Lila Vorn
Lowell,MA
Summary
Experienced medical billing specialist seeking a challenging position with growth and advancement opportunities. Energetic and reliable, motivated to exceed company expectations. Strong desire for a career change, bringing a proven track record of success and a commitment to delivering high-quality results.
Overview
13
13
years of professional experience
Work History
Assoc. Ops. Specialist
Fresenius Medical Care
07.2018 - 11.2024
- Primarily responsible for Commercial audits (Quality reviews)
- Examples of Quality reviews: Data Validation, HEDIS, Risk adjustments, & RADV
- Assist in Claim reviews (such as: APC Coding, Coding, Claim Processing, Pre-pay, & Post-pay)
- Assist other departments on special time-sensitive projects when needed
- Determined proper course of action for claims processing.
- Followed all company policies and procedures to deliver quality work.
- Proven ability to learn quickly and adapt to new situations.
3rd Party Account Rep
Lahey Health
01.2017 - 06.2018
- Work Medicare denials in Epic WQ's
- Adjust claims in Medicare FISS systems
- Work credit balance accounts
- Work COB accounts
- Upload ADR accounts into Cobius
- Prepare appeals with proper documentation on denied claims
- Follow-up call to insurance company on status of claims/appeals
- Created and distribute power point tip sheet to team staffs
- Work special projects
- Assist with other departments when needed
Trainer
LogixHealth
02.2015 - 01.2017
- Trained all new hires on company systems and billing guidelines for both billing & customer service department
- Audit new hires and existing employees' work to insure they are following company guidelines
- Minimal work in insurance carrier payment audits
- Work closely with manager on resolving billing issues, questions, & concerns
- Ensure documents and guidelines are up to date on SharePoint
- Work on special projects requested by manager
Billing Specialist
LogixHealth
01.2012 - 02.2015
- Experience with professional billing for all insurance carriers including: Medicare, Medicaid, Tufts, HP & Commercial policies
- Able to review and understands Explanation of Benefits
- Analyzed complex EOB forms to verify correct billing of insurance carriers.
- Determined proper course of action for denied claims.
- Prepare appeals with proper documentation on denied EOBs
- Follow-up call to insurance company on status of claims/appeals
- Worked EDI rejection reports, monthly A/R reports on assigned unpaid claims
- Assist with other departments when needed
Education
Technology And Business
Northern Essex Community College
Haverhill, MA05-2027
High School Diploma -
Lowell Middlesex Academy Charter School
Lowell, MA06.2005
Skills
- Allscripts Document Management
- Allscripts PM
- Amsoft
- EasyPrint
- ED Pace
- EPIC
- EClinical Works
- ECube Clinical
- ECube Financials
- FileMaker Pro
- JD Edwards
- Mac OS
- Microsoft Office
- PeopleSoft
- Practice Velocity
- QuickBooks
- Touch Chart
- WinRater
References
Available upon request
Timeline
Assoc. Ops. Specialist
Fresenius Medical Care
07.2018 - 11.2024
3rd Party Account Rep
Lahey Health
01.2017 - 06.2018
Trainer
LogixHealth
02.2015 - 01.2017
Billing Specialist
LogixHealth
01.2012 - 02.2015
High School Diploma -
Lowell Middlesex Academy Charter School
Technology And Business
Northern Essex Community College
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