REBECCA INOA
Hinesville,GA
Summary
Aiming to leverage my skills to successfully fill the void within your company. Qualified Provider Enrollment Specialist with amazing self-confidence and a background processing government payor applications. Offering more than 2 years overseeing credentialing for new providers. Also maintaining group revalidations.
Expert knowledge of claims processing from charge entry and code audits to denied claims. Experience with EDI issues payer ID numbers, and the electronic claim format.
Enthusiastic and eager to contribute to team success through hard work, attention to detail and excellent organizational skills. Motivated to share and grow with over 11 years within the Healthcare industry.
Overview
10
10
years of professional experience
1
1
Certification
Work History
Provider Enrollment Specialist
Change Healthcare
N. Charleston, SC
01.2022 - Current
- Maintain Provider/Group database for multiple clients
- Maintain Provider/Group Enrollment Payer Grid (Excel Spreadsheet Based)
- Maintain CAQH database provider profiles
- Communicate with Client Managers regarding provider documents, start dates, payer to enroll with, effective dates
- Prepared and processed provider enrollments with Medicare and Medicaid in multiple states.
- Monitored credentials and contact client managers when expiration dates were nearing.
EDI Specialist
Change Healthcare
N. Charleston, SC
07.2018 - 01.2022
- Handled denied claims from clearing house and specific denials from payers for 8-10 clients
- Reviewed electronic claim for any formatting issue or invalid/missing information.
- Tracked claims when denial was identified and corrected to ensure acceptance from payer
- Trained new employees with pathways created for work flow management
- Ran, and reviewed reports within MDIV software.
- Obtained electronic payer ID numbers for HCFA 1500 and UB92 forms
Credentialing Specialist
Change Healthcare
N. Charleston, SC
02.2017 - 07.2018
- Enroll new providers with Client payers
- Maintain Medicare Revalidation Enrollments for all Clients worked within office
- Maintain Provider Enrollment Logs via Excel Spreadsheets
Coder/ Charge Entry Specialist/Receptionist
Carolina Macula & Retina
Mount Pleasant, SC
09.2015 - 05.2016
- Complete Chart audits to code charges and input charges
- Claims Follow up, handle billing statements with patients
- Schedule appointments, answer phones, collect copay
- Handle appeals for denied claims/ procedures
Family Readiness Group Leader
US Army Volunteer
Fort Knox, KY
05.2012 - 05.2014
- Coordinates communication from Chain of Command to members of Family Readiness Group
- Organizes and presides over Family Readiness Group activities
- Delegates responsibilities to select volunteers in order to promote participation in Group activities.
- Oversee Family Readiness expenses with group Treasurer
Billing Specialist & Patient Representative
Southeast Orthopedic Center
Savanna, Georgia
01.2009 - 11.2010
- Examined diagnosis codes for accuracy, completeness, specificity and appropriateness according to services rendered
- Appropriately and correctly identified errors and re -filed denied/rejected claims as were received from Insurance Company
- Added modifiers as appropriate
- Thoroughly reviewed remittance codes from EOBS/AR's Completed appeals and refiled denied claims
- Meticulously tracked and resolved underpayments
- Prepared and attached all required claims documentation including referrals, treatment plans or other required correspondence to reduce incidence of denials
- Consistently informed patients of their financial responsibilities. Creating payment plans as needed
- Made follow up appointments, collected copays and deductible payments
- Balanced daily totals from copays
- Daily reviewed all providers patient intake sheet for procedure/diagnosis/modifiers and provider signatures
Education
Bachelor of Science - Human Resource Management
DeVry University
07.2017
Certificate in Medical Billing and Coding ICD-9 & ICD-10 (Jan 1995 -
Allied School of Business
10.2009
Associate of Arts -
Hillsbourough Community College
Tampa, FL12.1995
Skills
- Billing Codes
- Provider Enrollment Requirements
- Credentialing Data Coordination
- Medicare Part B
- HIPAA Regulations
- Billing Procedures
- Verifying Credentials
- Patient Billing
- Tracking Spreadsheets
- Insurance Requirements
- Healthcare Knowledge
Certification
Certified Professional Coder (AAPC)
Timeline
Provider Enrollment Specialist
Change Healthcare
01.2022 - Current
EDI Specialist
Change Healthcare
07.2018 - 01.2022
Credentialing Specialist
Change Healthcare
02.2017 - 07.2018
Coder/ Charge Entry Specialist/Receptionist
Carolina Macula & Retina
09.2015 - 05.2016
Family Readiness Group Leader
US Army Volunteer
05.2012 - 05.2014
Billing Specialist & Patient Representative
Southeast Orthopedic Center
01.2009 - 11.2010
Bachelor of Science - Human Resource Management
DeVry University
Certificate in Medical Billing and Coding ICD-9 & ICD-10 (Jan 1995 -
Allied School of Business
Associate of Arts -
Hillsbourough Community College
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