Pam Bousa
Anaheim,California
Summary
A challenging position in Medical Billing Analyst, Customer Service Rep, Provider Relation, Auditor, Technical Billing or where experience can be valuable to the company.
Overview
28
28
years of professional experience
Work History
Technical Billing Analyst
- Analyzed adjusted and unpended medial legal billings
- Assist with auditing of EOR’s for Technical Review Department
- Maintain reference library of legislative and industrial practice guides
- Auditor – Audit review sheets for accuracy of pertinent information including but not limited to Clint specification, provider information, and medical procedures according to ReviewCo’s policies
- Detect potential program errors and advise a proper solution
- Coder – Code current reference material related to the California Medical Fee
- Schedule and the company’s policies.
Client Representative
Stratacare Inc
11.2012 - Current
- Provide accurate advised to client calls and response to client emails timely,
- Review issues, and submit bills as RUSH per client request
- Provider Relation
Billing Analyst
03.2007 - 11.2012
- Provide accurate advice to provider calls, Review issue, and processing of reconsideration
- Provide guidance to team members of the problem and result issue provider complains and return calls within time matter., Review hospital bills in accordance with PPO contracts using per diem, stop loss rates, minimum and maximum allowance rate, tiers schedule, and exclusions
- Review hospital bills in accordance with all out-of-state
- Medical Fee Schedule and State’s Guidelines.
Medical Billing Specialist
Conventry
06.2001 - 03.2007
- Review medical bills and implement state’s rules and guidelines consistently and accurately
- QA100% from data entry person
- Duty: Audit Hospital bills,
- Re-Evaluation bills, surgery bills, regular bills, and report errors made by analysts to supervisor
- Train new employees on system and instruct client’s specifications and guidelines
- Demonstrate flexibility and positive attitude in adapting to needs of assignment
- Willingly takes on challenging accounts or jurisdictions
- Strives to consistently meet or exceed our accounts expectation.
Medical Billing Auditor
EOS
11.1998 - 05.2001
- Review bills in accordance with understand and meticulously apply all state required by individual insurance carriers and referral sources
- Understand and apply all state guidelines and implement state rules and guidelines consistently and accurately; maintain knowledge of fee schedule and usual customary guidelines
- Duties: Code/Audit regular bills, surgery bill, Hospital bills, Re-
- Evaluation bills, and also help print and post
- Reviews rush bills and assist supervisor with special projects
Technical Billing Auditor
ReviewCo
06.1995 - 11.1998
- Manage and maintain FHC Hospital PPO Network
- Enter audit testing and updating of contract information
- Maintaining rates and addresses information.
Education
Hollywood high school diploma -
Cal State LA
Skills
- Familiar with:
- Microsoft Words and Excel Fast learner and have the ability to
- Do multitasking
Timeline
Client Representative
Stratacare Inc
11.2012 - Current
Billing Analyst
03.2007 - 11.2012
Medical Billing Specialist
Conventry
06.2001 - 03.2007
Medical Billing Auditor
EOS
11.1998 - 05.2001
Technical Billing Auditor
ReviewCo
06.1995 - 11.1998
Technical Billing Analyst
Hollywood high school diploma -
Cal State LA
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