Rene' Anthony
Antioch,Tennessee
Overview
18
18
years of professional experience
Work History
Legal Assistant - Remote
Atlas- State Of TennCare
01.2020 - Current
- Assist state attorney's with preparation for auditing and court appearances.
- Call monitoring; transcribing calls for state attorneys.
- Trained and mentored all new personnel hired to fulfill their roles.
- Mentored new hires, resulting in stronger staff development and increased productivity.
- Monitored participant workflow and behaviors throughout training process.
- Assessed additional needs based on training progress and collaborated with management to meet requirements.
- Documented participation and evaluated learning for each participant.
- Work TennCare queues providing regular case maintenance, renewal case maintenance and reopening/reinstating denied cases, ensuring accuracy for the determination process within TennCare policy.
- Audits for quality control, ensuring policy and procedures are followed within TennCare system, within vendor's contractual agreement.
- Successfully completed TennCare and Policy training requirements, to include but not limited to, revisions within state requirements.
Payment Poster
Results Physiotherapy
Franklin, TN
08.2017 - 04.2018
- Insurance Payment Poster
- Prepped/scanned, posted and balanced of all electronic and lockbox payments for both insurance and patient accounts efficiently, in organized manner, on a daily basis
- Downloaded electronic payments (ERAs) from clearing house to accurately auto post
- Applied over the counter payments to patient accounts when posting insurance payments
- Balanced daily payment Batch deposits posted for all clinics
- Identified and reported payer payment & recoupment trends and/or out of network problems with carriers to designated insurance specialist and Billing Manager
- Reviewed accounts for overpayments and/or double discount credits Ensuring financial class is in correct payer group
- Worked posters portion of download error reports and forward to appropriate account specialist for review
- Utilized patient accounting system, adjunct software, and other tools proficiently in order to review, retrieve and update information as needed
- Documented appropriate follow up notes on accounts
- Tracked and maintained direct deposits from bank spreadsheet as provided by Finance Manager
- Maintained monthly spreadsheet for reconciliation of payments received/posted outside GL periods
- Balanced all outstanding previous years unbalanced batches
- Assisted insurances specialist with questions regarding payment posting transactions
Payment Poster
AmSurg
02.2016 - 08.2017
- Reviewed and maintained orders, invoices, and records to ensure accuracy
- Entered data electronically to process payments, denials, and adjustments from EOB
- Maintained all patients records
- Maintained strictest confidentiality and adheres to all HIPPA guidelines and regulations
- Managed proper submission of documents in a timely fashion
- Managed 20 centers completing all posting reaching 500 transactions daily
- Worked closely with A/R through emails requesting EOBs needed for posting
- Answered emails within 48 hours for adjustment and pricing corrections
- Maintained zero pays daily by entering for processing
- Worked on CashTrax, NextGen, and ViaTrack systems
Claims Specialist
Premise Healthcare
06.2015 - 11.2015
- Worked alongside the account manager to successfully manage 25 clinics
- Worked through and submitted clean UB04’s and CMS 1500 claims using Emdeon Billing Software
- Examined complexed or unusual claims to determine whether claims will be covered
- Authorized claim payments, set reserves on payments, and ensured timely disbursements of funds to clients
Unpostables Specialist
Community Health Systems
05.2014 - 10.2014
- Responsible for processing from the unpostable dashboard
- Responsible for any unresolved claims issues that aroused from the center
- Called insurance companies and clinics regarding patients’ claims status
- Constant communication via telephone and/or email to multiple entities (internally and externally) to resolve issues
Operation Support/Provider Relations/Claims Processing
MedSolutions Inc
01.2011 - 06.2013
- Provider support for contracting and credentialing
- Troubleshoots over 50 inbound Provider calls per day
- Created and resolved work order support tickets
- Keyed claims from electronic rejection report
- Pre released claims for reimbursement
- Reprocessed claims for correct reimbursement
Medical Biller, •Field Representative
Attorneys Healthcare, AHC, HCA
02.2009 - 11.2010
- Responsible for billing all Work Comp and Health Ins claims
- Preformed all work comp adjustments
- Responsible for billing for all 55 facilities
AR System Administrator/ Billing Manager
DSI
03.2006 - 12.2008
- Processed all electronic and paper format ESRD primary, secondary, and tertiary claims
- Correction and processing of all error claims
- Managed processing of charge rollbacks, repricing, and claim re-filing.
Chargemaster Specialist
Renal Advantage Inc, RAI
04.2005 - 01.2006
- Set-up insurance contracts for Renal Advantage and payers, and linked insurers to contract rate groups
- Entered all item pricing, drug pricing, and average wholesale pricing
- Updated system with current HCPCS codes, ICD-9 codes, CPT codes, condition codes, and value codes
- Set-up new insurance plans.
Medical Coding and Collections Specialist
EnableComp
05.2004 - 02.2005
- Responsible for coding inpatient and outpatient workers comp claims
- Responsible for billing, collecting, and follow upon WC claims
- Collected over 300k monthly
- In charge of investigating and identifying problems within claims and adjusting claims accordingly
- Reviewed contracts that have been negotiated between hospitals and insurance companies
- Worked extensively with HMO’s and PPO’s
- Utilized creative problem solving solutions to resolve issues.
Customer Service Representative
Cigna
Nashville, TN
05.2002 - 10.2002
- Maintained customer satisfaction with forward-thinking strategies focused on addressing customer needs and resolving concerns.
- Answered customer telephone calls promptly to avoid on-hold wait times.
- Answered constant flow of customer calls with minimal wait times.
- Offered advice and assistance to customers, paying attention to special needs or wants.
- Enter claims into system.
- Make adjustments on claims for incorrect denials for payment release.
Medical Assistant
Medical Solutions
Nashville, TN
04.1997 - 08.2000
- Sanitized, restocked and organized exam rooms and medical equipment.
- Obtained client medical history, medication information, symptoms and allergies.
- Directed patients to exam rooms, fielded questions and prepared for physician examinations.
- Collected and documented patient medical information such as blood pressure and weight.
- Preform EKG test
Education
Some College (No Degree) - Revenue Cycle
National College of Business And Technology 2004
Nashville, TNSome College (No Degree) - Medical Assistant
Nashville Medical College of Medical Careers 1997
Nashville, TNSkills
- Accounts Payable and Accounts Receivable
- Analyzing Claims
- Report Preparation
- Procedural and Diagnostic Codes
- HCPCS Coding Guidelines
- CMS Guidelines
- Medical Terminology Knowledge
- HIPAA Regulations
- Verbal and Written Communication
- Team Training and Mentoring
- Computer Savvy
Timeline
Legal Assistant - Remote
Atlas- State Of TennCare
01.2020 - Current
Payment Poster
Results Physiotherapy
08.2017 - 04.2018
Payment Poster
AmSurg
02.2016 - 08.2017
Claims Specialist
Premise Healthcare
06.2015 - 11.2015
Unpostables Specialist
Community Health Systems
05.2014 - 10.2014
Operation Support/Provider Relations/Claims Processing
MedSolutions Inc
01.2011 - 06.2013
Medical Biller, •Field Representative
Attorneys Healthcare, AHC, HCA
02.2009 - 11.2010
AR System Administrator/ Billing Manager
DSI
03.2006 - 12.2008
Chargemaster Specialist
Renal Advantage Inc, RAI
04.2005 - 01.2006
Medical Coding and Collections Specialist
EnableComp
05.2004 - 02.2005
Customer Service Representative
Cigna
05.2002 - 10.2002
Medical Assistant
Medical Solutions
04.1997 - 08.2000
Some College (No Degree) - Revenue Cycle
National College of Business And Technology 2004
Some College (No Degree) - Medical Assistant
Nashville Medical College of Medical Careers 1997
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