NICOLE FORD
Humble,TX
Summary
Motivated Benefits and Claims Professional specializing in healthcare and accounts receivables. Negotiates peaceful resolutions of all claims with emphasis on fairness and thoroughness. Trustworthy and dependable.
Overview
22
22
years of professional experience
Work History
Workers Compensation Specialist
Houston Spine and Rehabilitation
03.2002 - Current
- Determined liability outlined in coverage and assessed documentation such from police and healthcare providers to understand damages incurred
- Actively follow up and collect on all claims
- Research unpaid health insurance claims
- Initiate collection follow-up on all unpaid or denied claims with appropriate insurance carrier
- Follow up with attorney offices on unpaid claims
- Respond to correspondence from insurance carriers
- Proactively work with colleagues to ensure claims errors are resolved appropriately
- Handle multiple assignments in a fast-paced setting
- Exceptional organizational skills with attention to details
- Effective verbal and written communication skills
Accounts Receivable Specialist
Cole Health
03.2012 - 10.2019
- Posted customer payments by recording cash, checks and credit card transactions in accounting system
- Reviewed A/R aging reports to resolve payments/credit issues and past due accounts
- Resolved accounting errors observed through A/R review
- Posted revenues by verifying and entering transactions from lock box and local deposits
- Reviewed and monitored the reimbursements due from insurance companies
- Determined appropriate collection methods and account follow-up per departmental guidelines.
- Reconciled accounts receivable ledger to verify payments and resolve variances
Lead Benefits Specialist
United Heath Group
03.2008 - 12.2011
- Accurately entered claims and insurance data
- Updated benefit information in the billing system
- Verified that existing information is accurate
- Processed insurance open enrollment requests, payments, and cancellations
- Processed medical claims, grievances and appeals
- Researched coverage and plan options based on healthcare needs
- Assisted team members with escalated calls and complex claims issues
- Assisted Supervisor with performance metrics data for team members
- Explained benefits to plan participants in easy to understand terms in order to educate each on available options.
- Observed strict procedures to maintain data and plan participant confidentiality.
Education
Texas All Lines Licensing/Xactimate
1st Source Adjuster School
BS-Education -
University of Central Arkansas
12.2003
Skills
- Active Listening
- Medical Billing Experience
- Claims Management
- Advanced Medical Terminology
- Policy Interpretation
- Team Collaboration
- Regulatory Knowledge
- Critical Thinking
- Decision-Making
- Medicaid, Managed Care, PPO Plans
- ICD-9 and CPT Coding
- Problem-solving abilities
Software Knowledge
- MS Office Suite
- Brite Core
- Pega Claims Management
- Xactimate
- Ventiv
- Snapsheet
References
REFERENCES AVAILABLE UPON REQUEST
Timeline
Accounts Receivable Specialist
Cole Health
03.2012 - 10.2019
Lead Benefits Specialist
United Heath Group
03.2008 - 12.2011
Workers Compensation Specialist
Houston Spine and Rehabilitation
03.2002 - Current
Texas All Lines Licensing/Xactimate
1st Source Adjuster School
BS-Education -
University of Central Arkansas
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