Rachel Danielle Gillaspie
White House,TN
Summary
Detail-oriented professional with focus on deadlines and skilled in handling medical billing without errors. Confident Medical Biller knowledgeable in data confidentiality and privacy practices when reviewing patient information.
Overview
9
9
years of professional experience
Work History
DME Medical Billing
Advanced Medical Solutions, Inc
Nashville, TN
03.2021 - 09.2022
- Performed full-cycle DME medical billing in a fast-paced office
- Interpreted medical records and examined diagnosis codes for accuracy, completeness, specificity and appropriateness according to services rendered
- Precisely completed appropriate claims paperwork, documentation, and system entry
- Submitted electronic and paper claims to insurance companies including Medicare and Medicaid to collect medical payments
- Utilize tracking reports to follow up on unpaid claims
- Communicated with insurance providers to ensure any denied claims were resolved
- Resubmitted claims after denial and editing to achieve financial targets and reduce outstanding debt
- Appealed denied claims by submitting supporting documentation
- Maintained current accounts through aged revenue reporting
- Performed day-to-day operations of billing department including medical coding, payment posting, accounts receivables and collections
- Complied with all HIPPA regulations to protect patients' medical records and information
- Participated in work shops and other training opportunities to remain current on billing procedures and industry updates
DME Intake/Customer Service
Advanced Medical Solutions, Inc
Nashville, TN
08.2019 - 03.2021
- Receive and process DME orders received from referrals via fax or email.
- Verify medical necessity with healthcare providers and request any additional documentation per insurance guidelines
- Used Brightree to input information into computerized patient record system
- Contacted insurance providers to verify correct insurance information and get authorization for proper billing codes
- Schedule orders for delivery with patient's after insurance verification and medical necessity process has been completed
- Submit orders to warehouse for delivery
- Take inbound phone calls from referral sources and patient's to determine status of DME order
- Updated patient accounts and information on a daily basis
- Communicated with patients to obtain payments on accounts requiring deductibles or co-pays
DME Intake Coordinator
Bradley Health Services
Nashville, TN
09.2018 - 05.2019
- Receive fax referrals for DME equipment from physicians and other healthcare professionals
- Verify insurance eligibility prior to processing orders to guarantee reimbursement on the back end
- Review referral documentation and medical criteria has been met per insurance guidelines
- Educate healthcare providers via phone or email on proper insurance guidelines and medical documentation requirements for specific DME equipment
- Send in prior authorization request for equipment ordered if required by insurance
- Take inbound phone calls from referral sources and beneficiaries to determine the status of a DME order
- Ensure any release of information request were HIPPA compliant
- Maintained all medical record information in paper files as well as in the electronic system
- Coordinated delivery times for equipment between patients and the logistics team
- Pulled medical equipment for each order processed to prepare for delivery
- Worked retail floor as well as cash register periodically to accommodate business needs
Tier II Customer Service Representative
CGS Administrators
Nashville, TN
09.2013 - 09.2018
- Complete 100% of callback cases within 10 days from date of receipt
- Participate in all trainings and meetings as requested by management
- Act as a positive member of the department by encouraging tier 1 callers, educating tier 1 callers, and working a cohesive team to accurately and effectively assist DME suppliers
- Achieve performance requirements exceeding quality and timeliness processing goals
- Consistently demonstrate the ability to independently and effectively manage all assigned workloads
- Taking escalated calls from providers to resolve complex issues that cannot be handled on the front end
- Assist with tier 1 calls when it is a business need to ensure all metrics are met
- Take inbound prior authorization calls to assist suppliers in determining if they met all of the documentation requirements
- Reviewing claims to determine if an adjustment is necessary due to a contractor error
- Send all contractor errors back to the appropriate department for adjustments
Education
High School Diploma -
Goodpasture Christian School
Madison, TN05.2010
Skills
- Excellent organizational and computer skills
- Clear communication and customer service skills
- HIPPA compliance
- Claim entry and payment posting
- Word Processing Software
- ICD-10 coding and medical terminology
- Insurance Billing
- Accounts Payable and Accounts Receivable
- Strong attention to detail
Timeline
DME Medical Billing
Advanced Medical Solutions, Inc
03.2021 - 09.2022
DME Intake/Customer Service
Advanced Medical Solutions, Inc
08.2019 - 03.2021
DME Intake Coordinator
Bradley Health Services
09.2018 - 05.2019
Tier II Customer Service Representative
CGS Administrators
09.2013 - 09.2018
High School Diploma -
Goodpasture Christian School
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