Your Name
Orland Park,IL
Overview
14
14
years of professional experience
Work History
Remote Medical AR Denial Management
Teleperformance USA
Salt Lake City, UT
06.2024 - Current
- Understand medical terminology; understand HIPPA.
- Utilize Government, Commercial. and regulatory guidelines to collect outstanding accounts.
- Research remits and Explanation of Benefits (EOBs) for accurate payments or denials.
- Submits corrected claims or appeals.
- Obtains missing information and submits revised claims to insurance companies and other payers for payment.
- Reviews denials or partially paid claims and collaborates with insurance companies regarding discrepancies.
- Verify Eligibility and search for authorizations.
- Obtained client benefit information regarding insurance coverage to ensure appropriate reimbursement and help facilitate clients' treatment.
- Performing appeals on denials, underpayments, and/or unpaid claims.
- Contact major third-party payers when verifying insurance benefits.
- Scheduled patients investigate denied claims to ensure timely follow-up and collection of third-party payer receivables.
- Review root cause analysis to reduce/prevent future denials while working to overturn denials for payment resolution.
- Conduct daily, systematic reviews of the work list to verify that all accounts are completed.
- Documents process and communications on all claims and activities within the billing system.
- Answers inquiries about assigned accounts promptly.
- Complies with federal. state. and company policies. procedures. and regulations.
- Manage accounts and follow up with insurers.
- Prioritize collections and appeals.
- Reconcile, correct, and appeal claims.
- Obtain fiscal resolution of no-pay/overpayment determinations(denials) through appeal.
- Communicate with payors and resubmit claims.
- Provide excellent customer service and phone skills when speaking with insurance companies.
- Retro authorizations or file appeals within the appeal's timely filing.
- Bill patients for responsible portions and can relay information regarding copays, deductibles, and coinsurance.
Remote After-Hours Customer Service Rep.
Nationwide Inbound INC.
Freeport, IL
04.2021 - Current
- Take Inbound calls after hours from the medical office to on-call providers and the medical equipment office to the DME department.
- Gather customer call-back information for emergency service or non-emergency HVAC, plumbing, electrical, and appliance.
- Answer all customer questions and concerns promptly.
- Forward calls and messages when required to the office.
- Follow each client's guidelines and protocols.
Remote Patient Financial Services Specialist II
Beloit Health Systems
Beloit, WI
01.2024 - 05.2024
- Responsible for accurate billing of health system services.
- Prepare claims for billing through edit resolution.
- Ensure timely claim submission.
- Obtain fiscal resolution of no pay/overpayment determinations(denials) through appeal.
- Analyze payor claims processing and reimbursement to contractual obligations to ensure the facility received proper payment for services.
- Document all work by departmental standards Hospital Billing and Professional Billing.
- Medicare DOE/ Medicare Advantage plans.
Remote Insurance Follow-Up Specialist
Annuity Health / RevMD
Westmont, IL
02.2020 - 01.2024
- Utilize Government, Commercial, and regulatory guidelines to collect outstanding accounts.
- Research remits and Explanation of Benefits (EOBs) for accurate payments or denials.
- Submits corrected claims or appeals.
- Obtains missing information and submits revised claims to insurance companies and other payers for payment.
- Reviews denials or partially paid claims and collaborates with insurance companies regarding discrepancies.
- Verify Eligibility and search for authorizations.
- Obtained client benefit information regarding insurance coverage to ensure appropriate reimbursement and help facilitate clients' treatment.
- Bill patients for responsible portions and can relay information regarding copays, deductibles and coinsurance.
- Performing appeals on denials, underpayments, and/or non-paid claims.
- Contacting payers for follow-up and resolution of outstanding claims.
- Investigate denied claims to ensure timely follow-up and collection of third-party payer receivables.
- Review root cause analysis to reduce/prevent future denials while working to overturn denials for payment resolution.
- Conduct daily, methodical reviews of the work list to verify that all accounts are finalized.
- Documents process and communications on all claims and activities within the billing system.
- Answers inquiries on assigned accounts promptly.
- Complies with federal, state, and company policies, procedures, and regulations.
Dermatology Authorization Specialist and EDI Specialist
Pinnacle Dermatology LLC
Lombard, IL
06.2018 - 11.2019
- Monitor and review clearinghouse's daily EDI errors and make corrections to submit a clean claim.
- Research NPI numbers and collect licensure data to ensure each provider is accurately entered into the claims processing system.
- Work with the Claims Manager to create reports of common provider entry errors to perform frequent audits of data loaded to ensure accuracy.
- Enter pathology claims and verify CPT and cancerous dx codes.
- Knowledge of Dermatology, Moh's surgery, excisions, and pathology charges.
- Enter new payer ID numbers with new insurance plans and add new providers with clearing house.
- Export, import, research, and interpret ANSI X12 files from 837, 835, 834, or 278.
- Work rejections, TriZetto Clearing House.
- Communicate with payers and/or clearinghouse vendors to get clarification on rejections, denials, and eligibility.
- Assemble information concerning the patient's clinical background and referral needs per referral guidelines.
- Ensure that referrals are addressed on time.
- Obtain and scan Referrals I Pre-Certifications to patient accounts.
- Completed reauthorizations, referrals, and pre-certifications as required by payers before procedures.
- Contracts and major third-party payers when verifying insurance benefits, eligibility and prior authorization requirements.
- Provide appropriate clinical information to insurance by uploading clinical such as office notes and lab results, from the patient's EMR.
- Contact insurance companies, Labor Funds, Medical Care Management, and IHP, to ensure prior approval requirements are met.
- Verify insurance eligibility and proficiency in Medicare Part A & B, Medicaid, HMO guidelines, Labor Funds, and Commercial Insurance.
- Used Availity.
- Review medical notes to present necessary medical information such as diagnosis, and CPT codes.
- Bill claims electronically to Medicare I Medicaid, commercial insurance.
- Answer Incoming calls explain any patient statement billing questions and post payments.
- Monitor phone, fax queues, and emails for efficient productivity.
Medical Billing Specialist
Conifer Health Solutions
Tinley Park, IL
03.2015 - 05.2018
- Verify all Insurance eligibility to bill claims to Medicare/ Medicaid, commercial insurance, and third-party payers.
- Maintained the highest levels of accuracy and patient confidentiality.
- Quickly identified and resolved medical billing, coding, and insurance discrepancies.
- Explained to patients EOB and processed medical claims to insurance carriers after verifying eligibility.
- Reviewed patient bills for accuracy and completeness and obtained any missing information.
- Ascertained the reason for the call and assisted the caller with their questions, concerns, or problems, focusing on first-call resolution.
- Resolved billing issues identified by insurance carriers and patients.
- Reviewed claim denials and payer requirements and forwarded them to the Denial Department for corrective action and prevention.
- Screens patients for Financial Assistance Program eligibility.
- Documents insurance details, required payments, and any additional information to assist with patient access and collections.
- Researched and replied promptly to patients' and internal customers inquiries.
- Kept accurate records of all activity and conversations for each file.
- Took payments over the phone and set up payment arrangements.
- Clearly articulated response to patients using appropriate voice modulation.
Collections Agent
EOS CCA Chicago
Tinley Park, IL
04.2012 - 03.2015
- Executed adequate and timely collection and instigated recovery activities to minimize risk costs and optimize returns.
- Negotiating payments while continuing to build a positive relationship with customers.
- Performed telephone contact with customers according to guidelines and standards to ensure payment.
- Managed collection efforts with an elevated level of persuasiveness and professionalism.
- Met daily metrics and collection goals consistently.
- Clearly documented required payments and any additional information to assist patient access and collections.
- Oversaw 10 0+ inbound and outbound calls per day using the auto-dialer.
Timeline
Remote Medical AR Denial Management
Teleperformance USA
06.2024 - Current
Remote Patient Financial Services Specialist II
Beloit Health Systems
01.2024 - 05.2024
Remote After-Hours Customer Service Rep.
Nationwide Inbound INC.
04.2021 - Current
Remote Insurance Follow-Up Specialist
Annuity Health / RevMD
02.2020 - 01.2024
Dermatology Authorization Specialist and EDI Specialist
Pinnacle Dermatology LLC
06.2018 - 11.2019
Medical Billing Specialist
Conifer Health Solutions
03.2015 - 05.2018
Collections Agent
EOS CCA Chicago
04.2012 - 03.2015