Janice Maxwell
East Greenbush
Summary
Detail-oriented professional billing specialist with extensive experience in reconciling insurance and patient payments, resolving account disputes, maintaining high levels of productivity and accuracy. Committed to upholding strict patient confidentiality standards while delivering exceptional results.
Overview
29
29
years of professional experience
1
1
Certification
Work History
Medical Billing Specialist
Women's Cancer Care Associates, LLC
09.2013 - Current
- Verify eligibility and benefits on all new and existing patients.
- Add Insurance information for all new patients and patients that changed insurances.
- Charge entry.
- Down load remittances from various insurance companies.
- Transmit electronic claims and retrieve confirmation reports.
- Communicate with insurance providers to resolve denied claims and resubmitted.
- Locate errors and promptly refiled rejected claims.
- Precisely complete appropriate claims paperwork, documentation and system entry.
- Provide exceptional customer service to both patients and insurance representatives, resolving inquiries quickly and professionally.
- Efficiently process refunds or adjustments for patients when necessary, ensuring accuracy and compliance with company policies.
- Prepare and transmit patient statements.
- Collection calls.
- Post and adjust payments from insurance companies.
- Work insurance denials after posting.
- Effectively write appeal letters to overturn claim denials
- Work unapplied reports and refund patients where appropriate
- Obtain authorizations for chemotherapy.
- Scan checks weekly through digital check.
- Monthly cash deposits.
- Assist patients with understanding their medical bills and provided clarification on complex insurance issues, promoting a positive customer experience.
- Exam patients' insurance coverage, deductibles, insurance carrier payments and remaining balances not covered under policies when applicable.
- Ensure timely submission of claims to various insurance carriers, resulting in prompt payment for services rendered.
- Maintain strong working relationships with healthcare providers, fostering clear communication regarding billing-related matters.
- Manage patient accounts effectively, resolving discrepancies and addressing outstanding balances in a timely manner.
- Enhance revenue collection through diligent follow-up on unpaid claims and denials with insurance companies.
Medical Billing Specialist
Capital Region Orthopaedics
10.1999 - 01.2013
- Medical billing for 30+ providers specializing in CDPHP and MVP.
- Electronic and manual payment posting.
- Charge entry.
- Follow up of Insurance claims, reviews and denials utilizing knowledge of carrier policies and billing guidelines.
- Maintain an excellent rapport with Insurance Provider Representatives enabling a 98% successful outcome in favor of the physicians.
- Maintain an impeccable AR time frame for assigned insurances.
- Write and ensure accuracy of training materials and assist in training of employees.
- Incorporate procedures and protocols to ensure teamwork and increase productivity.
- Establish payment contracts for patients to increase accounts receivable.
- Counsel patients with delinquent balances in office and over the phone.
- Access various insurance carries web-sites checking claim status, eligibility and referrals.
- Maintain knowledge of and implement office procedures, referral and timely filing requirements.
Provider Correspondence Specialist
Capital District Physicians Health Plan
03.1999 - 11.1999
- Interacted with providers regarding correspondence by supplying written and verbal responses to provider inquiries.
- Responsible for administering/following plan policies and procedures so as to assist providers with interpretation, application and compliance of external policies and procedures.
- Researched incoming correspondence for accuracy prior to distributing claims for adjustment.
- Investigated claim denials and performed necessary research using group health contracts.
- Completed all Internal and Correspondence Service Forms within 10 days of receipt or initiation.
- Maintained quality and quantity of 98% or above on a consistent basis.
- Provided backup coverage for telephones as needed.
Quality Assurance Analyst/Claims Examiner
CSC Healthcare
06.1997 - 03.1999
- Performed daily individual quality review audits along with random monthly audits on claims processed.
- Provided training and guidance to inexperienced colleagues to ensure proper processing of claims and referrals.
- Prepared monthly statistic reports and provide proposals on quality improvements for management.
- Developed Strategic Action Plan to improve the Auditing Department policies and procedures making recommendations to management so as to increase department performance.
- Data entered and processed Medicaid claims per Pennsylvania state law.
Customer Service Representative
United Healthcare
05.1996 - 06.1997
- Processed large volumes of insurance claims and correspondence.
- Acted as a liaison with other insurance carriers, physician's offices and policy holders.
- Provided team members and other personnel training on proper claims processing per company guidelines.
- Performed special assignments with internal auditing on the accuracy of claims processed.
- Answered high volume of phone calls.
Education
Associate of Science - Administrative Assistant
Bryant & Stratton College
Albany, NY01.1996
Skills
- Knowledge of HIPAA standards
- ICD-10 coding proficiency
- CPT coding expertise
- Knowledgeable in medical terminology
- Skilled in Medent software
- Proficient in written communication
- Proficient in navigating insurance websites
- Strong interpersonal skills
- Proficient in computer applications
- Accurate payment posting
- Efficient claim management
- Insurance eligibility verification
Certification
Notary Public-2018
Bryant & Stratton-Medical Coding-2013
Timeline
Medical Billing Specialist
Women's Cancer Care Associates, LLC
09.2013 - Current
Medical Billing Specialist
Capital Region Orthopaedics
10.1999 - 01.2013
Provider Correspondence Specialist
Capital District Physicians Health Plan
03.1999 - 11.1999
Quality Assurance Analyst/Claims Examiner
CSC Healthcare
06.1997 - 03.1999
Customer Service Representative
United Healthcare
05.1996 - 06.1997
Associate of Science - Administrative Assistant
Bryant & Stratton College
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