DONNAMARIE ADAMS
PENNSAUKEN,NJ
Summary
Highly-motivated employee with desire to take on new challenges. Strong work ethic, adaptability, and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills.
Overview
8
8
years of professional experience
1
1
Certification
Work History
Follow-Up Specialist
Path Revenue Cycle Solutions
CHERRY HILL, NJ
02.2021 - Current
- Perform follow-up with Commercial, Manage Care, Government and Third-party payers, review correspondence, contact with insurance representatives on the phone, faxes, payer websites/portals, Availity/NaviNet
- Demonstrate high level customer service, interact with various internal/external contacts to obtain needed information to adjudicate claims in a timely manner; coding issues
- Resolve billing discrepancies, denials/rejections where claim have errors, missing details/insufficient information, authorization requested but not submitted resolve these issues promptly and efficiently, generate claims on 1500, dropped claims to paper and billed to payer, appeal all claims that denied with updated information needed along with medical records if required
- Analyze/Understand Explanation of Benefits (EOB) or Remittance Advice (ERA) received from insurance carrier and take appropriate action according to company guideline/process
- Ability to find trends and able to research payer policies/guidelines to provide back to the management team
- Update and file corrective claims with invalid procedure/diagnosis codes, Modifiers, invalid identification number,once updated bill a corrected claim to carriers
- Thoroughly document all accounts, monitor account receivables via work Queues/Reports
- Provided excellent customer service by responding promptly to inquiries.
- Participated in team meetings to discuss strategies for improving customer experience.
- Handle other duties as assigned
Revenue Cycle Associate
Christus Health
Irving, TX
04.2016 - 01.2021
- Heavy contact with payers for account status with Government Agencies, Commercial, MCO's, Third-party payers, patients/guarantors and via reimbursement activity on accounts via phone, e-mail, various payer portals online (Availity/Navinet) continued reimbursement activity until account fully adjudicated
- Thoroughly documented all followed-up activity given on all accounts
- Resolved claim processing issues on a timely basis by reviewing claim inventories, payments, adjustments, over payments, short pays on a daily
- Responsible for maintaining control of assigned inventory and ensure that daily productivity standards of accounts were met, reviewed correspondence, and addressed any issues pertaining to EOB's and RA's and other correspondences
- Took appropriate actions to ensure payments and adjustments have been posted properly as well as identify applicable accounts for secondary billing and follow-up
- Researched and documented any correspondence received related to assigned accounts for balance accuracy, coding issues, denials, and outstanding insurance requests for additional information, COB information, no authorization, invoices, NDC not on provided,W9 and invoice information,subrogation
- Provided needed documentation appropriately and submit corrected claims; or if payer error, escalated for re-processing in a professional and timely manner
- Requested additional information from patients and payers as needed
- Reviewed payer contracts and or fee schedule to determine expected reimbursement from claims, identified underpayments, and submitted appeals for reconsideration on claims rejections, and engaged the coding follow-up teams (HIM, Admitting, Billing) for any medical necessity or coding related issues or appeals
- Identify billing or coding issues and request re-bills, secondary billing, or corrected bills as needed
- Identified payer issues and trends, and escalate those issues to Management
- Ensured compliance with State and Federal Law Regulations for Managed Care and other Third-Party Payer
Education
High School Diploma -
Omega Institute
Pennsauken, NJ06-2000
Skills
- Medical Coding knowledge
- Understand EOB
- Provider portals, Navient/Availability/Teams
- Problem Solving
- Software Connance/Medix/
- HIPPA Compliant
Certification
- Certificate in Medical Billing and Coding
Timeline
Follow-Up Specialist
Path Revenue Cycle Solutions
02.2021 - Current
Revenue Cycle Associate
Christus Health
04.2016 - 01.2021
High School Diploma -
Omega Institute
- Certificate in Medical Billing and Coding
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