Pamela C. Simon
Warwick,USA
Summary
- Highly-motivated employee with desire to take on new challenges. Strong work ethic, adaptability, and exceptional interpersonal skills. Adapt at working effectively unsupervised and quickly mastering new skills.
- Experienced in fast-paced environments and adaptable to last-minute changes. Thrives under pressure and consistently earns high marks for work quality and speed.
- Thorough Billing Specialist offers account management, account reconciliation, and invoicing expertise coupled with outstanding time management and data entry capabilities. Focused and meticulous professional with many years of comprehensive experience developing and sending bills to customers for services.
- Skilled in reconciling accounts, identifying discrepancies, and resolving billing issues promptly. Strong attention to detail and numerical accuracy, with a commitment to maintaining confidentiality and upholding the highest standards of integrity in financial transactions.
Overview
15
15
years of professional experience
Work History
Patient Account Representative
Vibra Healthcare
Mechanicsburg, PA
02.2022 - 08.2024
- Collaborated with relevant parties to resolve billing issues, insurance claims and patient payments.
- Complete adjustments as needed.
- Review Medicare, Medicaid, and Commercial remittance advices.
- Contact patient when needed to verify coordination of benefits or to notify them of insurance denials.
- Maintained detailed notes on all patient interactions for future reference purposes.
- Follow up on aged receivables every 7-15 days.
- Escalated high dollar and problem accounts with commercial payers as needed.
- Maintained accounts receivables over 60 days to ensure the accounts don’t exceed the corporate standards.
- Initiated collection activities on delinquent accounts while adhering to HIPAA guidelines and regulations.
- Identify claims that require medical necessity appeals and enter them into the appeal log as appropriate.
- Investigated billing discrepancies and implemented effective solutions to resolve concerns and prevent future problems.
- Provided customer service to patients regarding billing inquiries and account information.
- Processed refunds, disbursements, and payments.
- Resolved any issues arising from incorrect or incomplete documentation relating to a particular claim.
- Submitted appeals on behalf of patients when appropriate based on findings from research conducted into denied claims.
- Worked effectively in team environments to make the workplace more productive.
- Provided support and guidance to colleagues to maintain a collaborative work environment.
- Reviewed all incoming documents related to claims and determined next steps accordingly.
- Reviewed and processed medical claims for accuracy and compliance with insurance carriers' reimbursement policies.
- Reviewed claim edits generated by automated systems prior to submission to payer organizations.
- Performed regular reviews of claims processing systems to identify areas that need improvement.
Dental Secretary
University Oral Surgery and Maxillofacial Associates
East Greenwich, RI
10.2021 - 02.2022
- Check in and check out patients
- Schedule patient appointments for surgeries
- Process insurance claims with dental insurance and medical insurance benefits
- Reconcile cash and credit card payments.
- Follow up with patients regarding their surgeries.
- File patient charts and pull them for following week.
- Verify PMPs.
- Verified patient insurance coverage prior to appointment scheduling.
- Scheduled appointments, managed patient records, and maintained a filing system.
- Answered phones, responded to inquiries, and provided customer service support.
- Greeted and registered patients, collected patient information and verified insurance coverage.
- Took customer payments and billed insurance companies for remaining balance.
- Answered telephones and directed calls to appropriate medical or adminstrative staff.
- Prepared reports, invoices, letters, or medical records using word processing, spreadsheet, or other software applications.
- Completed relevant insurance and other claim forms.
- Provided administrative support to dentists by preparing charts in advance of appointments.
- Verified that insurance coverage was up-to-date prior to scheduled treatments.
- Ensured compliance with HIPAA regulations related to the protection of confidential patient information.
- Monitored office supplies inventory and placed orders when necessary.
- Received and distributed incoming fax, mail and parcels to staff to facilitate communication.
- Maintained master calendar and scheduled new appointments based on provider availability.
- Demonstrated proficiencies in telephone, e-mail, fax, and front-desk reception within high-volume environment.
Accounts Representative II & Cashiering
South County Health
Wakefield, RI
01.2014 - 10.2021
- Performed administrative functions for assigned accounts, recorded address changes and purged records.
- Prepared journal entries for month-end close process.
- Monitored overdue accounts using automated information systems.
- Maintained accurate and complete records on past due accounts and collection actions.
- Arranged debt repayment or established schedules for repayment based on customer's financial situation.
- Completed month-end and year-end closings, kept records audit-ready and monitored timely recording of accounting transactions.
- Investigated billing discrepancies and implemented effective solutions to resolve concerns and prevent future problems.
- Provided customer service support to address inquiries regarding billing issues.
- Collaborated with other departments regarding accounting and department to department incoming revenue.
- Backup Customer Service Representative for front desk.
- In charge of sending all secondary and tertiary claims to all insurances through relay system.
- Analyzing relay insurance rejections.
- Filing and analyzing UB04 forms
- Handling in state and out of state Medicaid plans.
- Analyzing and comparing medical records with insurance claims.
- Analyzing medical coding and insurance companies’ contracts and guidelines.
- Providing insurance companies with the needed documents in order to correctly process claims in a timely manner.
- Reconciliation of bank deposits and remittance advices.
- Reconciliation of patient credit card payments.
- Assisted as a back up in many different areas of department.
- Assisted with self pay patient refunds as well as insurance refunds.
- In charge of mail distribution between departments.
- Depositing checks into citizen’s money manager.
- Analyzing and resolving financial items from payers.
- Working rejection batches for payments.
- Electronic postings via relay/change healthcare assurance/optum.
- Maintained updated knowledge through continuing education and advanced training.
- Assisted in developing new procedures when necessary.
- Provided training and support to junior account representatives, fostering team development.
- Investigated incorrect billings and processed refunds as necessary.
- Maintained accounting ledgers by verifying and posting account transactions.
- Gathered information to produce accounts payable reports for review.
- Performed insurance verification, pre-certification and pre-authorization.
- Completed efficient drop and bulk filing to maintain well-organized and easily accessed systems
- Provided support to other departments within the organization as needed.
- Maintained accurate records of collections, adjustments and denials in the system.
- Assessed billing statements for correct diagnostic codes and identified problems with coding.
- Submitted claims to insurance companies.
- Verified insurance coverage and identified third-party payers for billing purposes.
- Performed additional duties as assigned by management team.
Lead/Call Center-Billing Representative
CVS/Caremark Corporate Offices
Woonsocket, RI
01.2010 - 01.2014
- Filing and analyzing CMS-1500 forms.
- Moving payments, and adjusting claims.
- Analyzing and comparing medical records with insurance claims.
- Providing lab companies with needed information in regards to lab work conducted.
- Executed account updates and noted account information in company data systems.
- Performed insurance verification, pre-certification and pre-authorization.
- Reconciled codes against services rendered.
- Provided prompt and accurate services through knowledge of government regulations, health benefits and healthcare terminology.
- Contacted vendors to follow up on late invoices.
- Reviewed engine assigned codes and modifiers to update and verify accuracy.
- Resolved customer inquiries related to billing issues promptly.
- Completed efficient drop and bulk filing to maintain well-organized and easily accessed systems
- Performed data entry to update customer accounts with payment details.
- Answered customer invoice questions and resolved issues discovered during invoicing and collection process.
- Investigated customer complaints related to billing issues.
- Answered customer questions to maintain high satisfaction levels.
- Reviewed and analyzed contracts to resolve billing issues with vendors and carriers.
- Participated in workshops, seminars, and training classes to gain stronger education in industry updates and federal regulations.
- Investigated past due invoices and delinquent accounts to generate revenues and reduce number of unpaid and outstanding accounts.
- Served as primary contact for internal departments concerning billing matters.
- Followed up with customers on past due balances via phone or email communication.
- Developed strategies for improving the efficiency of the company's billing process.
- Collected, posted and managed patient account payments.
- Maintained detailed records of billing information in the company's database.
- Monitored customer accounts regularly for potential problems or discrepancies.
- Trained new team members on company policies and accounting systems to keep team operations productive and efficient.
- Submitted claims to insurance companies.
- Monitored past due accounts and pursued collections on outstanding invoices.
- Analyzed account history to identify trends or irregularities in billing processes.
- Assisted with training new staff members on proper billing procedures and protocols.
- Verified patient insurance coverage, created financial plan according to treatment schedules for collections and communicated between patient and billing company regarding health insurance.
- Worked with team members to identify and develop process improvements.
- Completed quality assurance reviews of practices and billing histories.
- Collaborated with other departments to resolve any outstanding billing issues quickly.
- Submitted claims to insurance companies and researched and resolved denials and explanations of benefit rejections.
- Recognized by management for providing exceptional customer service.
- Managed time effectively to ensure tasks were completed on schedule and deadlines were met.
- Worked effectively in team environments to make the workplace more productive.
- Prioritized and organized tasks to efficiently accomplish service goals.
Medical Biller/Administrative Assistant
Concentra Health Services
Cranston, RI
12.2009 - 01.2010
- Maintained accurate records of all billing activity in accordance with departmental standards.
- Maintained billing software by updating rate change, cash spreadsheets and current collection reports.
- Kept records of customer interactions or transactions, thoroughly recording details of inquiries.
- Maintained a high level of professionalism when dealing with difficult customers.
- Resolved complex problems by working with other departments to provide solutions that meet customer needs.
- Reviewed and verified invoices for accuracy and completeness.
- Reconciled monthly statements and transactions to keep records accurate and current.
- Responded promptly to patient inquiries about payment status and account balances.
Education
Medical Billing & Coding Program -
Lincoln Technical Institute
Lincoln, RI12-2009
Classical High School -
Classical High School
Providence, RI06-2008
Skills
- Microsoft Applications
- Medisoft
- Medicare
- Medicaid
- Commercial Insurance
- 3rd Party Billing
- Anatomy & Physiology
- OSHA
- JCAHO
- NCQA standards
- Excellent Interpersonal skills
- Athena
- Meditech
- Relay
- Assurance
- Wellsky
- Greenway
- Citizen’s Money Manager
- UB92
- CMS 1500 forms
- ICD-10
- CPT
- HCPCS
- DRG
- APC
- Patient Scheduling
- AP/AR
- Medical Records Management
- Excellent Customer Service
- Excellent Office Management
- Excellent Multi-tasking
- Organization
- Verbal and written communication
- Critical thinking
- Multitasking capacity
- Adaptability
- Goal setting
- Time management
- Train employees
- Reliability
- Teamwork and collaboration
- HIPAA guidelines
References
Available Upon Request
Timeline
Patient Account Representative
Vibra Healthcare
02.2022 - 08.2024
Dental Secretary
University Oral Surgery and Maxillofacial Associates
10.2021 - 02.2022
Accounts Representative II & Cashiering
South County Health
01.2014 - 10.2021
Lead/Call Center-Billing Representative
CVS/Caremark Corporate Offices
01.2010 - 01.2014
Medical Biller/Administrative Assistant
Concentra Health Services
12.2009 - 01.2010
Medical Billing & Coding Program -
Lincoln Technical Institute
Classical High School -
Classical High School