MICHELLE JOHNSON
Miramar,FL
Summary
Reliable Medical Biller and Collections Specialists with coding and medical terminology knowledge. Polished and hardworking performer with background overseeing accounts and handling records management tasks. Team-oriented person with great decision-making skills.
Overview
21
21
years of professional experience
1
1
Certification
Work History
Medical Biller/Collector and Cash Poster
KPC PROMISE HEALTHCARE
2015.09 - Current
- Specialty Long Term Acute Care and Skilled Nursing hospital billing and collections
- Responsible for coordinating the activity for assigned accounts ensuring payment and/or resolution of outstanding account balances
- Communicates with patients and third party agencies to assist in the resolution of outstanding account balances, completes and maintains timely, accurate reports of account activity, as well as responds to incoming calls and mail from patients and third party agencies regarding outstanding account balances.
- Verified insurance of patients to determine eligibility.
- Communicated with insurance providers to resolve denied claims and resubmitted.
- Managed appeals process for denied claims, resulting in successful reimbursements from insurance companies.
- Ensured timely payments from insurance providers through submission of accurate and complete claims.
- Collected payments and applied to patient accounts.
- Posted payments and collections for both LTACH and SNF
- Reduced claim denials by meticulously reviewing patient insurance information and coding practices.
- Enhanced revenue collections for the medical practice with diligent follow-ups on unpaid claims.
- Implemented quality control measures to identify potential errors before submitting claims, reducing rejections significantly.
- Liaised between patients, insurance companies, and billing office.
- Prepared billing statements for patients and verified correct diagnostic coding.
Medical Biller/Collector
Pediatric Associates Florida
2014.07 - 2015.09
- Performed billing and collections for patients office visits, vaccines and related administration codes
- Responsible for productivity of 50 accounts per day
- Reviewed annual provider manuals for insurance companies (i.e
- Rules, guild lines and contracts)
- Worked monthly aging reports utilizing excel spread sheets and also EOB's received from insurance companies
- Followed up with insurance companies to get claims reprocessed correctly in a timely fashion based on date of correspondence
- Reviewed accounts to assure all correct charges were added by the offices, if not; manually added missing charges and submitted corrected claims online or hard copy to the insurance companies to be processed correctly with medical records attached (if records are required or requested by insurance companies)
- Responsible for reversing & reposting charges correctly billed under the incorrect financial class to bill under correct fee schedule (i.e
- Commercial to capitated)
- Answered customer service calls from patient parents, reviewed accounts, followed up with multiple payors (commercial and government) provided feedback and resolutions within 24 hours or less
- Performed approved adjustments and also requested adjustments for approval
- Also updated modifiers and reviewed NCCI edits for approved overrides
- Special projects; Medicaid voids on line for electronic retractions and Batch Verifications
- Systems and sources used XPM, Document Manager, EHR, Tricare, Availity, UHC, Well Care and Florida Medicaid.
Medical Billing/Collection Specialist
Kindred Healthcare
2009.06 - 2014.06
- Responsibilities: Billing Medicare Exhaust, HMO, PPO, Third Party Claims, VA and Workers Comp claims for 5 Long Term Acute Care Hospitals in the South Florida Market
- Continuous review of failed claims/billing reports to ensure the quick and timely resolution of all billing discrepancies and minimize the number of unpaid accounts
- Track, resolve, and file appeals on underpaid claims and process refunds for overpaid accounts
- Review and clean up of aged accounts receivable
- Daily follow up with insurance companies regarding pending, rejected and denied claims
- Process letters of appeal on denied claims
- Assist Business Office Director and CFO with monthly financial projections and month-end closing process
- Data entry of patient financial information into patient accounting system
- Process hospital denials
- Interacted with providers and other medical professionals regarding billing and documentation policies, procedures, and regulations
- Examine patients' insurance coverage, deductibles, possible insurance carrier payments, and remaining balances not covered under their policies when applicable.
Medical Patient Account Representative
Lakeview Health System
2007.07 - 2009.06
- Responsibilities: Prepare charts
- Verify substance abuse benefits
- Provider liaison between providers of health care services, the patient, or other responsible person to ensure account resolution
- Dispute underpayments and file appeals
- Work denials and correspondence received from insurance companies
- Ensure all claims are being processed according to the patients benefits
- Assisted in the maintenance of medical charts and/or electronic medical record (filing, Op Reports, test results, home care forms)
- Verified patients' eligibility and claims status with insurance agencies
- Follow up on facility and professional fees to obtain payment status
- Data entry of patient financial information into patient accounting system.
Lead Medical Patient Account Representative
CCS of Florida
2004.08 - 2007.07
- Responsibilities: Locating and notifying insurance companies of new and delinquent account by mail and telephone to solicit payment
- Billing claims to insurance companies for payment
- File appeals to insurance companies which would include underpayments, untimely filing, and no authorization
- Provider liaison between the provider of health care services, the patient or other responsible persons and revenue sources to ensure correctness of charges, and current record of all transactions, and account resolution
- Collect medical and patient data such as diagnosis treatment, proof of eligibility, and insurance verification
- Submit claims to a variety of payment sources, and other third party reimburses and prepare correspondence for collection account
- Maintain active communication with the patient and insurance company until account is paid in full
- Assist team members with problem accounts that they are unable to solve.
Patient Account Representative/Medical Collector
Argent Healthcare
2003.02 - 2003.10
- Locating and notifying customer Medicaid and insurance companies of new and delinquent accounts by mail and telephone to solicit payment
- Billing and posting of payments
- Maintaining records of collection and account payment status.
Education
BS Health Services Administration in Health Services Administration -
Barry University
Miami, FL05.2024
Skills
- Medical Billing
- CPC
- Medical Insurance
- DME
- Medical Coding
- ICD-10
- CPT Coding
- EMR Systems
- Medical Collection
- Medical Office Experience
Certification
Certified Professional Coder (CPC)
Additional Information
- Summary of Qualifications Team player with a positive attitude, extremely goal-oriented with a strong work ethic and excellent communication skills. Possessing a solid knowledge base of both Acute Short Term and Long Term Inpatient settings in the areas of: Medicare and other Third-party payer billing, reimbursement and contracting, as well as, Medical billing and Microsoft software applications. EDI form […] 835, 277CA 999, TA1, 270/271 Experience
- SQL, Excel, EHDL, WEBMD, Medical Manager, Medi-solutions
- HBO-C software experience
- Medical Billing and Collections Experience
- Medicare, Medicaid and third party insurance carrier billing guidelines
- Strong communication, customer service and organization skills
- A team player
- Capable of producing prompt results in a steadfast workplace
- Ability to perform multiple tasks and prioritize workload
- Knowledge of HIPAA compliancy
- Versed in Insurance verification, Medicare, Medicaid, HMO and Commercial
- Claims verifications and EOB Determination in accounts receivable
- Training and Special Projects
- Computer skills: Medical Manager, XPM, Medi Tech & Medi-solutions, and other proprietary software. Microsoft Excel, Microsoft Word 2016, Microsoft Office
- Medical Terminology, Basic CPT- ICD-10 Codes, HCPCS Coding Customer Service Representative
- Type 100 wpm
Timeline
Medical Biller/Collector and Cash Poster
KPC PROMISE HEALTHCARE
2015.09 - Current
Medical Biller/Collector
Pediatric Associates Florida
2014.07 - 2015.09
Medical Billing/Collection Specialist
Kindred Healthcare
2009.06 - 2014.06
Medical Patient Account Representative
Lakeview Health System
2007.07 - 2009.06
Lead Medical Patient Account Representative
CCS of Florida
2004.08 - 2007.07
Patient Account Representative/Medical Collector
Argent Healthcare
2003.02 - 2003.10
BS Health Services Administration in Health Services Administration -
Barry University
Certified Professional Coder (CPC)
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