POVSOMALA OUCH
Murrieta,CA
Summary
A driven professional medical biller motivated to perform beyond expectations with the ability to resolve discrepancies through creative problem-solving. Seeking to secure a challenging position in a reputable organization. To be able to expand career, education, experience, and skills while preserving company values through impeccable work ethic.
Overview
10
10
years of professional experience
Work History
Patient Service Representative
Physical Rehabilitation Network
Carlsbad , CA
2021.04 - Current
- Manage primary and secondary claims
- Works directly with insurance companies and patients to get a claim processed and paid
- Answers patients’ billing questions
- Set up patient payment plans and work collection accounts
- Process patient and insurance refund requests in a timely manner
- Respond promptly to billing inquiries from patients, insurance companies, and departments
- Work with clinics to identify and resolve issues regarding outstanding account balances
- Utilize the most efficient resources to secure timely payment of open claims
- Research assigned correspondence and take necessary action to resolve requests
- Ensures daily accomplishments contribute toward company goals for A/R
- Resolve all accounts in follow-up queues
- Review all EOBs for correct payment, deductible, adjustments, and denials
- Research and resolve insurance denials through written appeal, telephone call, web-based adjudication system, charge correction, or write off request
- Assist in training of new employees
- Assist in verification of patient benefits and scheduling
- Maintain good work habits including attendance and punctuality
- Ability to be flexible and assist with other projects when needed.
Medical Billing Team Lead
Option Care Health
Corona , CA
2020.03 - 2021.04
- Provide training to new and existing staff members using company procedures
- Spot check work to be sure of accuracy, efficiency, and uniformity
- Report staff’s progress, deficiencies, and training needs to management
- Run productivity reports
- Respond to staff’s questions in a timely manner
- Assist staff in completing all assigned tasks in a timely manner and ensure they have the resources and tools to perform their jobs
- Provide coverage as needed to include performing staff’s work during their absences or as instructed by management
- Assist manager in staff development
- Promote teamwork by assisting staff as needed
- Assist manager by meeting the daily needs and deadlines imposed by the client
- Oversee special projects
- Work aged accounts on assigned payers prioritizing accounts that are approaching timely filing denial
- In conjunction with manager, review status of staff’s assignments
- Meet with staff to discuss deficiencies and correct errors
- Know how to navigate and work with all payer websites
- Break down incoming mail and distribute to designated A/R staff
- Work with Payment Posters or insurance companies regarding missing or misdirected checks
- Present ideas for improvements and strategies to meet goals
- Provide status updates to management upon request
- Follow up on invoices submitted to ensure prompt and timely payment and escalate issues as necessary
- Evaluates payments/denials received for accuracy and correct as needed
- Identifies bad debt write-offs and A/R adjustments
- Initiates write-off and adjustments in accordance with policies and procedures
- Ensures that secondary bills and patient invoices are accurately generated and submitted on a timely basis
- Identifies any overpayments and/or duplicate payments, investigate, and resolve as needed
- Processes refund requests in accordance with policies and procedures
- Research and appeal denied claims
- Verification of client insurance eligibility/benefits for copays and deductibles
- Perform other duties as assigned.
Billing Team Leader
Acadia Healthcare
Carlsbad , CA
2015.02 - 2020.03
- Provide training to new and existing staff members as instructed by director/manager
- Utilize and follow company procedures in training
- Spot check work to be sure of accuracy, efficiency, and uniformity
- Report staff’s progress, deficiencies, and training needs to management
- Run productivity reports monthly
- Answers team member questions, help with team member problems, and oversee team member work for quality and guideline compliance
- Communicates deadlines to billing staff
- Ensure staff completes all assigned tasks in a timely manner and ensure they have the resources and tools to perform their jobs
- Develops strategies to promote team member adherence to company regulations and performance goals
- Provide coverage as needed to include performing staff’s work during their absence as assigned by management
- Coordinates with Manager/Director to prioritize assignments based on current issues and business needs
Medical Biller
Acadia Healthcare
Carlsbad , CA
2014.04 - 2015.02
- Verify eligibility and benefits for new intake
- Obtain authorizations/referrals
- Bill and post revenue payments/charges to patient’s accounts and insurance payors
- Review and audit patient bills for accuracy, obtain and correct any incomplete or missing billing information
- Prepare, review, and transmit claims using automated systems and manual paper claim process
- Knowledge of insurance guidelines, including HMO, PPO, Medicare, and state Medicaid
- Follow up on unpaid claims within specified billing cycle timeframe
- Validate insurance payment for accuracy and compliance based on contractual terms
- Evaluate and investigate payor matters for any discrepancy in payments as necessary
- Identify and bill secondary payors
- Follow-up on all accounts with payor or patient
- Follow-up on payor specific appeals and denials of claims
- Respond to all patient or insurance telephone inquiries to ensure timely reimbursement
- Update cash spreadsheet, generate collection reports and ensure compliant collection efforts interpreting the explanation for benefits (EOB)
- Other duties as assigned.
Education
Medical Billing -
Kaplan College
01.2014
Associate - Business Management
National University of Management
01.2009
Skills
- AR Aging Reports
- Payment posting
- knowledge related to reading insurance EOB
- Online claim submission
- Creative Problem Solving
- Verbal and Written Communication
- Denial Appeals Process
- Spreadsheet Tracking
- Problem Investigation
- MS Office
- Computer Skills
- Medical terminology
- Adaptability
- Customer Service
- Ambition
- Detail -oriented
- Team Work
Timeline
Patient Service Representative
Physical Rehabilitation Network
2021.04 - Current
Medical Billing Team Lead
Option Care Health
2020.03 - 2021.04
Billing Team Leader
Acadia Healthcare
2015.02 - 2020.03
Medical Biller
Acadia Healthcare
2014.04 - 2015.02
Medical Billing -
Kaplan College
Associate - Business Management
National University of Management
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