Miriam Lea Dacumos
Columbus,OH
Summary
Dedicated employee known for punctuality, pursuing employment options where good customer service and positive attitude will make a difference.
Overview
10
10
years of professional experience
Work History
Patient Account Representative
Nationwide Children Hospital
Columbus, OH
04.2023 - Current
- Analyzed claims denials from third party payers and identified potential solutions for reimbursement.
- Submitted appeals on behalf of patients when appropriate based on findings from research conducted into denied claims.
- Communicated frequently with healthcare providers regarding payment status updates on their claims submitted.
- Applied HIPAA privacy and security regulations while handling patient information.
- Verified demographics and insurance information to register patients in computer system.
- Applied knowledge of payer requirements and utilized on-line eligibility systems to verify patient coverage and policy limitations.
- Contacted insurance companies to check status of claim payments.
- Answered customer questions regarding account discrepancies or problems.
- Wrote appeal letters to insurance companies for denial of claims.
Vax Track Team Lead
Milestone Technologies At Facebook
New Albany, OH
08.2022 - 12.2022
- Supervise 2-4 associates located in New Albany, OH site.
- Responsible for inventory of Covid-19 tests.
- Work closely with other vendors on site to ensure that all employees, contingent workers, and visitors pass through screening zone upon arrival and before admission to site.
- Effectively handle client concern and requests utilizing appropriate departments for resolution.
- Train incoming associates in SOP, including communication, during the onboarding process.
- Provide guidance to existing associates in new policy and procedures.
- Create schedule for site.
- Monitor compliance utilizing organizational guidelines while approving weekly payroll. Evaluate onsite associate performance and escalate issues as needed.
Patient Account Representative
Kona Community Hospital
Kealakekua, HI
11.2020 - 12.2021
- Responsible for Hawaii's Medicaid/Quest claims billing.
- Researched discrepancies in patient accounts to determine appropriate resolution.
- Initiated collection activities on delinquent accounts while adhering to HIPAA guidelines and regulations.
- Maintained detailed notes on all patient interactions for future reference purposes.
- Worked closely with insurance companies to obtain authorization for services rendered.
- Analyzed claims denials and identified potential solutions for reimbursement.
- Communicated frequently with healthcare providers regarding payment status updates on their claims submitted.
- Applied HIPAA privacy and security regulations while handling patient information.
Reimbursement Specialist
Alternate Solutions Home Healthcare
Kettering, OH
10.2017 - 03.2020
- Reviewed and processed reimbursement requests in accordance with company policies and procedures.
- Analyzed patient data to ensure accuracy of reimbursement information.
- Submitted Medicare claims to Medicare.
- Retro-authorization submission to appropriate insurance carriers.
- Communicate with insurance payers for denial resolutions.
Medical Claims Specialist
Premier Health Network
Dayton, OH
09.2014 - 10.2017
- Submitted and tracked medical claims to insurance companies via electronic or paper methods.
- Resolved issues related to denied or underpaid claims in a timely manner.
- Processed appeals on rejected or partially paid claims, including filing additional paperwork as needed.
- Adhered to HIPAA regulations while managing confidential patient information.
- Responded promptly to customer inquiries regarding claim status updates.
- Conducted research into complex medical coding issues to ensure proper reimbursement.
- Stayed current on HIPAA regulations, benefits claims processing, medical terminology and other procedures.
- Reviewed claims for accuracy before submitting for billing.
- Evaluated pending claims to identify and resolve problems blocking auto-adjudication.
- Documented file notes clearly and concisely in Epic.
Education
Associate of Science - Occupational Therapy Assistance
Sinclair Community College
Dayton, OH05-2004
Skills
- Billing Inquiries
- Patient Data Updates
- Customer Inquiries
- Claims Processing
- Insurance Coverage Verification
- Medical Insurance Knowledge
- Insurance Verifying
- Insurance Billing
- Outbound Calling
- Effective Written And Verbal Communication
- Adaptive Team Player
Timeline
Patient Account Representative
Nationwide Children Hospital
04.2023 - Current
Vax Track Team Lead
Milestone Technologies At Facebook
08.2022 - 12.2022
Patient Account Representative
Kona Community Hospital
11.2020 - 12.2021
Reimbursement Specialist
Alternate Solutions Home Healthcare
10.2017 - 03.2020
Medical Claims Specialist
Premier Health Network
09.2014 - 10.2017
Associate of Science - Occupational Therapy Assistance
Sinclair Community College