Joan Ralston

• Provide exceptional customer service to all callers by helping and ensuring customer satisfaction
• Provide face to face and phone counseling to patients regarding insurance benefits and patient liability for hospital and professional services including complex billing cases such as transplants, End Stage Renal Disease, and package pricing
• I am familiar with Michigan Medicine policies and procedures and the EPIC system as well as HIPAA and VPN management
• Interpret and explain hospital and professional patient statements
• Educate and coordinate between patients and insurance companies regarding payment responsibility
• Request payment in full or establish a payment plan (within established guidelines) at the conclusion of third-party adjudication
• Negotiate patient discounts and settlements as well as obtain and posting of payments received balancing of credit card transactions to cash drawers
• Demonstrate personal integrity, enthusiasm, and empathy to internal and external customers
• Answer patient calls for 80% of workday and able to handle the occasional difficult customer effectively
• Respond within 3 days to written inquiries received via mail, fax and e-mail
• Knowledge of MSupport, State and County assistance programs and Guest Assistance Program to help uninsured, under-insured or have policies with limited benefits or non-covered service by providing financial options
• Retrieve accurate eligibility and claim information from third party payer websites/portals
• Take ownership and research patient accounts for accuracy of charges, coding reviews, insurance billing, balances, and demographic data
• Ensure that all updates/corrections are completed and documented
• Interact with physicians, clinical areas, insurance companies, and departmental billing and coding units to resolve patient and insurance inquires
• Identify errors in revenue cycle including registration, clinic operations, information technology, charge entry, coding, documentation, billing, and inappropriate reimbursement/rejections from each third-party payer’s document and correct as needed
• Recommend patient satisfaction enhancements, cost saving opportunities and process improvements
• Committed to team efforts, quality improvement and lean thinking initiatives
• Respond quickly and act professionally/appropriately in stressful situations including de-escalation
• Prepare charge estimates for hospital and professional services for Destination Program patient and other departments and/or prior to service as well as pre-screening eligibility for MSupport
• Update to MLearning as required
• Assist patients in perusing access to manufacturer and extended coverage options
• Troubleshoot and resolve complex billing/prescription issues with associated clinic staff
• Complete and follow accounts for deceased patients and interact with family in the estate closure process

• Company Overview: MedEQUIP
• Responsible for creating monthly telephone schedule as well as working the Billing Call Center
• Verify and load insurance, request any PA’s and contact the patient to go over their new benefits
• Counsel patient regarding their account for benefits and responsibility
• Recommend patient satisfaction enhancements, cost saving opportunities and process improvements
• Perform critical and complex billing-related functions requiring analysis and evaluation of Medicare HMO’s, HAP, CIGNA, Priority Health, Medical Mutual of Ohio, Auto Insurance, Workers Compensation, as well as smaller Third-party insurances, MSupport, Private pay and Collections
• Preform critical and complex billing-related functions requiring analysis and evaluation for MIHome Construction patient’s that have Workers Compensation and Auto Insurance as well as Third party insurances
• Obtain and maintain documentation from Audiology Department for proper qualification and billing to the insurance companies for Cochlear units
• I continuously review all insurance guidelines through online webinars offered by the insurance carriers I currently bill for
• Create, fax, QA and confirm all proper DME Physician Orders, LMN and CMN
• Request any new or reoccurring prior authorizations needed from insurance companies
• Add narrative to the HAO records in order to send electronic claims
• Work Front End Rejections through our clearing house
• Obtain and maintain documentation relating to Ventilator department and the respiratory therapists for complex billing
• Creation of Vent Agenda as well as hosting the meeting
• Work closely with the contracting department whenever we are experiencing problems with how the insurance companies are paying according to our contract
• Participated in a Lean Project to help create first time quality for MedEQUIP
• Created step by step insurance verification guidelines for insurance companies I bill for use in the training of new employees
• Review ICD-9, ICD-10 and HCPC Codes to make sure the claims are coded properly for proper payment
• Converted product to a purchase and mailed the transfer of title letter to the patient
• Created and complete Change Alerts
• Keep track of monthly claims that are sent out, adjustments requested and turn in monthly recaps to Team Lead
• Update to MLearning as required
• MedEQUIP
• Resolved billing inquiries to ensure patient satisfaction and maintain positive relationships.
• Managed patient accounts, improving accuracy and efficiency of billing processes.
• Conducted account reviews to identify discrepancies and facilitate timely resolution.
• Improved account collections by coordinating with patients and insurance providers.

• Responsible for input of Laboratory Reports and Docu-scans into Medical Manager
• Responsible for the disbursement of monies received as well as the mail
• Responsible for input of Information and Release forms, updating of affiliations in Medical Manager
• Responsible for updating quarterly of patient’s insurance benefits specific to AETNA Student Health and Premier Care

• Responsible for input of Information and Release forms, updating of affiliations in Medical Manager
• Verified insurance of patients to determine eligibility.
• Communicated with insurance providers to resolve denied claims and resubmitted.
• Managed appeals process for denied claims, resulting in successful reimbursements from insurance companies.
• Filed and updated patient information and medical records.

• Responsible for obtaining and maintaining prior authorizations and referrals from insurance companies for DME billing
• Responsible for verification of benefits and eligibility as well as statusing of patients accounts for various insurance carriers for DME and Home Health Care billing as well as Customer Service and Call Center for DME
• Responsible for the disbursement of monies received for cash posting
• Responsible for credit checks of patients for DME and Home Health Care services
• Converted product to a purchase and mailed the transfer of title letter to the patient

Responsible for obtaining and maintaining prior authorizations and referrals from insurance companies for DME billing

• Responsible for verification of benefits and eligibility as well as statusing of patients accounts for various insurance carriers for DME and Home Health Care billing as well as Customer Service and Call Center for DME
• Request any new or reoccurring prior authorizations needed from insurance companies

• Responsible for verification of benefits and eligibility as well as statusing of patients accounts for various insurance carriers for DME and Home Health Care billing as well as Customer Service and Call Center for DME
• Responsible for obtaining and maintaining prior authorizations and referrals from insurance companies for DME billing
• Communicated with insurance providers to resolve denied claims and resubmitted.
• Posted and adjusted payments from insurance companies.
• Identified and resolved patient billing and payment issues.
• Examined patients' insurance coverage, deductibles, insurance carrier payments and remaining balances not covered under policies when applicable.
• Managed patient accounts effectively, resolving discrepancies and addressing outstanding balances in a timely manner.

• Responsible for verification of benefits and eligibility as well as statusing of patients accounts for various insurance carriers for DME and Home Health Care billing as well as Customer Service and Call Center for DME
• Responsible for obtaining and maintaining Prior Authorizations for Medicaid DME Billing
• Communicated with insurance providers to resolve denied claims and resubmitted.
• Posted and adjusted payments from insurance companies.
• Assisted patients with understanding their medical bills and provided clarification on complex insurance issues, promoting a positive customer experience.