Julie Lee
Wills Point,TX
Summary
Dedicated and motivated Reimbursement specialist bringing 15+ years of experience managing all aspects of revenue cycle management. Exemplary skill in resolving billing disputes, providing excellent customer service, updating and maintaining credentialing and reimbursement files, creating portals for optimum speed and access to claims, payments, and quicker opportunity for appeals, as well as updating provider demographics, certifications and recertification's. Adept at accurate payment posting, researching payer websites to find answers and quick solutions as well as understand and share rules and regulations for both myself and my peers. Strong knowledge and understanding of all payer types with a resolve to know how and why a payer makes a decision. Recognized for effective leadership with consistent achievement of objectives.
Overview
15
15
years of professional experience
Work History
Billing Specialist
Little Spurs Pediatric Urgent Care
San Antonio, TX
02.2024 - Current
- Accurately posted payments and adjustments both electronically and manually.
- Maintained compliance with HIPAA regulations while handling sensitive patient information during payment posting tasks.
- Handled payment transactions for customer purchases.
- Proactively identified potential underpayments from insurers and took appropriate actions to rectify discrepancies swiftly.
- Reconciled accounts receivable ledger to verify payments and resolve variances.
- Submitted enrollments for both commercial and governmental payers to set up EFT and ERAs.
- Completed bank changes for payers as needed
Billing Specialist
Neurovative Diagnostics
Dallas, Texas
10.2023 - 02.2024
- Researched and resolved billing discrepancies to enable accurate billing.
- Identified, researched, and resolved billing variances to maintain system accuracy and currency.
- Worked with multiple departments to check proper billing information.
- Assisted colleagues in resolving complex billing issues, promoting teamwork and knowledge sharing within the department.
Credentialing and Reimbursement Specialist
Emergicon
09.2021 - 10.2023
- Initiate and maintain ERA, EDI & EFT enrollment for all carriers.
- Setup and maintain provider and payer portals.
- Maintain DSHS licensure and ensure current with TMHP.
- Ensure provider ERA's are pulled from proper portals and saved to client folders for maximum company revenue.
- Create more efficient workflows for department by keeping training workbooks current.
- Initiate and maintain credentialing applications for provider address, demographic and financial changes.
- Initiate and Maintain Banking changes.
- Draft and maintain bank letters, provider credentialing letters, VA authorization letters, provider W9s.
- Work closely with team on VA/Immigration projects.
- Establish and maintain credentialing trackers and checklists to provide most current updates and changes.
- Respond to customer concerns and questions on daily basis.
- Negotiate with payers to ensure increased profit on settlement offers.
- Keep providers updated on HRSA Provider Relief Fund dates and deadlines.
Medical Billing and Collections Specialist
Dallas Plastic Surgery Institute
05.2019 - 06.2020
- Entered daily office and surgery charges, including all cpts and icd 10 codes.
- Posted all insurance payments, cash and credit card payments accurately.
- Maintained close relationship with both office manager and physician to discuss maximum cash flow.
- Turned in weekly and monthly AR reports to physician and discussed any coding or reporting concerns.
- Filed appeals for all insurances including private and Medicare.
- Initiated all pre-certifications and pre-authorizations to ensure coverage of procedures.
- Discussed and setup payment options and plans with patients.
- Processed online and paper appeal submissions and refund requests.
- Audited and corrected billing and posting documents for accuracy
- Kept vendor files accurate and up-to-date to expedite payment processing
Specialty Team Department Manager
Aprima Medical Software Inc.
10.2015 - 05.2019
- Managed department of 9 account representatives assigned to a multitude of practices and specialties.
- Provide guidance and assist team members in resolving accounts that need clarification or additional direction.
- Assist in managing day to day functions of RCM.
- Maintain productivity standards and goals set up by department.
- Identify, resolve, and report to RCM Senior Leadership any issues affecting revenue cycle.
- Plan and assign appropriate work load balance for staff.
- Track staff hours and submit timesheets. Maintain strict confidentiality within medical practice and HIPPA compliance.
- Correlate team building projects
Medical Billing Specialist
Jaffe Cosmetic Eyelid Center
05.2014 - 10.2015
- Performed full cycle medical billing in an office setting.
- Efficiently performed insurance verification, obtained pre certifications and authorizations along with referrals.
- Entered charges and filed claims both electronically and by paper.
- Prepared and attached all required claims documentation to reduce incidence of denials.
- Posted payments and followed up on unpaid claims and filed appeals as necessary.
Benefits Coordinator
Touchstone Medical Imaging LLC
01.2013 - 05.2013
- Prepared and summarized patient benefits by contacting insurance companies and supplying all supporting documentation to obtain pre-certifications and authorizations.
- Contacted patients to review benefits related to Imaging studies.
Medical Billing Specialist / STAT Medical Resources
STAT Medical Resources
11.2012 - 04.2013
- Performed full cycle medical billing operations.
- Submitted electronic and paper claims to insurance companies including Medicare and Medicaid to collect medical payments.
- Analyzed medical records to satisfy insurance company mandates.
- Posted payments and collections on a regular basis.
- Communicated with insurance providers to ensure any denied claims were resolved and resubmitted.
Front Office and Billing Manager
Heartcare
01.2010 - 11.2012
- Performed all front office duties including scheduling, insurance verification, obtaining referrals and pre-certifications.
- Performed all medical billing duties including entering and filing claims, posting payments, working all AR, filing appeals and patient collections.
- Roomed patients, took vital signs, performed EKGs, reconciled medication lists
- Helped provider setup and grow his practice, increasing revenue by $100,000 each year.
- Reviewed billing problems, researched issues, and resolved concerns
- Managed monthly billing process to complete billings and returns to meet and exceed company revenue projections,
Education
Diploma - Medical Billing and Coding
Remington College
Dallas, TX05.2008
Skills
- 15 years of experience in revenue cycle management
- Maintaining productivity standards and goals set up by department
- Identify, resolve, and report to RCM Senior Leadership any issues affecting revenue cycle
- Ability to asses deadlines and prioritize work flow with high volume
- Maintain strict confidentiality within medical practice and HIPPA compliance
- Plan and assign appropriate work load balance for staff as well as lead in team training and cross training
- Familiarity with Novitas, TMHP, Pecos, DSHS, DOL, NPPES and MCR RR
- Aging Reports Analysis
- Accurate Payment Posting
- Interpersonal Communication
- Meticulous and Detail-Oriented
Additional Information
- January 1st, 2019 Promoted to Department Manager for Specialty Team.June 1st, 2018 Assigned to new department that was developed to support facilities and physicians who required a higher level of detail and expanded relationship with their Account Representative. (Specialty Department)
Timeline
Billing Specialist
Little Spurs Pediatric Urgent Care
02.2024 - Current
Billing Specialist
Neurovative Diagnostics
10.2023 - 02.2024
Credentialing and Reimbursement Specialist
Emergicon
09.2021 - 10.2023
Medical Billing and Collections Specialist
Dallas Plastic Surgery Institute
05.2019 - 06.2020
Specialty Team Department Manager
Aprima Medical Software Inc.
10.2015 - 05.2019
Medical Billing Specialist
Jaffe Cosmetic Eyelid Center
05.2014 - 10.2015
Benefits Coordinator
Touchstone Medical Imaging LLC
01.2013 - 05.2013
Medical Billing Specialist / STAT Medical Resources
STAT Medical Resources
11.2012 - 04.2013
Front Office and Billing Manager
Heartcare
01.2010 - 11.2012
Diploma - Medical Billing and Coding
Remington College