to meet or exceed performance goals.
- Wrote appeal letters to insurance companies for denial of claims.
- Investigated billing discrepancies and implemented effective solutions to resolve concerns and prevent future problems.
- Followed department calling scripts and procedures to optimize collections efforts.
- Generated reports of past due accounts and sent to management team.
- Analyzed trends in collections data and provided feedback accordingly.
- Prepared letters, memos and other documents using word processing or spreadsheet software,
- Verified proper coding, sequencing of diagnoses and procedures.
- Applied HIPAA privacy and security regulations while handling patient information.
- Maintained timely and accurate charge submission through electronic charge capture, including billing, and account receivables (BAR) system and clearing house.
- Maintained accounting ledgers by verifying and posting account transactions.
- Processed credit card payments over the phone or internet using secure payment systems.
- Generated appeals for denied claims as necessary based on guidelines set forth by the provider's contracts.
- Confirmed patient demographics, collected copays and verified insurance.
- Analyzed EOBs for accuracy and compliance with contractual arrangements between provider and payer.
- Reviewed claims for coding accuracy.
- Monitored past due accounts and pursued collections on outstanding invoices.
- Verified patient information, including medical history and insurance coverage, to ensure accuracy of coding and billing.
- Assigned additional diagnosis codes based on specific clinical findings (laboratory, radiology and, pathology reports as well as clinical studies) in support of existing diagnoses.
- Quickly responded to staff and client inquiries regarding CPT codes.
- Developed policies and procedures related to medical coding processes.
- Conducted audits of medical records to identify missing or incorrect documentation that could affect accurate coding and billing.
- Assigned appropriate codes using ICD-10-CM for diagnosis, CPT for procedures, HCPCS for supplies and modifiers as required by payers.
- Interpreted medical reports to apply appropriate ICD-9, CPT-4 and HCPCS codes.
- Maintained current working knowledge of CPT and ICD-10 coding principles, government regulation, protocols and third-party billing requirements.
Billing Specialist
Catholic Health Initiatives/ Conifier-Full Time
Exton, PA
01.2011 - 01.2013
- Responsible for collecting, posting and managing account payments
- Responsible for submitting claims and following up with insurance companies
- Essential functions of the position include the following: Validated denial reason on Explanation Of Benefits (EOB), Verifying Trends or Issues; Escalating Payment Variance Trends or issues on underpaid claims; Researched contract terms/ interpretation and compile supporting documentation appeal; Reviewed Managed Care Contracts; verified insurances were paying according to contract; Escalated exhausted follow up trends to supervisor for resolution; and Worked on various projects as directed by supervisor.
Registration Representative
Brandywine Hospital-Part Time
Coatesville, PA
01.2010 - 01.2011
- Responsible for greeting patients and families while initiating the medical record, both written and electronic
- Responsible for quality patient registrations by obtaining thorough and accurate information in a timely and efficient manner and entering this data correctly into the system
- Essential functions of the position include the following: Updating and verifying patients' addresses and insurance information; Copying the patient insurance card, so we can have all insurance information to submit claim for payment of services; Entering all the patient demographics into the computer system if the patient has never been seen before in the facility, if patient has been seen than verifying any changes; and Discharging patients after being seen by doctor by giving all info to patient.
- Asked various questions from clients to obtain the information necessary for paperwork.
- Generated forms related to registration process such as release of information forms and financial responsibility forms.
- Maintained confidentiality of protected health information according to HIPAA guidelines.
- Verified patient eligibility for services through various online systems or by calling the insurance companies directly.
- Advised patients of monies required to be paid prior to services.
- Registered patients for outpatient procedures and emergency services.
- Gathered, verified, and processed patient paperwork.
- Collaborated with nurses and other personnel to process patient paperwork and direct to appropriate departments.
- Carefully checked insurance information for benefits coverage and input pre-authorization documents into system.
- Checked insurance benefits, received payments and provided receipts.
- Collaborated with clinical staff members to ensure proper documentation was completed prior to patient being seen by physician or specialist.
- Entered all patient information into the registration system accurately and efficiently.
- Adhered to department policies and procedures as well as established safety protocols.
- Responded to incoming department phone calls and directed callers to appropriate team members based on need.
- Protected medical information against unauthorized access, loss, or corruption by consistently following security protocols.
- Reviewed patient information and verified accuracy of demographic data in order to register patients.
- Greeted visitors and ascertained purpose of visit, issuing needed credentials and directing to appropriate staff or department.
- Processed cash, debit and credit card payments for services rendered and printed receipts detailing services.
- Communicated effectively both verbally and in writing with patients, families and healthcare professionals in a professional manner at all times.
- Gathered personal and insurance information from each patient.
- Maintained HIPAA compliance and integrity of hospital policies and procedures.
- Answered questions about admissions, financial, and hospital policies.
- Utilized knowledge of Medicare and Medicaid regulations to ensure compliance with billing practices.
- Explained forms and documents to patients, guardians and family members, distributing copies and confirming comprehension.
- Adhered to HIPAA guidelines and maintained integrity of hospital policies and procedures.
- Provided customer service support and advice on regulations and requirements regarding various registration programs.
- Exceeded customer satisfaction by finding creative solutions to problems.
- Understood and followed oral and written directions.
- Approached customers and engaged in conversation through use of effective interpersonal and people skills.
- Provided excellent service and attention to customers when face-to-face or through phone conversations.
Health Claims Specialist
Children's Hospital of Philadelphia-Full Time
Philadelphia, PA
01.2002 - 01.2010
- Responsible for gathering and processing information needed to complete medical insurance claims
- Responsible for taking inbound customer service calls and making outbound calls to patients and health care providers
- In addition to processing routine claims, responsible for investigating pending claims and resolving discrepancies
- Essential functions of the position include the following: Identifying and resolving issues for various payers to improve organizational revenue; and Working paper edits that have been made at the front office and would not clear with the clearinghouse.
Payment Posting Specialist/Accounts Receivable Representative
Practicare-Full Time
Malvern, PA
01.1994 - 01.2003
- Responsible for posting cash and working with Medicaid, Medicare, and private insurance companies
- Essential functions of the position include the following: Responsible for posting payments to patient's accounts received from third party payers; Update patient insurance information in the customer call center; and Charge dispute resolution.
- Researched and resolved payment posting discrepancies.
- Participated in workshops, seminars, and training classes to gain stronger education in industry updates and federal regulations.
- Processed electronic payments from insurance companies, patients and other sources.
- Processed invoice payments and recorded information in account database.
- Worked closely with internal departments to resolve any issues related to payments.
- Monitored account balances and made adjustments when necessary.
- Collected, posted and managed patient account payments.
- Executed account updates and noted account information in company data systems.
- Verified accuracy of claims submitted by providers for reimbursement purposes.
- Completed day-to-day duties accurately and efficiently.
- Submitted claims to insurance companies and researched and resolved denials and explanations of benefit rejections.
- Submitted claims to insurance companies.
- Investigated and resolved issues to maintain billing accuracy.
- Reconciled patient accounts with insurance companies to ensure accuracy of payments.
- Input payment history and other financial data to keep customer accounts up-to-date in system.
- Investigated past due invoices and delinquent accounts to generate revenues and reduce number of unpaid and outstanding accounts.
- Entered procedure codes, diagnosis codes and patient information into billing software to facilitate invoicing and account management.
- Analyzed billing reports for errors or discrepancies in payment postings.
- Wrote appeal letters to insurance companies for denial of claims.
Medical Coder
Otolaryngology Consultants-Full Time
Wilmington, DE
01.2001 - 01.2002
- Responsible for gathering and processing information needed to complete medical insurance claims
- Responsible for taking inbound customer service calls and making outbound calls to patients and health care providers
- In addition to processing routine claims, responsible for investigating pending claims and resolving discrepancies
- Essential functions of the position include the following: Responsible for coding various charts that were received from the provider postoperatively; and Collecting and totaling all super bills to be ensure accuracy
- Maintained current working knowledge of CPT and ICD-10 coding principles, government regulation, protocols and third-party billing requirements.
- Created detailed reports highlighting areas of improvement or potential risk associated with certain types of claims.
- Received, organized and maintained all coding and reimbursement periodicals and updates.
- Maintained positive working relationship with fellow staff and management.
- Assigned additional diagnosis codes based on specific clinical findings (laboratory, radiology and, pathology reports as well as clinical studies) in support of existing diagnoses.
- Applied coding rules established by American Medical Association and Centers for Medicare and Medicaid Services for assignment of procedural codes.
- Read through patient health data, histories, physician diagnoses and treatments to gain understanding for coding purposes.
- Interpreted medical reports to apply appropriate ICD-9, CPT-4 and HCPCS codes.
- Validated accuracy of diagnosis codes as well as modifiers used on claims before final submission to payer and insurance companies.
- Performed audits on coded claims to ensure that all required data elements are included for accurate payment processing.
- Assisted in the development of coding guidelines and policies.
- Identified opportunities for process improvements related to medical coding operations processes and procedures.
Education
Health Claims Specialist Program -
Harris School of Business
03.2011
Training
D'Souza & Associates, Hockessin, Delaware, 2011-02-01, 2011-03-01, Health Claims Specialist, 180, Responsible for gathering and processing information needed to complete medical insurance claims., Responsible for taking inbound customer service calls and making outbound calls to patients and health care providers., In addition to processing routine claims, responsible for investigating pending claims and resolving discrepancies., Telephone Techniques, CMS-1500, Insurance Verification, Patient Demographics, Patient Account Analysis, Electronic Insurance Claims, Claim Auditing, Claim Resubmission, Computerized Billing
References
References available upon request.
Timeline
Accounts Receivable Rep/Collection Customer Service Representative
Azura Vascular Care- Full Time
11.2014 - Current
Billing Specialist
Catholic Health Initiatives/ Conifier-Full Time
01.2011 - 01.2013
Registration Representative
Brandywine Hospital-Part Time
01.2010 - 01.2011
Health Claims Specialist
Children's Hospital of Philadelphia-Full Time
01.2002 - 01.2010
Medical Coder
Otolaryngology Consultants-Full Time
01.2001 - 01.2002
Payment Posting Specialist/Accounts Receivable Representative
Practicare-Full Time
01.1994 - 01.2003
Health Claims Specialist Program -
Harris School of Business