ELIS MILES
Satanta,KS
Summary
Accomplished individual with a comprehensive understanding of medical coding, billing and claims procedures. Experienced in using various medical billing software and databases. Proven track record of successfully resolving billing disputes and providing accurate and timely billing solutions. Committed to delivering exceptional customer service and building long-term relationships with clients.
Detail-oriented individual with exceptional communication and project management skills. Proven ability to handle multiple tasks effectively and efficiently in fast-paced environments. Recognized for taking a proactive approach to identifying and addressing issues, with a focus on optimizing processes and supporting team objectives.
Overview
15
15
years of professional experience
Work History
Business Office Manager
Stevens County Hospital & Clinic
03.2024 - Current
- Oversaw patient registration, insurance verification, and billing workflows for the hospital.
- Oversaw patient registration, insurance verification, and billing workflows for hospital and clinic operations.
- Coordinated payroll, timekeeping, and staff scheduling to maintain office coverage and compliance.
- Supervised front office staff, providing training, coaching, and performance feedback for consistent service.
- Working directly with Cerner adding build into our system and improving the billing process in it.
- Updating self-pay business office policies. Working directly with collections and pre collections agencies.
- Ensured compliance with company policies and industry regulations through regular audits and process updates.
- Established workflow processes, monitored daily productivity, and implemented modifications to improve overall performance of personnel.
- Resolved financial discrepancies and customer billing issues with timely attention.
Billing/AR Follow Up Team Lead
RevMax Pro,LLC
07.2023 - 03.2024
- Oversaw accounts with issues such as overpayments, contracting discrepancies, and claim denials or rejections, ensuring accurate resolution of payment posting errors.
- Supervised the daily work of staff to ensure work prioritization and quality.
- Trained staff on medical billing and insurance follow up procedures, enhancing their understanding of insurance verification processes.
- Respond to staff’s questions in a timely manner ensuring they fully understand how to perform their jobs
- Supervised daily staff activities, ensuring effective work prioritization and maintaining quality standards.
- Researched denied or rejected claims for accuracy and took appropriate action to resolve discrepancies. Specifically for Medicare and Medicaid (AZ,PA,MD)
Central Billing Representative I
Allegheny Health Network
11.2021 - 04.2023
- Resolves any billing-related issues covering all aspects of insurance billing, claims follow up, appeals and underpayments for PA Medicare/Medicaid billing team
- Utilized third-party payer sites to address unpaid claims, including denied claims and those requiring appeals, facilitating quicker resolutions.
- Responsible for the financial resolution of all self-pay account balances from technical and professional billing systems.
Single Billing Office Representative I
Allegheny Health Network
11.2020 - 11.2021
- Serves as primary contact for patients with inquiries regarding AHN patient statement balances, and resolves any billing related issues while ensuring patient satisfaction in a high-volume call center environment
- Demonstrated exceptional verbal and written communication skills while maintaining a friendly customer service demeanor.
- Initiated rebilling of insurance claims and conducted follow-up to resolve outstanding issues.
- Guided patients through application processes for Charity Care and other assistance programs offered by Allegheny Health Network.
- Discovers and initiates rebilling of insurance claims and follow up
- Provided timely follow up on past due accounts using phone calls, emails or letters.
Pre-Services Coordinator II
Allegheny Health Network
10.2017 - 11.2020
- Performs all scheduling/pre-registration functions, verifies health insurance coverage, obtains detailed benefit information, validates authorization, and calculates patient liabilities
- Called patients to collect copayments before services were performed any copayments prior to services performed
- Contacted patients, physician offices, case managers, and social workers to obtain complete demographic and insurance information and secure authorizations for all procedures
- Reviews claims for medical necessity
- Collaborated with Utilization Review team to resolve denied and appealed accounts during downtime
Lung Cancer Screening Scheduler
Allegheny Health Network
07.2016 - 10.2017
- Outbound calls and registered patients for Low Dose Lung Screening CT exams, confirming presence of authorizations in conjunction with approved AHN testing sites.
- Works with other departments associated to the program to ensure smooth operations (i.e. Primary Care Physician offices, Pulmonary Specialist Radiology sites) Confirms scheduled appointments with patients
- Verified established criteria that qualify patients for exams, ensuring compliance with program requirements.
- Files the appropriate authorizations per insurance payer needed
- Maintains scheduling and patient files associated to the associated NCR Program registries
- Facilitated communication by understanding surgical and medical terminology and accurately transcribing physician dictation.
- Experience with ICD-10 and CPT coding, reading and transcribing radiology reports as assigned by Nurse Navigator.
Patient Information Coordinator
UPMC Shadyside Hospital
10.2015 - 07.2016
- Interview and pre-register patients at the time of or prior to the visit date
- Collected and refreshed demographic, next-of-kin, and insurance information, including referrals and authorizations for all patients.
- Confirm/verify insurance benefits with the appropriate carrier via online verification systems or telephone inquiries
- Verified insurance benefits with appropriate carriers using online systems and telephone inquiries, ensuring accurate patient information for treatment.
- Utilized hospital information systems, including eRecord, MARS, Medipac, Bedboard, and Teletracking, to streamline patient registration and data management.
- Assigned patients to hospitalist groups during Emergency Room registration via Emergency Room registration, registering patients for lab work prior to the specimen being processed
- Communicated with patients regarding their admission status for timely treatment to update them on their direct admit status for treatment.
Health Unit Coordinator
UPMC Shadyside Hospital Medical Surgical ICU
11.2014 - 10.2015
- Maintained accurate unit communication by promptly answering telephones, activating paging system, facilitating timely faxing, and distributing patient and unit mail to ensure efficient operations.
- Greets and assists visitors, physicians and other staff members
- Utilizes hospital information systems, including but not limited to eRecord, MARS, Medipac, Bedboard, and Teletracking
- Updated Bed board per unit standards and communicated changes to appropriate staff.
- Enters physician orders timely and accurately, Maintains the medical record and patient chart according to established policy
- Coordinated unit activities such as scheduling tests and procedures, scheduling patient transports, maintaining supply logs, filing reports, and assisting with payroll in Kronos to support smooth unit functionality.
- Assigned nurses to patients based on workload and requested additional nursing staff from float pool as needed to ensure adequate patient care.
Environmental Services Lead
UPMC Presbyterian & Montefiore Hospitals
02.2012 - 11.2014
- Swing Shift Supervisor when needed for both Montefiore and Presbyterian Hospital, assisted in the onboarding process of a UPMC Support Aide/ Floor Technician
- Developed and implemented bi-annual training for UPMC Presbyterian and Montefiore facility staff, ensuring compliance with Department of Health standards
- Oversaw the distribution of supplies and equipment, ensured that the daily work of all team members was assigned and that team members were working efficiently.
- Delegated specific cleaning tasks to team members to ensure efficient workflow to workers, and inspected completed work to UPMC cleaning standards
- Oversaw distribution of supplies and equipment, coordinating daily assignments and enhancing efficiency of team operations
Education
Certified Outpatient Coder - Outpatient Medical Coding Program
AAPC Certified Outpatient Coding Program
06-2019
Associate of Arts - Biology And General Studies
Community College of Allegheny County
Pittsburgh, PA01-2019
High School Diploma - General Studies
Pinconning High School
Pinconning, MI06-2006
Skills
- Critical access hospital and rural healthcare billing
- Claims payment knowledge
- Medicaid billing expertise
- 1 Years of Medicare (Part A & Part B) billing experience
- Denials and appeals expertise
- State billing guidelines knowledge
- Explanation of benefits analysis
- Claims research proficiency
- Revenue cycle management
- Multi-system navigation skills
- Microsoft Office proficiency
- Project flexibility
- Effective communication skills
Timeline
Business Office Manager
Stevens County Hospital & Clinic
03.2024 - Current
Billing/AR Follow Up Team Lead
RevMax Pro,LLC
07.2023 - 03.2024
Central Billing Representative I
Allegheny Health Network
11.2021 - 04.2023
Single Billing Office Representative I
Allegheny Health Network
11.2020 - 11.2021
Pre-Services Coordinator II
Allegheny Health Network
10.2017 - 11.2020
Lung Cancer Screening Scheduler
Allegheny Health Network
07.2016 - 10.2017
Patient Information Coordinator
UPMC Shadyside Hospital
10.2015 - 07.2016
Health Unit Coordinator
UPMC Shadyside Hospital Medical Surgical ICU
11.2014 - 10.2015
Environmental Services Lead
UPMC Presbyterian & Montefiore Hospitals
02.2012 - 11.2014
High School Diploma - General Studies
Pinconning High School
Certified Outpatient Coder - Outpatient Medical Coding Program
AAPC Certified Outpatient Coding Program
Associate of Arts - Biology And General Studies
Community College of Allegheny County