Diana M Dries
San Antonio,Texas
Overview
17
17
years of professional experience
Work History
Specialist
Advantage Ctr Wound Care
10.2015 - 12.2020
- Serve as main point of contact for Wound Care Clinic staff and field personnel to obtain missing documentation required for vac placement, billing and recertification of NPWT.
- Obtain and submit wound assessments to recert for vac recertification process.
- Verify payer benefits and eligibility.
- Process complete clinical reviews for Medicare orders.
- Assist new hires with training questions and assist team members with unbilled and ship pending orders when needed.
- Respond to email inquiries from PCT, AOB/POD, Collections and various other departments.
- Performed Ship Pending audits and report coaching opportunities for lead and supervisor review.
- Obtained clinical documentation and subsequent wound information required to submit wound assessments for recertification process.
- Reviewing and analyze payer specific requirements and coverage criteria to determine required documentation and accurate billing criteria.
- Performed daily Ship Pending audits and reported coaching opportunities for lead and supervisor review.
Healthcare Billing specialist
MCO
09.2003 - 10.2015
- Researches and verifies rates to ensure correct claims are processed appropriately.
- Processed DC disputes.
- Generate corrected claims based on QA process.
- Submits claims to payers with paper claims by mail or electronically.
- Familiar with B check reviews and validate claims orders are released properly by ship pending team members.
- Submit QA issues and coaching opportunities to lead and supervisors to ensure minimal lost days/ rate adjustments.
- Reviews incoming documents through P8 workflow application and updates accounts accordingly.
- Request authorization recertification by obtaining subsequent wound assessments and providing updated clinical documents received through P8 application, Reviews payer contract and verifies all payer requirements are correct to include rates, claims address and clinical criteria are met to ensure order meets billing requirements and responsible for escalating payer issues to appropriate Contracting Analyst if necessary.
- Familiar with bill to corrections, rate corrections/adjustments and break in service transactions based on payer criteria used in Payer tool and PORT application.
- Prepares and updates complete review on newly released orders with appropriate paperwork necessary for billing and update Delair document screen accordingly.
- Previous Lead experience in Recert department Healthcare Billing specialist (MCO).
Education
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Highlands High School
San Antonio, TXundefined
Kaplan College
San Antonio, TXSkills
- Experienced in medical billing and claims validation
Timeline
Specialist
Advantage Ctr Wound Care
10.2015 - 12.2020
Healthcare Billing specialist
MCO
09.2003 - 10.2015
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Highlands High School
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Kaplan College