Pandora Beach
Clarksville,TN
Summary
Seeking a position that offers opportunities for advancement, where I can effectively utilize my strong work ethic, leadership, and communication skills to make a productive difference. Ability Summary Highly experienced in all phases of medical billing HMOs, Medicare, Medicaid, Workers Compensation, and Third party insurance claims. Excellent customer service skills. Trained in computer hardware/ software, electronic data transmission, and health care claim reimbursement, Strong telephone communication, Patient relations-professional/courteous, Strong knowledge of medical insurance benefits, Strong research and analysis skills. Comprehend effectively and perform efficiently. Work well under pressure in a fast-paced, time sensitive environment. Excellent problem solving skills. Assist in employee training. Authorized to work in the US for any employer
Overview
23
23
years of professional experience
Work History
Customer Service Advisor
Parallon
Nashville, USA
05.2016 - Current
- Talk with customers by phone or in person to obtain information needed to resolve inquiries
- Confer with other staff members to obtain additional information and clarification needed to resolve customer concerns
- Reconcile accounts according to insurance contracts and submit/ process correct contractual
- Review accounts for appeal requests and forward appropriately
- Review accounts for duplicate or charge errors, forwarding to audit if necessary
- Correct or add insurance information and request rebill
- Encourage payment from patient through credit card, check or payment arrangement
- Answer all inquiries from customers promptly (generally the same day received)
- Assist patient account inquiries by courteously supplying accurate and timely information, including bills if requested
- Follow all guidelines and policies for SSC employees, both general policies and those specific to customer service activities
- Maintain a courteous and professional attitude with customers and coworkers
Credentialing Specialist
Parallon CPC
Nashville, TN
10.2023 - 02.2025
- Maintain high quality, timely and accurate credentialing processes of medical and allied healthcare professionals per CPC policy and procedure
- Assist in the credentialing process by entering/logging/scanning information into credentialing system for initial, updated, add on applications and maintenance processes
- Acts as liaison with MSO as point person for completing and ensuring compliance and delivery of required information to clients in a timely manner
- Process and maintain credentialing and recredentialing in accordance with CPC policy and procedure, Joint Commission standards, State and Federal Regulatory regulations. National Practitioner Data Bank OIG/GSA.
- Medicare/Medicaid exemption DEA Verification Licensure Board Certification Training verified.
- Residency/ Fellowship Peer Recommendation Professional Schooling Verified
- Ensure that all credentialing files are current and complete pursuant to expiration date of medical licenses, board certification, professional-liability insurance coverage, DEA and other pertinent information, per CPC policy and procedure
- Monitor collection of all information received; follow up on missing items and/or incomplete forms per CPC policy and procedure, submit follow up requests for verifications as needed
- Identifies and evaluates potential red flags and works in collaboration with practitioner to document the issue and physician response
- Advise Manager and/or Director of questionable information received and any issues identified during the processes
- Submit closed files for audit/final review and secure missing items as identified by audit/final review
- Maintain all credentials files ensuring that all correspondence in the credentialing and reappointment process is accurately filed; is knowledgeable and current on the process and legal/regulatory requirements
- Compliance with HCA policy and procedure, Federal and State regulatory and accrediting agencies as required
- Perform other duties and works on special projects as requested
Customer Service Billing Representative
Heritage Medical Assoc PC
Nashville, USA
08.2008 - 01.2016
- Answer incoming telephone call, direct calls, and assist patients
- Troubleshoot and resolve patient issues and concerns
- Explain customer options, entitlement, and benefits
- Process payment on accounts
- Process no show adjustment
- Work insurance denials and correct/resubmit for filing
- Correct coordination of benefits
- Verify insurance eligibility via website
- Void and re-enter charges for DOS
- Process returned mail
- Process estimates for self-pay services
- Process PECS program eligibility
- Train new CSR
- Process medical records request
- Work front end billing rejections
- Process Bad Debt adjustment
- Work daily Que
Medical Insurance Biller
Augusta Center for Optimal Health
Augusta, USA
12.2007 - 06.2008
- Processed insurance claims
- Medicare, Medicaid, Blue Cross/Blue Shield, HMOs and other commercial insurance claims manually and electronically with a 97% accuracy rate
- Troubleshoot and resolve patient billing issues and concerns
- Correct and resubmit insurance denials
- Processed patient refunds
- Explained customers options, entitlements and benefits
- Analyzed claim information
- Performed medical coding with most accurate and descriptive HCPCS code
- Medical terminology, IDC-9 and CPT codes
- Verified surgical procedure codes
- HCFA 1500 and UB billing
- Processed patient billing statements
- Checked patients before each office visit
- Processed all medical records request
- Collect all co-payment and deductibles
- Created month end aging report
- Processed accounts receivables
- Reviewed all accounts for patient liability balances
- Maintained heavy volume telephone traffic
- Prepared non-payment accounts for collections
- Evaluated consumer and employee filed for accreditation by JCAHO
Financial Counselor
Liberty Regional Medical Center
Hinesville, USA
08.2002 - 10.2007
- Processed Medicaid applications for expected mother
- Complete eligibility verification
- Perform account reconciliation
- Received and post cash receipts
- Create reports and statistics for outsource placement for collections
- Reviews and verifies all patient accounts for non-payment
- Strong communication with customers, providers and co-workers on the telephone and face-to-face
- Reviews complaints and issues to ensure all appropriate information has been obtained
- Identify discrepancies and apply all cost containment measure to asset in the claim adjudication process
- Preform administration and data entry functions such as answering and making telephone calls, faxing, mailing follow up letters, emails and filing
Education
High School Diploma - General
Pearl High School
Nashville, TN01.1981
Skills
- Medical billing
- ICD-10
- Accounting
- Medical coding
- Problem solving
- Insurance verification
- CPT coding
- Medical records
- Medical office experience
- Accounts receivable
- Leadership
- Microsoft Excel
- Microsoft Office
- Active Directory
- Windows
- Certifications and Licenses
- Medical Terminology I & II
- Training new employees
- Account reconciliation
- Customer relationship management
- Customer service
Timeline
Credentialing Specialist
Parallon CPC
10.2023 - 02.2025
Customer Service Advisor
Parallon
05.2016 - Current
Customer Service Billing Representative
Heritage Medical Assoc PC
08.2008 - 01.2016
Medical Insurance Biller
Augusta Center for Optimal Health
12.2007 - 06.2008
Financial Counselor
Liberty Regional Medical Center
08.2002 - 10.2007
High School Diploma - General
Pearl High School
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