Pam Moore
Manila,AR
Summary
Dedicated medical billing specialist with a proven track record in customer service and insurance knowledge. Known for effective communication and relationship management, ensuring accurate claims processing and enhanced operational workflows.
Overview
36
36
years of professional experience
Work History
NE Arkansas Network Management Support Specialist
AR BlueCross BlueShield
Jonesboro, AR
04.2023 - Current
- Provide support to Providers - assisting with Credentialing, status and claims questions.
- Review Request for Application to accept or decline applications.
- Assist with credentialing for all providers types, Clinics, Hospitals, Residential Behavioral Facilities, DME Supplies, Ambulance and Pharmacy.
- Communication with the Provider Network Operations team on a daily basis.
- Manage vast email box for NE ARK Regional Support and contiguous counties of NE Arkansas.
- 1 of the 3 Support Specialist for the whole state of Arkansas.
Medical Biller
Wagner Medical Clinic
Manila, AR
07.2007 - 04.2023
- Processed patient insurance claims accurately and efficiently for 1 Rural and 3 non Rural Clinics.
- Communicated with insurance providers to resolve denied claims and resubmitted
- Liaised between patients and insurance companies.
- Analyzed complex Explanations of Benefit forms to verify correct billing of insurance claims
- Managed billing calendar and scheduled claims for payment thru ARBCBS, Medicare ( Traditional and Rural Clams), AR Medicaid ( Traditional and Rural claims), Edemon Clearinghouse and various other insurance companies.
- Helped with setup and maintained new electronic billing system.
- Adhered to establish standards to safeguard patient's health information.
- Trained new employees on multiple billing programs and data entry software
- Reviewed patient diagnosis codes to verify accuracy for prompt payments.
- Delivered timely and accurate charge submissions.
- Translated and interpreted medial billing codes with strong accuracy to enable swift payments form insurance compaines.
Medical Biller
Monette Family Practice Clinic/ Buffalo Island Medical Clinic
Monette, AR
01.1990 - 06.2007
- Complete financial control of 18,000 patient accounts. Reviewed patient records, identified medical codes and created invoices for billing purposes.
- Managed billing calendar and scheduled claims for electronic transmission, to ARBCBS, AR Medicaid, Medicare and NEIC Clearing House, Workman's compo claims and various other insurance paper claims.
- Helped with Set up and maintained new electronic billing systems X 3
- Prepared Medical Leave and Family Medical Leave forms and Attending Physician Statements for various companies.
- Communicated with insurance companies to resolve denied claims and resubmitted.
- Posted payments and collections on regular basis.
- Collected payments and applied to patient accounts.
- Liaised between patients and insurance companies.
- Analyzed complex Explanation of Benefit forms to verify correct billing of insurance carriers
- Orchestrated day-to-day operations of billing department, including medical coding, payment posting, accounts receivables and collections.
- Prepared accounts with past due balance and transferred those cases to a collection agency.
- Adhered to establish standards to safeguard all patients' health information.
- Trained new employees on multiple billing programs and data entry software.
- Reviewed patient diagnosis codes to verify accuracy to enable swift payment
- Filed and updated patient information and medical records.
- Communicated with insurance carriers to resolve denied claims and resubmitted.
Skills
- Medical Billing
- Patient Account Analysis
- Insurance Knowledge
- Account Reconciliation
- Billing Systems
- Medical Record Review
- Billing Inquiries
- Electronic-Medicare, Medicaid, Commercial claims processing
- Customer Service support
Timeline
NE Arkansas Network Management Support Specialist
AR BlueCross BlueShield
04.2023 - Current
Medical Biller
Wagner Medical Clinic
07.2007 - 04.2023
Medical Biller
Monette Family Practice Clinic/ Buffalo Island Medical Clinic
01.1990 - 06.2007