Renetta Jones
Dallas
Summary
Detail-oriented professional in patient account management, specializing in claims processing and reimbursement. Successfully resolved denials and managed high claim volumes, ensuring compliance with billing standards. Consistently contributed to revenue cycle efficiency while maintaining strong relationships with patients and insurance providers.
Qualified and hardworking Reimbursement Specialist with expertise in policy research and customers service. Offering experience in analyzing coverage and securing collection for claims. Excellent written and verbal communication skills.
Overview
17
17
years of professional experience
Work History
Reimbursement Specialist
US Renal Care
Plano
04.2025 - Current
- Work Denials and Submit Appeals.
- Reviewed insurance policies to determine coverage details.
- Claim follow-up
- Insurance Verification
- Submit Adjustments
Patient Account Rep (Contract)
GUIDEHOUSE
02.2024 - 04.2025
- A/R follow up on Ambulatory claims for pediatric services
- Re-billing claim, submitting appeals, requesting Medical Records, and sending correspondence to patients
- Proficient in Commercial, Medicare, and Medicaid follow up
Patient Account Rep (Contract)
VIRTUAL BUSINESS OFFICE ASSISTANT
07.2023 - 02.2024
- A/R follow up on hospitals claims to resolve denials
- Re-billed claims, filed appeals, requested Medical records, and contacted patients for outstanding claims
Patient Account Rep (Contract)
FRESENIUS
04.2023 - 08.2023
- A/R Collections
- 40 claims per day
- Followed up with insurance
- Worked denials with all Commercial, Medicare, and Medicaid insurances for dialysis claims
Medical Biller (Contract)
BAYMARK HEALTHCARE
Lewisville
10.2021 - 01.2023
- Manual billed claims for Substance Abuse and Alcohol for Residential Treatment Centers
- Contact insurance companies on aged and past due balances
- Reviews and follow-up Explanation of Benefits denials
- Submit claims to clearinghouse
- Submit billing report to accounting and other departments
- Follow HIPPA and PHI guidelines and requirements
- Verifies coding to assure appropriate reimbursement for the treatment services.
- Regular attendance and time required
Collections Specialist - Addison Group Contract
POST ACUTE MEDICAL
Plano
04.2021 - 08.2021
- Processes and follows-up on third party collections. Reviews their party aging and follows-up on outstanding claims
- Contacts insurance companies, patients, government agencies, other hospital departments, physician offices, attorney offices and other third-party payers on aged and past due balances
- Reviews and follows-up on Explanation of Benefit denials
- Submits re-bills, tracers, and appeals; submits adjustments using appropriate reason code classifications
- Identifies bad debt accounts for adjustment and identifies credits and refunds
- Performs collection duties, rebilling research, correspondence, returned mail and problem solving of account billing errors
- Verifies billing information for electronic claims transmission and hard copy billing
- Follows-up on accounts billed both electronically and manually
- Review remittance advice forms to verify proper reimbursement and make adjustments as necessary
- Verifies coding with claims processors at third party payer companies regarding disputes/denied claims and follows-up on all bills not processed within usual claim period
- Regular attendance and timeliness is required
Denial Resolution Specialist
PARALLON/HCA
Coppell
09.2018 - 06.2021
- Billed employee services claim for drug screens, physicals, blood work, and vaccines daily for different markets.
- Collect on outstanding invoices from the employers by emailing and mailing the invoices.
- Mail correspondence pre-collect letters to start the collection process.
- Submit outstanding claims to OnBase to proceed with the collections process.
- Take payments and submit to department for processing credit card payments.
- Scan and email payment receipts back to the employer.
- Research and resolve payment issues.
- Process Work Comp payments and submit WC conversion to be billed correctly on a HCFA form.
- Follow up on emails, voice mails and correspondence and help with other department duties.
Collection Specialist
COTIVITI HEALTHCARE
McKinney
10.2015 - 09.2018
- Work with the audit team, providers and other support teams in communicating with them effectively to meet department standards for the collections process.
- Follow up on A/R on outstanding unpaid claims.
- Worked with Commercial and Government payers.
- Handled timely filing for appeals.
- Follow HIPPA guidelines.
A/R Specialist
MCKESSON
Plano
05.2015 - 10.2015
- Follow up of outstanding A/R all payers and/or including self-pay and/or including resolution of denials.
- This position is responsible for handling all correspondence related to an insurance or patient account, contacting insurance carriers, patients and other facilities as needed to get maximum payment on accounts and identify issues or changes to achieve client profitability.
- Responsible for working EDI transactions and ERA files, including reconciling carrier submissions, edits and rejection reports.
- Ability to research and resolve accounts appearing on Delinquent Insurance Report, Collection Ledger and Government Payor report as directed by management making appropriate decisions on accounts to be worked to maximize reimbursement.
Third Party Collector
DAVITA RX
Coppell
03.2012 - 05.2015
- Collect on third party payments for Medicare, Medicaid and Commercial insurance for patient’s renal and maintenance medications A/R greater than 60-120 days.
- Back billed copay cards and insurance plans to assure timely filing for electronically billing and paper claim submissions on HCFA claim forms.
- Processed approval s for pending COBRA patients and patient’s spend down to receive medication in a timely manner.
- Submit adjustments on debit balances, research recoupments and authorizations.
Reimbursement Coordinator
US BIO SERVICES
Frisco
12.2009 - 03.2012
- Collect on third party payments for Medicare, Medicaid and Commercial insurance.
- Maintain A/R 360 days and billing of specialty drugs, RN visits and per diem supplies via through email or telecommunication, pull EOB's or RA's for all insurance.
- Request for medical records, write up adjustments, work credit and debit balances, mail correspondence or claims on 1500 HCFA, follow up on claim status via e-mail or telecommunication, research recoupments, self-pay accounts, authorizations.
- Posting payments and posting unapplied cash.
Education
Certified Medical Biller - Medical Billing and Coding
SANFORD BROWN INSTITUTE
Atlanta, GASkills
- Customer Service
- Medical Terminology
- ICD-9 and ICD-10 Coding
- CPT
- HCPCS
- Reimbursement
- Claims Processing
- Knowledge of Commercial and Government Payers
- Knowledge of Employer Services Payers
- Knowledge of Self-Pay
- Electronic Medical Records (HPF)
- Microsoft Word
- Microsoft Excel
- Billing Pharmacy System OSRx
- Clearing house Navinet and Navicure
- Oracle A/R system
- Vision A/R system
- Availity Claims system
- Practice Velocity Billing system
- Artiva A/R System
- Diamond Invoices
- Onbase-document system
Timeline
Reimbursement Specialist
US Renal Care
04.2025 - Current
Patient Account Rep (Contract)
GUIDEHOUSE
02.2024 - 04.2025
Patient Account Rep (Contract)
VIRTUAL BUSINESS OFFICE ASSISTANT
07.2023 - 02.2024
Patient Account Rep (Contract)
FRESENIUS
04.2023 - 08.2023
Medical Biller (Contract)
BAYMARK HEALTHCARE
10.2021 - 01.2023
Collections Specialist - Addison Group Contract
POST ACUTE MEDICAL
04.2021 - 08.2021
Denial Resolution Specialist
PARALLON/HCA
09.2018 - 06.2021
Collection Specialist
COTIVITI HEALTHCARE
10.2015 - 09.2018
A/R Specialist
MCKESSON
05.2015 - 10.2015
Third Party Collector
DAVITA RX
03.2012 - 05.2015
Reimbursement Coordinator
US BIO SERVICES
12.2009 - 03.2012
Certified Medical Biller - Medical Billing and Coding
SANFORD BROWN INSTITUTE