Lois Mackey
Seattle,United States
Summary
Strong medical billing, auditing and managed aged accounts receivable over 15 years. Advance knowledge of medical insurance benefits, prior authorization and referral processes. Exceptional track record appealing denied claims with 95% successful rate.
Overview
23
23
years of professional experience
1
1
Certification
Work History
Medical Biller
Careage Home Health
Bellevue, Washington
08.2023 - 02.2024
- Verified Eligibility and benefits via One Health Port, Provider One, VA Administration, Government Service, and NAVIA Benefit Solution. Requested authorization for home care services via NAVIA, and United Health Care. EHR/EMR proficiency.
Billing/Collection Specialist
Beacon Hill Staffing Group LLC.
Seattle, Washington
10.2019 - 07.2023
- Managed Aged Accounts and resolved plant shortages, damages, and pricing discrepancies.
- · collaboration with plants, warehouses, and sales to settle disputes.
- · Followed up on aged accounts receivables.
- · Negotiated payment arrangements, and implemented write-offs on attorney approval.
- · Assist in researching clients, and updating client demographic profiles.
Billing Specialist
PhenoPath Laboratories
Seattle, WA
02.2014 - 12.2016
- Verified out-of-state Health Plan eligibility, and benefits, and procure pathology authorizations.
- Assigned ICD-9/ICD-10-CM,
- Current CPT code; appended Modifiers
- Matching Pathology Reports with requisitions in laboratory 4D system
- Requested medical documentation to established correct diagnosis for coding.
Appeals/Grievance Coordinator
Community Health Plan Of Washington
Seattle, WA
02.2001 - 08.2007
- Successfully conducted first-level appeals 100 volumes, adjudicating claims, pre-authorizations,
- Timely filing issues, subrogation, and medically necessary denials with 98% accuracy.
- Facilitated 2nd level appeals;
- Fair Hearings with Health Care Authority.
- Resolved 50 to 100 weekly written and verbal member and provider complaints.
- Written internal processing guidelines, and mentored and trained new appeals/grievance coordinators.
Education
Associate of Arts - Marketing
Milwaukee Area Technical College
Milwaukee, WI05.1981
Skills
Accounts Receivable
Microsoft Suite, Excel, Outlook
Medical Coding
Medical Terminology,
ICD-10CM
CPT-4 Coding, HCPCS Coding
Credentialing
Subrogation
OneHealth Portal, ProviderOne
Availity, NAVIA, UHC/Optum
HIPAA, NCCI, EHR/EMR
Medicare Part B, Medicaid,
MCO, EGHP, Tricare
Written Communication Skills
Certification
CMS Certificate of Completion Part C Organization Determinations/Appeals & Grievances, February 2022
CMS Certificate of Completion ICD-10-PCS Procedure Coding, September 2021
CMS Certificate of Completion, Medical Billing Form CMS-1450 & the 837 Institutional, March 2022
CMS Certificate of Completion Medicare Secondary Payer March 2022
Timeline
Medical Biller
Careage Home Health
08.2023 - 02.2024
Billing/Collection Specialist
Beacon Hill Staffing Group LLC.
10.2019 - 07.2023
Billing Specialist
PhenoPath Laboratories
02.2014 - 12.2016
Appeals/Grievance Coordinator
Community Health Plan Of Washington
02.2001 - 08.2007
Associate of Arts - Marketing
Milwaukee Area Technical College
CMS Certificate of Completion Part C Organization Determinations/Appeals & Grievances, February 2022
CMS Certificate of Completion ICD-10-PCS Procedure Coding, September 2021
CMS Certificate of Completion, Medical Billing Form CMS-1450 & the 837 Institutional, March 2022
CMS Certificate of Completion Medicare Secondary Payer March 2022
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