Loutener Franklin
Irmo,SC
Summary
Energetic, results-driven contract Senior billing specialist and credentialing representative with over 14 years of remarkable /performance in accurately handling financial reporting in deadline-oriented environments. Proficient in efficiently ensuring that all billing activities are carried out with timeliness and accuracy, holding all clients and third-party payers accountable for their contracts and bills through consistent billing and collections methods. Dynamic leader proficient in various contract administration, accounts payable, and recording transactions. Well-recognized for tolerant yet decisive temperament, demonstrating expert skills in developing and delivering billing needs and requirements to staff, counselors, and physician. More than prepared to utilize extensive background to serve as a Senior Medical Billing Specialist and Credentialing Representative, Invoice Processing Contract Guidelines Billing Dispute Resolution Vendor Records Client Services Administrative Functions Payable Systems Quality Control Assessment Reports Credentialing
Overview
16
16
years of professional experience
Work History
Billing and Collection Representative
United Health Group / Optum
11.2021 - Current
- Analyzes daily denial management correspondence to appropriately resolve issues
- Reviews and resolves accounts assigned via work lists daily as directed by supervisor
- Research root cause to report to Supervisor
- Identify payer performance trends at the payer level
- Capable of navigating payer portal
- Identifies bad debt write-offs and adjustments
- Process refunds as identified to meet payer guidelines
- Adheres to regulatory/payer guidelines and policies and procedures
- Provides exceptional customer service to internal and external customers
- Investigated and resolved issues to maintain billing accuracy.
- Managed account receivables to maintain payments within net terms.
- Completed billing audits in identified timeframes to report and investigate findings.
- Checked claims coding for accuracy with ICD-10 standards.
- Monitored past due accounts and pursued collections on outstanding invoices.
- Submitted claims to insurance companies and researched and resolved denials and explanations of benefit rejections.
Senior Medical Biller/Credentialing Specialist
Crossroads Counseling Center
Lexington, South Carolina
06.2007 - 11.2021
- File all primary and secondary claims accurately and promptly to ensure Timely payments and optimize reduction of AR/ Aging report
- Manage all electronic posting of payments and adjustments, entering and posting all charges (third party and client responsibility) and payments in Medisoft and all Medicaid Payments
- Accurately record all payments, and EOB information in the patient data band daily, ensuring that claims submitted daily with all claims submitted and transmitted claims to clearinghouses
- Completed appeals and filed and submitted claims.
- Interpret remittance advices, fee schedules, and other pertinent information, recognizing inappropriate diagnosis codes, identifying diagnoses or procedures which require supporting documentation
- Review bill requests, identifying matters with escrow and/or unapplied cash balances, identifying inconsistencies or errors on bill requests and working through to resolution
- Determine and verify all valid CPT and ICD-9 and 10 CODES, managing all facets of initiating completing electronic hilling and 1500 forms and/or telephone inquiries to appropriate third-party payers, employers, and/or claims administrators sharing information
- Respond to customer billing needs or transfer communication to the appropriate party, logging all incoming payments from customers and update internal records to reflect current balances
- Verify primary and secondary insurance for all clients, in addition to completing payment contracts for self- pay clients (based on fee schedule and sliding scale schedules
- New intakes, filing and doing all reports
- Authorization for all patient insurance
- Discussed financial and insurance options with patients
- Negotiated settlements and payment plans
- Updated accounts with latest patient, payment, and insurance information
- Initiated repossession process or service disconnection upon failure of other collection methods
- Compiled and analyzed data for review by senior management of loan loss reports to measure portfolio performance
- Prepared billing statements for patients and verified correct diagnostic coding
- Reviewed patient records, identified medical codes, and created invoices for billing purposes
- Trained new employees on multiple medical billing programs and data entry software
- Prepared accounts with past due balances and transferred those cases to collection agency
- Analyzed complex Explanation of Benefits forms to verify correct billing of insurance carriers
- Worked with revenue cycle team to identify denial trends
- Captured and entered professional charges using UB-04 and CMS 1500 forms
- NPDB verifacation
- CAQH application
- Proof of Malpractice, Organize onboarding, Negotiate Contracts
- Maintain Licensure
Education
Kingstree Senior High
06.1990
Skills
- 14 years of experience working in an office, customer service, in the medical field, computer skills including
- CPR, Waystar, Facets, Carelink, Microsoft Word, PowerPoint and Excel spreadsheet, Strong multitasking and typing
- Files and Records Management
- Billing and Invoicing
- Billing Data Verification
- Account Posting
- Discrepancy Resolution
- Stop Payments
- Financial Documentation
- Verbal and Written Communication
- Accounts Payable
- Decision Making
- Team Collaboration
- Dispute Negotiation
- Word Processing
- Data Analysis
- 10-Key Data Entry
- Spreadsheet Tracking
- Conflict Resolution
- Charge Slips
- Bill Payment
Timeline
Billing and Collection Representative
United Health Group / Optum
11.2021 - Current
Senior Medical Biller/Credentialing Specialist
Crossroads Counseling Center
06.2007 - 11.2021
Kingstree Senior High
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