JULIANA COBB
Las Vegas,NV
Summary
PERSONAL SUMMARY Professional with over 10 year’s expertise in Administrative Support, Customer Service with a Medical Billing background within the Healthcare Industry. Specialized in working with commercial and government payers, patient assistance programs, appeals process, and copay assistance support. Exceling in educating providers on product fulfillment procedures, including physician’s buy and bill, and specialty pharmacy options for billing to third parties. QUALIFICATIONS 10+ years Customer service and Documentation for insurance claims and clients 5 + years Leadership multiple areas 10+ years Medical Billing/Medical Records processing/CMS 1500 Form submission, Medical Terminology/ICD 10/ CPT/HCPCS Coding Knowledge, Customer Service, & Call Center experience.
Overview
10
10
years of professional experience
Work History
Medical Reimbursement Technician/Veterans Administration
Veterans Administration
01.2023 - Current
- Performed verification of patients' insurance coverage for inpatient/outpatient services
- Entered information into database and generated reports
- Document pre-admission requirements and identify patients requiring second opinions.
- Perform re-imbursement billing activities, including consideration of professional and facility services, sharing agreements, Tricare, Champ VA, Medical and Pharmacy billing
- Monitor reports to assure all possible billable cases are processed
- Ensure proper sequencing of diagnostic and procedural codes
- Track, review and correct insurance denials
- Perform third-party collections from insurance companies, including humanitarian, Department of Defense, Tricare, workman's compensation, etc
- Perform research, resolve problems and post payments, adjustments, denial codes, and non-payment collections
- Verify accuracy of payments, resolve discrepancies and closing, and audit accounts
- Maintain tracking system on Debt Management and Department of Treasury Off-set program.
- Communicate with insurance companies and patients, answering questions/inquires
- Explain health care services eligibility and entitlements to patients
- Provide input for responding to Congressional inquiries
- Verified accuracy of accounts payable payments, resulting in 85% reduction in payment errors and check reissues
- Corrected, completed and processed claims for multiple payer codes
- Processed online and paper appeal submissions and refund requests
- Processed billing calls and answered questions from patients and third-party carriers
- Assisted in reconciling deposit and patient collections
Medical Insurance Program Support Representative/Care Manager /IQVIA
01.2022 - 01.2023
- (Remote)
- Assist with writing SOP’s for current business needs, also training new hires to preform Care Manager duties as outlined in current job description
- Responsible for answering in-bound calls and making outbound calls to patients, Pharmacies and providers
- Contact insurance companies to perform appropriate benefit investigation(s) and coverage eligibility for Manufacturer copay assistance programs and assists with the completion of the prior authorizations with attention to detail
- Assist patients with the enrollment process for manufacturer and non-profit organization copay assistance programs
- Provide Patients with courteous, friendly, fast and efficient service Work efficiently both individually and within a team to complete projects and accomplish required tasks.
Medical Claims Biller
Accrue Partners for Cardinal Innovations
06.2021 - 10.2021
- Preformed Electronic Claim Billing for HCP ‘s for Psychiatric services in Greater Charlotte NC/Piedmont area.
- Tracked and reconciled claims and completed follow-up task to complete adjudication.
- Billed Medical claims for insurance providers including Medicaid, Medicare, Tricare, Commercial and private payers
- Responsible for single point of contact communication with providers and patients
- Contact insurance companies to perform appropriate benefit investigation(s) and coverage eligibility for client product only – medical benefit 90%, pharmacy benefit 10%
- Provide courteous, friendly, professional, and efficient service to internal and external customers including physicians and patients
- Work efficiently both individually and within a team to accomplish required tasks
- Eligibility authorization and enrollment into Patient Assistance Program(s)
- Ability to verify insurance requirements to support current billing processes
- Demonstrate a firm grasp of medical billing processes communicating knowledge to internal and external customers
- Identifying and providing corrective action for medical billing reimbursement support specifically to provider offices
Patient Case Coordinator
AmerisourceBergen/ Lash Group
10.2018 - 05.2021
- Answered detailed questions about the Co-Pay program and hours of Operation
- Obtained all information from patient to Triage to Nurse help line also to the Administrator of Copay Program for Rebate eligibility
- Contacted McKesson to Verify Members continued eligibility, Copay ID numbers and to retrieve patients card balance
- Counseled patients on their insurance Summary of Benefits in order complete the benefit verification process
- Effectively resolved complex accounts with minimal supervision
- All tasks are handled with the highest regard to quality driven, Patient First Customer service.
Billing Claims Specialist/Special Operations
AmerisourceBergen/ Lash Group, Premier Source
07.2013 - 06.2018
- Reported directly to Director of Operations
- Identifies and resolves claims/eligibility issues
- Reviews accuracy of all data
- Provides excellent customer service
- Ensures that all claims submitted to government and private payers comply with applicable federal and state regulations
- Provides timely follow up on unpaid, denied, and/or short paid claims
- Appropriately documents all payer, patient and client interaction
- Ensures that necessary data for submitting accurate claim has been obtained and processed to adjudication.
- *Other duties: Invoice all supply requests Audit all accounts receivables/payables with authority to approve all billing statements for business unit.
Education
GED -
Zimmerman High School
Flint11.1987
Some College (No Degree) - Computer Technology/Business Math
ITT Technical Institute - Indianapolis
Indianapolis, INMortgage Brokerage Licensing Course -
Central Piedmont Community College
Charlotte01.2008
Skills
- Medical Billing:
- EHR/EMR/Systems
- Patient plus
- Salesforce
- Fusion
- Administrative Support
- Microsoft Office
- Customer Contact
- Medical Records Management
Timeline
Medical Reimbursement Technician/Veterans Administration
Veterans Administration
01.2023 - Current
Medical Insurance Program Support Representative/Care Manager /IQVIA
01.2022 - 01.2023
Medical Claims Biller
Accrue Partners for Cardinal Innovations
06.2021 - 10.2021
Patient Case Coordinator
AmerisourceBergen/ Lash Group
10.2018 - 05.2021
Billing Claims Specialist/Special Operations
AmerisourceBergen/ Lash Group, Premier Source
07.2013 - 06.2018
GED -
Zimmerman High School
Some College (No Degree) - Computer Technology/Business Math
ITT Technical Institute - Indianapolis
Mortgage Brokerage Licensing Course -
Central Piedmont Community College