Octavia Foster
Houston,TX
Summary
Detail-oriented revenue cycle specialist with a systematic nature and good grasp of billing processes. Successful planner and problem-solver. Ready to apply several years' experience and take on a challenging role.
Overview
8
8
years of professional experience
Work History
REVENUE RECOVERY SPECIALIST
Knowtion Health
Remote
01.2023 - 12.2023
- Record information about status of collection efforts
- Identify errors and re-file denied or rejected claims quickly to prevent payment delays
- Complete appeals and file and submit claims
- Review patients' insurance coverage, deductibles, possible insurance carrier payments, and remaining balances not covered under policies
- Maintain current working knowledge of CPT and ICD-10 coding principles, government regulation, protocols, and third-party billing requirements
- Perform quality control of data entry system to verify proper posting of claims and payments
- Prepare billing statements for patients, ensuring correct diagnostic coding
- Post charges, payments, and adjustments
- Review and verify benefits and eligibility with speed and precision
- Apply payments, adjustments, and denials into medical manager system
- Enter procedure codes, diagnosis codes, and patient information into [Software]
- Contact insurance providers to verify insurance information and obtain billing authorization
- Collaborate closely with other departments to resolve claims issues
- Contact patients for unpaid claims for HMO, PPO, and private accounts and perform friendly follow-ups to ensure proper payments were made according to contracts
- Precisely complete appropriate paperwork and system entry regarding claims
- Post and adjust payments from insurance companies
- Maintain timely and accurate charge submission through electronic charge capture, including billing and account receivables (BAR) system and clearing house
- Prepare and attach referrals, treatment plans, or other required correspondence to reduce incidence of denials
- Remain up-to-date details of patient financial responsibilities, fee-for-service, and managed care plans by participating in training programs
- Analyze and interpret patient medical and surgical records to determine billable services.
ACCOUNTS RECEIVABLE SPECIALIST
Medasource
Remote
07.2022 - 01.2023
- Responsible for collection efforts on, as assigned by the Revenue Cycle Director
- Responsible for claim progress by using every available avenue, such as online tools, automated systems, and payor representatives
- Maintain timely and accurate documentation on the patient account to reflect the current status of the claim
- Responsible for analysis of Explanation of Benefits for zero pay and/or denied charges
- Complete required research for disposition, i.e
- Claim correction, all levels of disputes, or adjustments
- Prepare appeals to the payor specifications, i.e., dispute forms and/or any documentation for dispute and copy of patient's medical record to support medical necessity denials
- Coordinate all activity for claim corrections through the patient account system, electronic billing system, payor websites, as appropriate to the payer
- Responsible for analysis of Aged Trial Balances for assigned payors
- Ensure that every account has been worked through resolution
- Communicate all payer issues, denial patterns, or other payment delays to the RCM Leadership team
- Assist in determining appropriate action to move outstanding claims to final adjudication
- Responsible for reviewing/monitoring payor websites and all available avenues for any changes/updates that affect the billing and/or patient account process related to assigned payors
- Inform Revenue Cycle Leadership of changes to initiate implementation of system/process updates.
FOLLOW-UP SPECIALIST
Janus
Remote
01.2022 - 07.2022
- Prepare and submit billing data and medical claims to insurance companies
- Ensure the patient's medical information is accurate and up to date
- Prepare bills and invoices, and document amounts due for medical procedures and services
- Collect and review referrals and pre-authorizations
- Monitor and record late payments
- Follow up on missed payments and resolve financial discrepancies
- Examine patient bills for accuracy and request any missing information
- Investigate and appeal denied claims
- Help patients develop patient payment plans
- Maintain billing software by updating rate change, cash spreadsheets, and current collection reports
- Monitor all assigned accounts to ensure maximum collection dollars are collected and paid on these accounts
- Transfer remaining balance to the secondary payer/payee if there is co/pay or co-ins due.
CLAIMS REPRESENTATIVE
Anthem
Remote
01.2021 - 01.2022
- Respond to customer questions via telephone and written correspondence regarding insurance benefits, provider contracts, eligibility, and claims
- Analyze problems and provide information/solutions
- Operate a PC/image station to obtain and extract information; document information, activities, and changes in the database
- Thoroughly document inquiry outcomes for accurate tracking and analysis
- Develop and maintain positive customer relations and coordinate with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner
- Research and analyze data to address operational challenges and customer service issues
- Provide external and internal customers with requested information
- Under immediate supervision, receive and place follow-up telephone calls/e-mails to answer customer questions that are routine in nature
- Use computerized systems for tracking, information gathering, and troubleshooting.
Accounts Receivable/collections Specialist
Kforce
Houston, Texas
02.2020 - 01.2021
- Accounts Receivable/Collections Specialist processes billing for program areas through each funder's electronic portal within established timeframes
- Enters accounts receivable transactions into the accounting system and reconciles information with billed services in the funder's portal and EHR system.
- Maintains and distributes accounts receivable reports
- Processes payments received for organizational services, grants and donations; And reconciles payments to daily bank deposit log; Provides and maintains all backup information for payments received
- Researches and resolves payment discrepancies to ensure accounts receivable balances are accurately reported
ONSITE MEDICAL BILLER COLLECTOR
Bay Area Regional Medical Center
Houston, Texas
01.2016 - 05.2018
- Remotely prepare and submit claims to various insurance companies electronically
- Research and resolve claims on hold and denials
- Verify patient benefits, eligibility, and coverage
- Prepare appeal and reconsiderations for denied and or underpaid claim
- Bill directly from the DDE system
- Work both physician and hospital claims specializing in RHC facilities
- Review and respond to correspondences and EOB's
- Work follow up queues for underpayments, credits, and denials
- Document multiple hospital and billing systems
- Follow HIPAA guidelines
- Work AR report on denied, underpaid, and aging AR
- Charge entry/cleaning claims for coding accuracy prior to submitting to insurance
- Complete all required documentation in a timely and accurate manner
- Correct RTP claims in FISS/DDE Medicare system for accuracy
- Analyze accounts for errors, adjustments, and credits
- Issue corrected entries when necessary
- Update account information accordingly, rebill through the SSI data system.
Education
GED -
San Jacinto College
01.2015
Skills
- Epic ub04/1500 claims epst
- Amazon workspace
- Microsoft word / excel and office
- Compass rycan
- Microsoft teams mediysis
- Medical terminology dde
- Meditech custom point
- Meditech billing
- Payor portals typing
- allscripts
- collect logix
- sorian
- DocHub
- Athena
- Webex
- Ability
- ICD9/10
- Maccess
Personal Information
Title: Skilled Accounts Receivable Specialist/Medical Biller
Timeline
REVENUE RECOVERY SPECIALIST
Knowtion Health
01.2023 - 12.2023
ACCOUNTS RECEIVABLE SPECIALIST
Medasource
07.2022 - 01.2023
FOLLOW-UP SPECIALIST
Janus
01.2022 - 07.2022
CLAIMS REPRESENTATIVE
Anthem
01.2021 - 01.2022
Accounts Receivable/collections Specialist
Kforce
02.2020 - 01.2021
ONSITE MEDICAL BILLER COLLECTOR
Bay Area Regional Medical Center
01.2016 - 05.2018
GED -
San Jacinto College
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