Jaye L. Weaver
Atlanta,GA
Summary
To obtain a career oriented position as a Certified Medical Insurance Biller and A/R Specialist. Excelling in my role and job duties.
Overview
19
19
years of professional experience
Work History
Medical Collections Specialist
Crossroads Treatment Centers
Greenville, SC- Remote
06.2024 - Current
- Review and correct behavioral health, substance abuse rejected claims that are submitted through the clearing house. Verify patient eligibility for commercial and Medicaid insurance plans. Check payment status and resolved denied claims with commercial and Medicaid payors. Send reconsiderations and medical records to payors to process payments and resolved. Work on various projects resolving denials, taxonomy codes, provider enrollment, voided claims. Resolving denial trends within the payors.
Account Resolution Specialist, Insurance Verification
Currance
San Francisco, CA - Remote
07.2021 - 06.2024
- Follow up on status of outstanding aging hospital claims and under payments. Review and submit medical records for processing of payment. Submit appeals and reconsideration to Commercial and Government payors for unpaid or denied claims.
- Pre registration and verify insurance coverage, updating demographic information, updating patients coordination of benefits to get claims processed. Manage and confirm patient data, insurance, demographics information for claims to process through clearing house.
- Communicate with staff and insurance companies by phone or via email for denied claims , pre cert and authorizations.
- Submit refund to payors for overpayment of claims.
- Submit adjustments for claims for unposted contractual adjustments.
- Discuss daily metrics of target goals and issues, trends in daily shift briefing.
- Verifying insurance coverage for government, Medicare, Medicaid , and commercial payors.
Medical Billing and Collections Specialist
Summit/ WellStreet Urgent Care
11.2020 - 06.2021
- Submit claims via EDI , by mail and follow up on status of outstanding A/R, submitted claims, and invoices to Commercial and Workers Comp payors.
- Correspond with employers and patients of balances owed, generate and submit invoices in timely manner for processing of payment.
- Follow up with employers to update WC insurance information.
- Submit appeals for denied claims, under payments and unpaid balances.
- Transfer balances to patient or third party.
- Make adjustments and writeoff small balances.
- Correct or edit CPT/ ICD 10 / HCPCS codes.
- Process EFT/ACH/Credit Cards payments.
- Send out invoices by mail or email.
A/R Rep FSU Collector/Medical Biller
Kindred At Home
05.2019 - 05.2021
- Submitted electronic and paper claims to insurance companies including Commerical and Government payors.
- Processed insurance payor denials by auditing patient files, researching procedures and diagnostic codes to determine proper reimbursement.
- Execute billing tasks and recorded information in company billing system.
- Communicated with insurance payors to resolve any under paid claims.
- Follow up on aging accounts, under payments and recouped payments.
- Research and follow up on denied, and reconsideration claims.
- Submit adjustment for proper write off of payment received.
- Research and fix rejected claims with the appropriate action within EDI.
- Submit refund to payors for overpayments received.
- Submit adjustments for contractual writeoffs.
- Transfer balances to patient responsibility.
- Review patient eligibility status.
- Handled high volume of in-bound calls pertaining to patient accounts and reconciliation of delinquent accounts.
Medical Biller / AR Specialist
AICA Orthopedics
04.2017 - 04.2019
- Responsible for following up on status of aging MVA and Workers Comp accounts.
- Accelerate the revenue cylcle.
- Working rejected claims from the clearing house.
- Coordinate with 3rd party carriers to resolve claim and payment issues.
- Communicate effectively with patients to resolve billing issues.
- Checked the eligibility status of of patients.
- Submitting claims, filing , faxing and obtaining claim status on appeals and claims submitted.
- Verify insurance, preauthorizations , precertifications.
- Submitting 1st & 2nd level appeals to insurance carriers.
- Following up on correspondence sent from various carriers request.
- Correspond with attorneys to follow up on status of balances and payments.
- Submitting medical records or disabilty documentation to process the claims.
- Process refunds request over payments from carriers.
Accounts Receivable Specialist
Hexaware Technologies
01.2016 - 04.2017
- Responsible for handling all correspondence related to insurance carriers, patients, and other facilities as needed to obtain payment status on outstanding accounts or trends which affect claims payment.
- Precisely completed appropriate claims paperwork, documentation and system entry timely manner.
- Followup on outstanding A/R with various goverment payers and resolution denials.
- Develop reports to detail aging and past due accounts
- Review/ Manage aging accounts
- Review coding errors
- Request EOB/ EOR
- File appeals
- Data Entry
Lead Supervisor
Air Serv
01.2009 - 01.2016
- Greeted customers entering the work area to ascertain what each customer wanted or needed at the time.
- Served as the main liaison between customers, management and dispatcher team.
- Learned, referenced and applied product knowledge information.
- Directed calls to appropriate individuals and departments.
- Assisted customers in person and via telephone.
Medical Assistant
Atlanta West Primary Care
03.2006 - 11.2007
- Assisted in the maintenance of medical charts and/or electronic medical record (filing, Op Reports, test results, home care forms).
- Scheduled appointments, registered patients and distributed sample pharmaceuticals as prescribed.
- Verified patients’ eligibility and claims status with insurance agencies.
- Assessed patients and documented their medical histories.
- Managed team of medical support personnel.
Education
Associate of Science - Medical Billing and Coding
MEDTECH
Atlanta, GA2016
Associate of Applied Science - Medical Assistant
MEDIX
Atlanta, GA2006
Skills
- Certified Professional Coder
- VDI Software
- FACS Software
- Medisoft Version 17
- Patient chart auditing ability
- Insurance and collections procedures
- Office support (phones, faxing, filing)
- Schedule Patients/ Register Patients
- Case Manager software
- NaviNet Software
- TriZetto
- Change Healthcare
- Unity
- Homecare Homebase (HCHB)
- Emdeon
- Availty
- Star software
- Artiva Software
- EPIC Software
- Read EMR
- Create Claim
- Post payments
- CPT/ HCPCS Coding Guidelines
- Medical Records
- Medical terminology
- Insurance Verification
- Inpatient records coding proficiency
- Rapid Practice Management software
- NexGen Software
- Optum /UHC/UMR
- ICD-9/ ICD -10
- Client App
- Direct Connect
- Payment Processing
- Cerner
- Waystar
- Citrix
Certification
NHA Certified Medical Biller/Coder
Timeline
Medical Collections Specialist
Crossroads Treatment Centers
06.2024 - Current
Account Resolution Specialist, Insurance Verification
Currance
07.2021 - 06.2024
Medical Billing and Collections Specialist
Summit/ WellStreet Urgent Care
11.2020 - 06.2021
A/R Rep FSU Collector/Medical Biller
Kindred At Home
05.2019 - 05.2021
Medical Biller / AR Specialist
AICA Orthopedics
04.2017 - 04.2019
Accounts Receivable Specialist
Hexaware Technologies
01.2016 - 04.2017
Lead Supervisor
Air Serv
01.2009 - 01.2016
Medical Assistant
Atlanta West Primary Care
03.2006 - 11.2007
Associate of Applied Science - Medical Assistant
MEDIX
Associate of Science - Medical Billing and Coding
MEDTECH