Jacqueline Clemmons
Senior Billing Specialist
Framingham,MA
Summary
I am a dedicated employee who enjoys all aspects Medical Insurance Billing. From verifying coverages, researching why claims are not received to following appeals for payment, all aspects in a life of an insurance biller. Organizing time to be able to complete all tasks within the guidelines set by each Third Party Payer. Detail-oriented and methodical Senior Billing Specialist offering 20 years of experience in related roles. Exceptional abilities in conducting research, problem-solving and prioritizing simultaneous tasks. Leverages resourcefulness, critical thinking skills and superior work ethic for top job performance.
Overview
19
19
years of professional experience
Work History
Senior Billing Specialist
Wayside Youth and Family Support Network
02.2015 - Current
- Daily Cash Posting from Bank Deposit to include
- Download 835 from online payor to Carelogic
- Process Recoups, denials and payments
- Coordinate any discrepancies utilizing EOB
- Review any payments showing as $0.00 balance and document discrepancies
- Verify each 835 balances
- Monthly review of unapplied/unposted payments
- Data Entry Manual payments into Carelogic
- Reconcile Depost to Clearing account Monthly through reconciliation procedures
- Review Aging for Commercial and Public Payers
- Utilize both online websites and automated phone responses for payment updates
- Run aging reports in Carelogic
- Verify claim received at insurance companies
- Verify payments received are paid at contracted rates
- Contact insurance companies to find out why claims are not paying at contracted rate. Escalate as needed with insurance and document each step taken in Carelogic.
- Start appeal as needed
- Review denials as needed and take appropriate steps for payment if possible.
- Contact local or national provider relations for issues with incorrect pay rates as needed.
- Coordinate Client Billing and Payments
- Run Monthly Guarantor Report for outstanding client balances.
- If MCD plan in place for DOS, transfer money to bill
- Verify each client does not have a MCD plan open for DOS
- Generate monthly Client Statements
- Pull payment made online and open Cash Sheet
- Enter Client payments received via mail into the Cash Sheet within the Carelogic system.
- Provide Monthly spreadsheet to Program Directors showing current client balances
- Establish payments plans with families as needed
- Identified by agency as key point of contact for all clients and families for any billing matter
- Post Cash Sheets on the last day of the month.
- Responsible for the reconciliation of Self Pay Payments of Cash to Balance Sheet Cash Account.
- Submit Claims for Payment
- Review claims for accuracy.
- Review Supervisor Protocol procedures are in place for each claim depending on the insurance requirements
- Verify POS as needed
- Batch claims for submitted
- Upload claims for 837 submissions. Verify 277/999.
- Mail claims for those not able to submit via 837.
- Review and correct any claims with errors so they can be submitted.
- Miscellaneous Responsibilities
- Coordinate Weekly Production numbers for CFO
- Maintain rosters for Insurance payers including updating as needed.
- Administrator for Insurance Websites including adding staff as needed/requested from Program Directors.
- Assist with Insurance Re-Credentialing.
- Review Bulletins from MH as they are received.
- Review updates from Commercial payers regarding any upcoming changes.
- Review and maintain updated spreadsheets for new paid rates for Public and Commercial Insurance Plans
- Strong Working knowledge of CBHI/BHCA Claims cross-over and how to process claims with complex client plans
- Trained numerous new staff. Documented procedural steps for Training.
- Maintain weekly cash spreadsheets for Revenue Director
- Weekly/Monthly/Fiscal Year
- Assistant Administrator to Agency’s EHR Billing Administration
- Maintain and update rates as needed
- Add/close insurance plans as needed
- Verify APM is set up for all payers
- Key person when vetting and implementing new EHR System
- Large knowledge base on behavioral health coding and associated modifiers- both professional (1500) & institutional (UB-04)
- Responsible for verifying and closing Month End to include system closing, reporting and analytics.
- Communication Coordinator with Front End Auth/Eligibility Teams.
- Assisted in Month End/ Year End Documentation and Processes. Helped Support the filing of the Agencies UFR Filing
- RCM Admin for Carelogic/Qualifacts
- Strong Microsoft Skills to include Excel, Word, Outlook, Teams etc
- Completed Medical Terminology Course
- Received the Agency Vice President award of 2019 & Customer Service Award during 2022.
- Identified, researched, and resolved billing variances to maintain system accuracy and currency.
- Researched and resolved billing discrepancies to enable accurate billing.
- Processed payment via telephone and in person with focus on accuracy and efficiency.
- Produced and mailed monthly statements to customers and assisted with related requests for information and clarification.
- Responded to customer concerns and questions on daily basis.
- Collaborated with customers to resolve disputes.
- Generated monthly billing and posting reports for management review.
- Maintained accurate records of customer payments.
- Audited and corrected billing and posting documents for accuracy.
Billing Specialist
Metrowest Medical Center/St Vincent Hospital Central Billing Office
04.2006 - 02.2015
- Company Overview: Harvard Healthcare 4/06 -7/14; Tenet Health 7/14-2/15
- Concentration on Commercial insurance & non contracted insurance
- Coordinate payments from Skilled Nursing Facilities, Worcester County Jail, VA facilities in Worcester and Adcare Worcester.
- Maintain 1800+ claims monthly with follow up
- Back up cash posting
- Bankruptcy coordinator
- Daily submit of claims
- Utilize Meditech system
- Coordinate offsite storage from boxing to logging of EOB’s sent
- Coordinate credits to determine if refund due to insurances or clients
- Harvard Healthcare 4/06 -7/14; Tenet Health 7/14-2/15
- Identified, researched, and resolved billing variances to maintain system accuracy and currency.
- Researched and resolved billing discrepancies to enable accurate billing.
- Audited and corrected billing and posting documents for accuracy.
Rental Space Coordinator
The Conference Center at Waltham Woods
03.2014 - 02.2015
- Reception
- Booking for Spaces
- Verifying what electronic devices needed from IT
- Verifiy what catering items may be needed
- Provided guests with outside interests as needed
- Keeping area clean and neat
- Assist as needed in other departments
Assistant to National Account Coordinator
McLaughlin Moving
Nashua, NH
04.2013 - 01.2014
- Coordinate moves for families
- Including dates, equipment needed, vehicles, outside furniture and children’s outdoor play sets.
- Arrange for pickup of belongings and crew to load truck
- Arrange for storage location prior to delivery at new home
- Arrange for drop at new home with day workers to empty trucks and assist families.
Education
High School Diploma -
06.1983
Some College (No Degree) - Bachelor of Science
Skills
- Microsoft Word
- Microsoft Excel
- Microsoft Teams
- Revieiwng Third Paty EOB's
- Looking for payment trends and short payments
- Completing timely insurance appeals
- Posting Insurance Paymets from multiple sources
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Timeline
Senior Billing Specialist - Wayside Youth and Family Support Network
02.2015 - Current
Rental Space Coordinator - The Conference Center at Waltham Woods
03.2014 - 02.2015
Assistant to National Account Coordinator - McLaughlin Moving
04.2013 - 01.2014
Billing Specialist - Metrowest Medical Center/St Vincent Hospital Central Billing Office
04.2006 - 02.2015
Duxbury High School - High School Diploma,
Framingham State College - Some College (No Degree), Bachelor of Science
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