GISELLE DOUMERC

Company Overview: Long Beach Memorial Hospital, Miller Children Hospital, Orange Coast Memorial Medical Center, Saddleback Memorial Medical Center

Hospital billing follow-up

• Follow-up for Managed Care Medi-Cal
• Coordinate with other departments for account updates
• Adjustments requests
• EOB & Contract review
• Identify and work denials such as Coding issues/Medical Necessity/Experimental
• Generate reconsiderations and appeals
• Request re-bills
• Initiate requests for missing payments, coding, and audit review.
• Contacted patients through phone and mail to update COB information
• Eligibility verification
• Retro-Authorization Requests
• Monitored and updated Trending log regularly
• Assisted with day-to-day operations, working efficiently and productively with all team members.
• Identified issues, analyzed information and provided solutions to problems.
• Managed time efficiently in order to complete all tasks within deadlines.
• Worked well in a team setting, providing support and guidance.

Hospital billing follow-up

• Follow-up for Commercial: PPO, HMO, Managed Care Medicare/Medi-Cal
• Account Updates and Adjustments
• Re-billed claims never received with proof of timely filing
• Patient Refund Requests
• Authorization Status prior to initial billing
• Reviewed patients for Charity
• Provide Patients/Insurance an estimate for future charges based on CPT
• Requested re-bills
• Reviewed EOBs
• Identified and worked denials - Coding/Medical Necessity/Experimental
• Generated reconsiderations and appeals
• Initiated requests for payment transfers, missing payments, coding review
• Helped train new hires
• Retro Authorization Requests-Work with Doctors Office
• Re-stepped statements for patients

Hospital and Physician billing follow-up.

• Helped resolve balances for office, hospital and physician visits
• Followed-up for Commercial, PPO, HMO, Managed Care Medicare/Medi-Cal
• Account Updates and Adjustment requests
• Re-billed claims never received with proof of timely filing
• EOB and Contract review
• Identified and work denials
• Generated reconsiderations and appeals
• Initiated requests for payment transfers, missing payments, coding review
• Helped train new hires
• Answered patient calls
• Worked independently and correspond with teams on special projects
• Worked Hospital systems for: University of New Mexico Hospital, Stanford Healthcare

Hospital billing follow-up

• Helped resolve balances for office, hospital and physician visits
• Followed-up for Commercial, PPO, HMO, Managed Care Medicare/Medi-Cal
• Re-billed claims never received with proof of timely filing
• EOB and Contract review
• Generated appeals
• Initiated requests for payment transfers, missing payments, coding review, refunds
• Adjustment posting and Update insurance information
• Helped train new hires
• Answered patient call backs
• Worked independently and correspond with teams on special projects
• Worked Hospital systems for: Cedar Sinai Medical Center, Providence Health Systems-all California Hospitals and Alaska, Community Memorial Hospital

Hospital billing follow-up

• Followed-up for Commercial, PPO, HMO, and Medical groups
• Re-billed claims never received with proof of timely filing
• EOB and Contract review
• Reviewed reports
• Generated appeals, and refunds
• Initiated requests for payment transfers, missing payments, coding review
• Adjustment posting and Updated insurance information
• Helped Train New hires
• Answered patient rollover calls.
• Worked independently and corresponded with teams on special projects.
• Worked Hospital systems for: Providence Health Systems-all California Hospitals, Queen of the Valley Medical Center, Vail Medical Center (Prof & Facility claims), Marin Medical Center, Good Samaritan Medical Center, St Jude Medical Center, Cedars Sinai Medical Center
• Analyzed claims denials from third party payers and identified potential solutions for reimbursement.