JACINTA TULLIE
SHIPROCK
Summary
Skilled Contact Representative with background in managing customer inquiries, addressing complaints and providing solutions to ensure customer satisfaction. Strong communication skills, ability to manage multiple tasks at once, and resolve conflicts effectively. Significant impact made in previous roles by enhancing customer experience through proactive problem-solving and relationship-building skills. Results-driven professional with a robust background in medical billing, coding, and patient eligibility. Known for strong analytical skills and ability to manage complex claims processes, ensuring compliance and efficiency while maximizing reimbursement opportunities.
Overview
27
27
years of professional experience
1
1
Certification
Work History
Contact Representative
Northern Navajo Medical Center
Shiprock
09.1998 - Current
- Responsible for verifying and determining patient eligibility for care under the Purchased Referred Care program. It requires me to assess whether a patient is eligible, utilizing the five eligibility factor requirements. Determine if a patient is eligible using the prerequisites for authorization of funds, and require making accurate and independent decisions for the provision or denial of payment for services based upon eligibility criteria. Experienced in communicating and interpreting the five eligibility factors to patients, providers, case managers, co-workers, and other invested individuals. First-hand experience verifying if patients are eligible for alternate resources (i.e., Medicare, Medicaid, VA, private insurance, or other potential payers, as appropriate) that are available and accessible to the individual. Coordinate with outside billing providers in order to notify and coordinate the patient’s alternate resources so that the appropriate alternate resources are billed to decrease the funds utilized by I.H.S., which includes identifying special circumstances for private insurance for authorizations and coordination of benefits. Monitor alternate resource outcomes for approval or denial for potentially eligible patients. Verify alternate resources via the New Mexico Medicaid Portal, Colorado Medicaid, Arizona Medicaid Portal, Utah Medicaid Portal, and various private insurance web portals. Understanding the process to verify third-party coverage, with direct experience adding data to Patient Registration records via page 4 insurance information in the RPMS (Resource and Patient Management System). Familiar with the process to investigate and analyze controversial issues related to patient referrals for PRC, with minimal oversight by the lead employee and PRC supervisor. Responsible for researching the status of incoming medical claims, or statements of charges, from non-IHS providers or patients. Assist with incoming telephone calls from patients and medical providers related to inquiries regarding services rendered, pending referrals, faxes to facilities, payments, and patients admitted to non-IHS facilities, outstanding charges, and PRC eligibility. Responsible for maintaining confidentiality while reviewing incoming faxes, requests, telephone calls, or other requests. Required to report on CHEF cases. Review the documentation received to enter into the RCIS (Referred Care Information System). Provide daily assistance to patients by processing referrals, obtaining notifications, updating information as needed, assisting patients with appeal letters if needed, screening billing statements, and attempting to assist with bill resolution. Review the case management list using TLOG (Transfer Log) of all patients who are transferred or inpatient at other facilities. Regularly scheduled as the rotating lead contact representative, in addition to acting as the delegated supervisor when required. Acting delegation requires overseeing staff, assessing any backlog, reviewing case information, assigning workload, getting updates on workload, and distributing daily workload to staff. Providing and assisting staff with any discrepancies in referrals; in addition, I am required to oversee patient flow and make sure the office is processing cases efficiently. Familiar with obtaining prior authorization for cases before PRC funds are used. Direct experience with determining required ICD-10/CPT-4 codes for diagnosis and procedure codes related to prior authorization. Regularly screen incoming claims from vendors, and claims previously entered into RCIS, to verify if the case is approved. Responsible for issuing approved Purchase Orders upon approval, and denial notifications if not approved. Assign the patient case to the appropriate contact representative, which involves printing referrals and a demographic factsheet. Maintain the DCR (Document Control Register) as needed, and/or during the absence of the PRC (Purchased Referred Care) Accounting Technician (AT). Export purchase order activities through the applicable automated systems in a timely manner, reconcile the FI (Fiscal Intermediary) pended reports on an as-needed basis without errors, and complete them in a timely manner. Reconcile purchase order and financial report issues through CHS/MIS and FI. Print purchase orders in the absence of the Accounting Technician, verify fiscal information, and prepare corrective action from documented discrepancies for purchase orders. Work with the Electronic Health Record on a daily basis, verify referrals are entered by the provider in the RCIS tab, and review provider documentation for more information if needed.
- Created new customer accounts and maintained existing ones in accordance with established procedures.
- Greeted customers and provided them with assistance upon request.
- Attended training sessions aimed at enhancing knowledge of relevant software applications and systems used in the contact center environment.
- Ensured compliance with applicable laws and regulations relating to contact center operations.
- Verified customer information and updated records accordingly.
- Developed relationships with key stakeholders within assigned accounts to ensure customer satisfaction at all times.
- Answered customer inquiries in a timely manner, both over the phone and via email.
- Adhered to established policies and procedures while providing exceptional customer service.
- Responded to customer complaints and escalated issues when necessary.
Billing Technician
Chinle Comprehensive Health Care Facility
Chinle
09.1998 - 10.2003
- I identify and verify third-party private insurance, Medicare, and Medicaid in private insurance systems and Medicaid portals. I identify billable items for third parties and determine eligibility for reimbursement. I analyze patient information to determine primary and/or secondary insurance. Prior to billing, effective dates and termination dates are reviewed to determine which insurance is billable. I abstract billable items from PCC forms, medical documentation, and accurately code CPT-4 for medical, vision, mental health, and prescription. I utilize UB-92 and HCFA-1500 forms per the requirements of insurance companies. Mental health, dental, vision, and prescription drugs are billed separately. I am responsible for the accurate and timely submission of claims to third-party payers in a timely manner. I run reports to identify claims that are ready for billing, and submit them to insurance companies. Any corrections needed on billing or rejected claims, I make corrections and resubmit claims. I have documented all activities performed for my supervisor. Surgical codes, revenue codes, HCPCS codes, and E-Codes, as well as specific injections, are also applied for accurate billing. The dispensing of medication is calculated. I submit all approved claims onto the HCFA-1500 and UB-92 claim forms. I used surgical codes and revenue codes for accurate billing. I file claims in the open and closed binder in numerical order, or the Non-Ben binder. I used a Dell computer to input all my claims that are billable. I write correspondent letters to all policyholders if any type of information is needed. Claims are approved and exported to insurance companies manually on a daily basis. Claims are filed by dates of service for easy accessibility for follow-up. I call various insurance companies about follow-up claims that are denied, to be corrected for proper reimbursement. I did bill collection for housing and outstanding bills.
- Reviewed insurance claims for accuracy and compliance with regulations.
- Communicated with patients to clarify billing inquiries and resolve issues.
- Collaborated with medical staff to verify services rendered for billing purposes.
- Assisted in training new staff on billing procedures and software use.
- Updated patient information in billing systems to ensure data accuracy.
- Coordinated with insurance companies to facilitate timely payments and follow-ups.
- Maintained accurate records of all payments received and posted them to the appropriate accounts.
- Performed data entry tasks into various systems to update customer information as needed.
- Researched customer complaints regarding billing errors, making necessary corrections as needed.
- Generated monthly invoices to clients and customers using specialized software programs.
- Provided training to new staff members on company policies related to billing procedures.
- Identified potential areas of improvement in existing billing processes and procedures.
- Reviewed and processed claims for accuracy and completeness, ensuring compliance with industry standards.
- Prepared reports on outstanding balances due from clients or customers for management review.
- Collaborated with other departments within the organization such as Accounts Receivable and Payable when necessary.
- Verified insurance coverage to ensure proper billing procedures were followed.
- Maintained up-to-date knowledge of applicable laws, regulations and guidelines governing medical billing practices.
- Responded promptly to customer inquiries via phone or email regarding billing issues or questions.
- Developed strategies to improve overall efficiency of the billing department operations.
- Compiled financial statements for review by supervisors or managers on a regular basis.
- Reconciled discrepancies between paper-based invoices and electronic versions of those invoices.
- Analyzed patient accounts for discrepancies, resolving any issues in a timely manner.
- Answered customer invoice questions and resolved issues discovered during invoicing and collection process.
- Submitted claims to insurance companies and researched and resolved denials and explanations of benefit rejections.
Education
AAPC CERTIFICATION - CODING LICENSE
AAPC
Salt Lake City, UT06-2008
High School Diploma -
Chinle High School
Chinle, AZ05-1992
Some College (No Degree) - Business Administration
DINE COLLEGE
Tsaile, AZSkills
- Patient eligibility verification
- Medical billing and coding
- Claims processing and management
- Customer relationship management
- Case management
- ICD-10 coding
- Alternate resource identification
- Electronic health records
- Problem solving
- Effective communication
- Empathy and patience
- Goal oriented
- Strong interpersonal skills
- FLUENT IN NAVAJO LANGUAGE
- Resolving issues
- Providing customer support
- Quality assurance
- Communicating with clients
- Answering questions
- Data entry
- Customer service
- Call logging
- Problem-solving skills
- Documentation and reporting
- Typing 60 wpm
- Logging call information
- Customer support
- Gathering information
Certification
- AAPC CODING LICENSE
Timeline
Contact Representative
Northern Navajo Medical Center
09.1998 - Current
Billing Technician
Chinle Comprehensive Health Care Facility
09.1998 - 10.2003
AAPC CERTIFICATION - CODING LICENSE
AAPC
High School Diploma -
Chinle High School
Some College (No Degree) - Business Administration
DINE COLLEGE