Edna Spriggs
Winnetka,California
Summary
Dedicated RCM- Medical Billing Professional. Offering an organized and quality-oriented mindset along with 25 years of experience in all aspects of Revenue Cycle Management. Results-driven billing manager with expertise in overseeing billing processes and optimizing revenue streams. Skilled in managing billing systems, resolving discrepancies, and ensuring compliance with billing regulations. Strong leadership, analytical, and communication skills, with a focus on driving efficiency and accuracy in billing operations.
Overview
7
7
years of professional experience
Work History
Medical Billing (RCM)-Collector-Follow up
Universal Diagnostic Laboratories
Van Nuys, CA
05.2023 - Current
- Developed and implemented performance management strategies.
- Enhanced efficiency in insurance eligibility. Working manager-Collector ,follow up, research, appeals, correcting coding, full cycle billing.
- Successfully managed responsibilities concerning insurance verification and pre-authorization.
- Developed efficient workloads for billing team, ensuring prompt entry of charges and submission to clearinghouse.
- Implemented effective strategies for organizing and prioritizing report reviews by the AR team
- Identified areas for enhancement and successfully executed changes in the medical billing process.
- Produced comprehensive reports on revenue cycle management, specifically focusing on denials and rejections.
- Ensured compliance of claims submitted by medical billing staff with all applicable laws and regulations by conducting thorough audits.
- Emphasized the importance of communication and documenting accounts
- Developed and implemented comprehensive training programs with the goal of maximizing performance and operational efficiency across the organization.
Medical Practice Administrator(1 Day a Week)
Total Image Wig & Hair Restoration
Woodland Hills , CA
09.2021 - Current
- Ensured successful accreditation of all providers through meticulous credentialing procedures
- Demonstrated expertise in efficiently handling daily administrative operations such as appointment scheduling, insurance claim filing, and verifying insurance coverage, Collections, denials
- Developed and implemented policies and procedures to ensure compliance with applicable laws and regulations.
- Streamlined the medical billing system through accurate entry of demographics, insurance information, coding, and charges
- Served as a liaison between physicians and other departments within the organization.
- Achieved optimized operations and efficient management of accounts receivable through diligent follow-up on EOBS.
- Utilized data analytics to identify areas of improvement and enhance collections process
- Ensured patient comfort and privacy through compassionate communication and strict adherence to confidentiality protocols.
- Managed payment posting and report review.
- Worked one day per week starting in August 2022.
Medical Billing Specialist-Collector
Sinai Laboratory
Encino, CA
09.2022 - 05.2023
- Efficiently identified and reprocessed denied or rejected claims
- Verified benefits and eligibility with precision. Worked aging reports, appeals, follow up, unpaid & underpaid claims
- Maintain updated knowledge of CPT and ICD-10 coding principles, regulations, and billing requirements
- Ensured accurate data entry of procedure codes, diagnosis codes, and patient information.
- Managed and maintained data entry quality control procedures for accurate posting of claims and payments.
- Managed regulatory and strategic initiatives to ensure accuracy of medical claims.
- Delivered effective solutions to billing issues by leveraging comprehensive knowledge and conducting thorough research.
- Investigated intricate billing matters involving multiple providers or the provision of services over a specified timeframe.
- Executed claim appeals following insurance company guidelines.
- Demonstrated commitment to protecting patient privacy by adhering to HIPAA guidelines and ensuring confidentiality of all personal medical records.
Medical Billing Coding & Collectors
Lesin Balfour and Ziv Professional Inc
Van Nuys, CA
02.2018 - 09.2021
- Entered charges, reviewed medical reports for coding, and input payments from EOB/ERA
- Submitted claims to various providers on paper and electronically
- Conducted AR follow-ups, insurance follow-ups, and managed patient statements, billing errors, denials, and non-payment
- Served as a liaison between the business department, billers, and third-party payers
- Investigated and corrected rejected and denied claims, including coding issues
- Investigated discrepancies in medical billing and coding to identify errors or irregularities.
- Conducted audits of medical records to identify missing or incorrect documentation that could affect accurate coding and billing.
- Verified patient information, including medical history and insurance coverage, to ensure accuracy of coding and billing.
- Handled insurance verification and authorization requests
- End-of-month closing and reporting.
Medical Billing Supervisor (Contract Assignment)
Hanna Alexander MD (Dr. Expired)
Torrance, CA
05.2017 - 11.2018
- Developed and maintained effective billing processes for medical office.
- Communicated with doctors and staff regarding CPT and ICD-10 codes
- Managed day-to-day operations of the medical billing team including setting goals, assigning tasks.
- Resolved any billing issues that arose in a timely manner.
- Submitted claims both on paper and electronically
- Prepared billing statements for patients
- Working with Billing Posting charges, payments, and adjustments
- Verified insurance information and obtained authorization for billing codes
- Meticulously tracked and resolved underpayments.
- Established relationships with insurance companies and managed appeals process when necessary.
- Prepared documents for auditing purposes including patient account histories, eligibility verifications.
- Ensured compliance with HIPAA regulations by implementing privacy protocols throughout the organization.
Education
Some College (No Degree) -
Locke High School
Los Angeles, CASome College (No Degree) - Medical Technology
Uniersal Online Classes
Los Angeles, CASkills
- AR Reports
- Workflow Management
- HIPAA and OSHA Regulations
- Policy and Procedure Development
- New Hire Training
- Medical Terminology
- Documentation Oversight
- Revenue Cycle Management
- Insurance Verification
- ICD-10, CPT, HCPCS, CCI Edits
- Knowledgeable in EMR Systems: Greenway, Epic, Meditech, Nextgen, Primecare, Cerner, Office Ally, Prime Clinical, Simple Practice, Kareo
- Experience processing expense reports
- Experience initiating requisitions
- Excel, Word and outlook
- Collections experience
- Invoice Processing
Timeline
Medical Billing (RCM)-Collector-Follow up
Universal Diagnostic Laboratories
05.2023 - Current
Medical Billing Specialist-Collector
Sinai Laboratory
09.2022 - 05.2023
Medical Practice Administrator(1 Day a Week)
Total Image Wig & Hair Restoration
09.2021 - Current
Medical Billing Coding & Collectors
Lesin Balfour and Ziv Professional Inc
02.2018 - 09.2021
Medical Billing Supervisor (Contract Assignment)
Hanna Alexander MD (Dr. Expired)
05.2017 - 11.2018
Some College (No Degree) -
Locke High School
Some College (No Degree) - Medical Technology
Uniersal Online Classes
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