Lisa Thomas
Cleveland
Summary
Driven team player successful at meeting production targets through consistent productivity. Punctual and hardworking with great written and verbal communication skills. Experienced Reimbursement Specialist guaranteeing patients' medical records are coded and abstracted according to standard rules and regulations. Efficiency-driven, highly accurate and well-organized with open and clear communication style and self-motivated approach. Qualified and hardworking Reimbursement Specialist with expertise in policy research and customers service. Offering experience in analyzing coverage and securing collection for claims. Excellent written and verbal communication skills.
Overview
25
25
years of professional experience
Work History
Reimbursement Specialist
MEDICAL SERVICE COMPANY
Cleveland
05.2018 - Current
- Answering incoming billing calls on durable medical equipment, processing payments over the phone
- Making outbound calls on large past due balances
- Reviewing denied claims, updating diagnosis, and modifier codes. Resubmitting to insurance companies. Experienced with multiple healthcare websites, including the list below: Avality, Echo, Navinet, Zellis, and Quantiam..
- Entered procedure codes, diagnosis codes and patient information into billing software to facilitate invoicing and account management.
- Responded to customer inquiries regarding the status of their reimbursement requests.
- Processed invoice payments and recorded information in account database.
- Coded patient care records to provide accurate information for billing.
- Determined medical necessity, using individual insurance carrier regulations.
- Verified clients' insurance claims coverage by coordinating with providers.
- Developed strong professional rapport with vendors and clients.
- Eliminated inaccuracies in accounts payable payments by verifying information prior to generating checks and electronic payment transfers.
- Reviewed legal claims for accuracy and issues.
Medical Biller
KELLISON & CO
Warrensville Heights
05.2017 - 03.2018
- Follow up work queue with eligibility & registration taking incoming phone calls & processing credit card payments
- Correcting and updating insurance effective dates and termination dates
- Resubmitting claims to multiple insurance companies
Medical Billing Specialist
EXECUSEARCH, INC
New York
05.2016 - 04.2017
- Follow up working in queue with eligibility and registration correcting and updating insurance effective dates and termination dates
- Resubmitting claims to multiple insurance companies
- Experience with Navinet Xperian and all local and national health insurance websites
- Clerical duties scanning, faxing, copying
- Making outbound follow up phone calls on ACO & HEDIS audits and receiving inbound calls
Customer Service Associate
INTEGRATED RESOURCES
Newark
04.2013 - 01.2015
- Generated daily report to count how many emails and faxes that was received the prior day from different email accounts
- While generating reports updating and maintaining spreadsheets to email the entire teams
- Answer incoming phone from healthcare insurance members assisting with password reset, registration and signing into accounts
- Assisted with navigating once signed on website
Provider Services Representative
ACTIVE HEALTHCARE/AETNA
New York
05.2000 - 02.2010
- Answered incoming calls regarding medical claims and benefits from members & providers
- Processed claims over the phone with members & providers while taking calls
- Updated and coordinated benefits researched and reprocessed claims
Education
Associates of Arts - HealthCare Administration
UNIVERSITY OF PHOENIX
Online01.2017
Skills
- Reviewing explanation of benefits
- Health insurance policies & procedures
- Alpha & Numeric Data Entry
- Compliant Handling & Appeals
- Maintaining claim reports
- Epic software
- Brightree software
- IDX software
- Generating EOB's
- CPT
- HCPC
- DRG
- High levels claim processing
- Billing
- Warehouse safety
- Loading and unloading
- Barcode scanning
- Shipping procedures
- Time management
- Troubleshooting techniques
- Medical billing
- ICD 9 coding
- Managed care
- Policy evaluation
- Insurance verification
- Commercial insurance
- Eligibility verification
- Healthcare industry
- ICD-10 coding
- Denial management
- HIPAA compliance
- Microsoft office
- Appeals handling
- HCPCS coding
- Order picking
- Stock replenishment
- Manual dexterity
- Forklift operation
- Product packaging
- Pick-list processing
- Inventory management
- RFID scanning
- Shipping and receiving
- Weight and dimension measurement
References
References available upon request.
Timeline
Reimbursement Specialist
MEDICAL SERVICE COMPANY
05.2018 - Current
Medical Biller
KELLISON & CO
05.2017 - 03.2018
Medical Billing Specialist
EXECUSEARCH, INC
05.2016 - 04.2017
Customer Service Associate
INTEGRATED RESOURCES
04.2013 - 01.2015
Provider Services Representative
ACTIVE HEALTHCARE/AETNA
05.2000 - 02.2010
Associates of Arts - HealthCare Administration
UNIVERSITY OF PHOENIX
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