Rhonda Baynard
Aiken,South Carolina
Summary
Organized in professional client relations, customer service and teamwork. Proficient in over 10+ years in AR, medical claims denial and resolution, billing and coding, appeals, as well as knowledgeable and well versed in various insurance filing rules and regulations (3rd party billing, Medicaid, Medicare, BCBS etc.). Excels in the ability to utilize perceptive attention to detail to examine claims and documents for accuracy and completeness. Desire a Medical Billing position with a reputable company to help increase revenue by reviewing for accurate billing practices.
Overview
16
16
years of professional experience
Work History
Medical Billing Specialist
Piedmont Hospital formerly University Hospital
Augusta, GA
03.2020 - Current
- Processed all types of denials and rejections from insurance companies using Epic EHR System for Hospital and Providers.
- Filed appeals, disputed claims and updated and tracked claim status, complete all steps to resolve denials, and completed associated paperwork
- Track and resolve outstanding payment issues on denied claims with providers, as well as processed and documented refunds.
- Review accounts for delinquency and refers to bad debt accounts over to collection agency, as necessary.
- Send claims to insurance companies, as necessary
- Appropriately document all correspondence with patients, insurance companies, and vendors in the health information system per CBO guidelines.
- Reviewed and tracked Provider Enrollment for new onboarding providers and re-credentialed providers.
Electronic Data Interchange Technician
Medac Medical Billing Service
North Augusta
07.2012 - 11.2019
- Processed all types of denials and rejections received from insurance companies and clearinghouses using KAM EH Software.
- Filed appeals, update status, complete all steps to resolve denials, and completed associated paperwork.
- Communicated between internal departments as well as external vendors and clients regarding EDI matters.
- Submitted medical records and correspondence electronically and manually as needed.
- Researched and Resolved denials and rejections for medical claims daily for timely filing.
- Followed up the status of Claims, filed appeals and refiled updated claims. Verified eligibility for insurance by websites and calls, obtained carrier filing requirements (preauthorization, etc.) for electronic claim submittal.
- Worked with Provider Enrollment to Ensure ERA and EDI agreements and applications for Providers are completed and approved
- Strengthened Productivity as a liaison between Clearinghouse, IT and Insurance carriers by identifying trends and glitches in system that effect claim filing issues.
- Processed and Printed paper claims and correspondence (HCFA's EOB's, Appeals) to be mailed to insurance carriers per HIPPA guidelines.
Front Office Clerk
Margaret J Weston HealthCare Center
Edgefield, South Carolina
04.2008 - 06.2012
- Checked patient's in and out of Medical Office.
- Created as well as updated patient Medical charts.
- Provided customer service support by checking patients in office, answering questions about medical bills or other matters relating to accounts receivable and billing processes.
- Maintained electronic records of all claims submitted, tracking payments received from insurance companies
- Answered office phone and emails to schedule appointments, took messages as well as forwarded to appropriate personnel.
- Resolved customer complaints in an efficient manner while preserving client relationships.
- Reviewed safety, health and sanitation processes throughout areas and enforced rules to promote security and safety.
- Collected copays and account balance payments as well as created and updated patient charts and medical records. Participated in credit and collections activities.
- Updated office calendars with new appointments and accommodated last-minute schedule changes.
- Performed basic bookkeeping tasks such as balancing cash drawers at end of day.
Education
Associate in Science (A.S.) - Healthcare Reimbursement
Virginia College
09.2011
Skills
- Database Systems(Excel)(PDF)
- Data Entry
- Reviewing Secure Patient Infor
- Time Management
- Patient Account Management
- Billing Processes
- Healthcare Terminology
- Medicare, Medicaid & Commerical Processes
- File and Records Management per HIPPA
- Epic EHS Software for Hospital & Providers, KAM Software
- Software Applications Proficiency
- Microsoft Word, Excel, Windows,
- CMS 1500, UB04 Form
References
References available upon request.
Timeline
Medical Billing Specialist
Piedmont Hospital formerly University Hospital
03.2020 - Current
Electronic Data Interchange Technician
Medac Medical Billing Service
07.2012 - 11.2019
Front Office Clerk
Margaret J Weston HealthCare Center
04.2008 - 06.2012
Associate in Science (A.S.) - Healthcare Reimbursement
Virginia College
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