Jenika Redding

• Enhanced customer satisfaction with prompt resolution of billing disputes, addressing concerns professionally and empathetically.
• Collaborated with interdisciplinary teams to ensure accurate patient information for timely and precise billing processes.
• Monitored daily claim submissions to identify errors or potential issues, taking corrective action as needed for timely processing.
• Established positive relationships with insurance company representatives, facilitating effective communication during the claim resolution process.
• Developed an efficient system for organizing and tracking outstanding claims, leading to quicker reimbursement times from insurers.
• Provided exceptional customer service to patients, addressing billing inquiries promptly and professionally.
• Kept abreast of industry trends and changes in medical billing practices, ensuring continuous improvement to the department''s processes.
• Communicated with insurance providers to resolve denied claims and resubmitted.
• Verified insurance of patients to determine eligibility.
• Liaised between patients, insurance companies, and billing office.

• Investigate accounts to identify root cause of credit balance.

• Responsible for credit balances, undistributed payments and requests for refunds for government payers.

• Conducting timely and accurate review of undistributed payments, overpayments, credits and requests for refunds in ACE. Responsible for taking all steps necessary to facilitate prompt and accurate resolution of payments including follow up with third party payers to determine coordination of benefits, insurance primacy rules and filing order.

• Initiate refunds to patients/guarantors, insurance companies, and other third parties by following established refund procedures, contractual obligations, payer and regulatory requirements.

• Conduct timely and accurate review of refund requests for payers with contracted recoupment language to reduce future recoupment reconciliations.

• Responsible for reviewing, validating and correcting adjustments on accounts based on insurance reimbursement and coverage, contracted payers, and services provided.

• Validate and update patient demographic and insurance information to ensure accuracy of future claims.

• Reviewed accounts, resolved coding areas, and tracked recurring expenses for accrual entry.
• Generated reports and analyzed trends to maximize reimbursement and reduce claim denials.
• Reviewed workflows to improve, implement, communicate and maintain AR resolution process.
• Liaised between patients, insurance companies, and billing office.
• Reviewed patient diagnosis codes to verify accuracy and completeness.
• Reviewed patient records, identified medical codes, and created invoices for billing purposes.
• Oversees accounts for 9 medical offices and 2 surgical practices.

• Followed up with medical staff regarding missing information in patient records.
• Applied official coding conventions and rules from American Medical Association and Centers for Medicare and Medicaid Services to assign diagnostic codes.
• Reviewed patient charts to better understand health histories, diagnoses, and treatments.
• Verified accuracy of patient information in medical records.
• Utilized active listening, interpersonal, and telephone etiquette skills when communicating with others.
• Correctly coded and billed medical claims for various hospital and nursing facilities.
• Generated reports to identify coding trends and discrepancies.
• Verified signatures and checked medical charts for accuracy and completion.
• Monitored changes in coding regulations to provide recommendations for compliance.
• Resourcefully used various coding books, procedure manuals, and on-line encoders.
• Utilized electronic medical record systems to store, retrieve and process patient data.
• Interacted with physicians and other healthcare staff to ask questions regarding patient services.
• Reviewed outpatient records and interpreted documentation to identify diagnoses and procedures.
• Communicated with insurance companies to research and resolved coding discrepancies.
• Reviewed, analyzed, and managed coding of diagnostic and treatment procedures contained in outpatient medical records.

• Monitored referrals to foster timely completion and followed up with physicians to facilitate.
• Responded to patient inquiries to offer timely updates regarding referral status.
• Assisted with completion of referral forms and verified data accuracy and completion
• Developed and maintained strong working relationship with referral sources to streamline processing.
• Maintained accurate records on in-progress and completed referrals, ensuring full data integrity throughout process.
• Facilitated referrals to other healthcare providers and resources to bridge service gaps.
• Obtained prior authorization for diagnostic procedures.
• Developed and implemented effective strategies to increase referral sources.
• Notified and reminded clients of appointments.
• Scheduled appointments with specialists on behalf of clients.
• Built professional relationships with service providers.
• Weighed patient need, provider availability, and insurance coverage to determine optimal scheduling.
• Processed referral requests from patients, doctors and other health care professionals.