Rosena Unruh
Longview,TX
Summary
Experienced in medical billing and collections for 27 years. Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.
Overview
37
37
years of professional experience
Work History
Director of Account Management
Voyage Medical Solutions
07.2022 - 04.2024
- Reviewed each account manager daily work log for productivity
- Instructed daily meetings with account manager team and assigned daily tasks
- Daily interaction with the department managers to resolve order issues
- Weekly meetings with management to discuss the department requirements per sales reps and products
- Frequent communications with the VP of sales regarding new products, sales rep requests, rush orders, new client business, and training for new products
- Created daily excel spreadsheets by order status and sales rep
- Submitted authorizations through Department of Labor portal and interaction with case workers and the patient on three way conference call
- Created authorizations through insurance website portals and verified the online status for approval or denial
- Contacted insurance carriers via telephone to create an authorization verbally
- Daily summary report for management pertaining to order totals by status
- Maintained and updated the excel spreadsheets for each sales representative for commission reports at the end of the month
- Daily emails and telephone calls with sales reps for the proof of delivery form
- Frequent communication with provider office staff and physicians via email and telephone for information to complete an order such as medical records, insurance information, request for prescription updates and/or verification of product
- Daily communication with sales reps via group email pertaining to rush orders, cancellations, approvals, and add on products for upcoming surgery orders
- Created documentation to appeal an authorization denials based on the insurance plan requirements of medical necessity
- Reviewed insurance medical policies to ensure the product meets medical necessity
- Durable medical equipment which included bone stimulator's, lumbar and cervical braces, shoulder braces and slings, walking boots, knee braces, canes, walkers, breast pumps, dvt/scd, shower commodes, cpm machine rentals, shoe inserts, wrist braces, and crutches
- Orthofix submission of an order for bone stimulator's and uploading supporting documentation. Created an excel worksheet which included submission date, inventory, shipping dates, fedex tracking, approval/denial, and payment
- Verified insurance eligibility and benefits, matching the policyholders name, patient's name, patient's address, guarantor information, date of birth, sex, policy number, group number, payer ids, and insurance address
- Filed insurance claims electronically and paper claims
- Appealed insurance denials for additional payment
- Skip trace for return mail on patient statements
- Patient collections and setting up payment arrangements and/or offering discount amounts
- Scheduled patients for in house fitting appointments
- Answered telephone and assisted in patient billing questions
- Contacting attorney offices for letter of protection, representation status, and emailing billing invoices for product costs
- Negotiated fee schedules and contracted rates with insurance carriers and adjusters
- Workman compensation and no fault claims obtaining the required information needed
- Provided leadership and coaching for staff by analyzing performance and adapting to customer recommendations.
- AR Dashboard formatted to collect patient payments, set up payment plan, print and/or email patient receipt
- Offered cash/self pay option for products verses high deductible and/or out pocket cost for the patient
- Authorized to write-off a patient balance as a courtesy or due to incorrect billing
- Authorized to make insurance adjustments based on explanation of benefits
- Issued insurance and patient refund requests
- Negotiated fees with Multiplan and other third party repricing carriers
- Provided leadership and training to staff by offering a positive supportive attitude
- Financial assistance offered to patients by referring to other suppliers
- Created excel spreadsheet for claims A/R and aging
- Initiated patient demographics for new accounts
- Npi website to search and verify a new provider
- Utilized icd10 search for 4th and 5th digit
- Waystar clearinghouse for insurance payments and rejections
- Coding for HCPCS for durable medical equipment
- Contacting patients, guarantors, next of kin, emergency contacts for insurance and patient information
- Submitted medical record request forms to provider office via fax and/or email
Account Representative
Pyramid Medical Management SERVICES
06.2006 - 07.2022
- Office trainer for new hire
- Billed for the following providers: obgyn, women's and pelvic health, biote hormone therapy, ob ultrasounds, pediatric, neurology, behavior health, internal medicine, infectious disease, gastroenterology, skilled nursing, orthopedic, anesthesia, pain management, and inpatient/out patient surgery
- Corresponded with providers verbally and via email
- Generated month end reports for various providers
- Created and distributed monthly quarterly spreadsheet for provider bonuses
- Filed insurance claims electronically and paper
- Verify insurance benefits and eligibility through insurance portals
- Utilized credit card payments through Square and Care Credit
- Access for Mother Frances website for medical records, insurance, and patient demographics
- Transferred patient and insurance credits within an account
- Contacted provider relations for provider contracts
- Created in-network provider for a provider to join the network with a insurance carrier by completing the required forms and uploaded to the portal or by mail based on specification
- Contacted Medicare, Medicaid, and commerical carriers regarding new updates and training
- Corrected insurance posting errors on patient accounts
- Appealed claims online with various insurance carriers and paper appeals
- Entered claims online with Superior, United Healthcare, Molina, TMHP, and other insurance carriers
- Downloaded remittances to view or print an explanation of benefit for all insurance thru Waystar clearinghouse
- Added and adjusted new fee schedules, NDC numbers, provider information, procedure codes, icd10 codes, new insurance carriers, payor id’s, new referrals to Eclinicals
- Issued Insurance refunds based on policy requirements
- Issued patient refunds due to overpayments or other circumstances
- Transmitted electronic claims for Zeid Medical Group and Premier Pediatrics thru Waystar
- Created new patient demographics
- Corresponded with providers regarding payments, insurance, medical records, and patient issues
- Called patients for insurance information
- Communicated with doctors office for patient information and/or medical records by phone or email
- Obtained authorizations for outpatient and inpatient surgery
- Obtained authorization for ultrasounds and office visits
- Patient estimator for coinsurance, copay, and out patient benefits per procedure
- Posted insurance and patient payments
- Posted insurance non-payments
- Posted office charges and hospital charges for Zeid Medical Group and Premier Pediatric
- Patient monthly collection report submission to Merchants Collections
- Corresponded with Merchants Collection Agency regarding patient payments, insurance payments, and paid account information each month
- Submitted multiple excel spreadsheets for transmittal thru FileZilla to Merchant Collection
- Skip traced patient addresses
- Returned mail which included updating patient addresses, flagging accounts, and stopping statements
- Authorized to contact and issue certified letters for patient insufficient checks
- Contacted and submitted returned checks to district attorneys office
- Resolved insufficient checks for insurance carriers by contacting carrier to resolve a recoupment
- Icd10 coding for 4th and 5th digit requirements for obgyn and pediatric billing
- Cpt coding by utilizing cpt professional coding books
- Obtained information on commerical update for deleted codes and new codes
- Courier to pick up documentation and payments to return to office and distribute
- Claim auditing
- Negotiated pay plans with patient balances
- Negotiated fees with Multiplan and other third party payers
- Corresponded with no fault and wmc adjusters
- Contacted and corresponded with attorneys regarding letter of protections
- Obtained bankruptcy notices and adjusted patient balances
- Scanned daily work consisting of payments, denials, and correspondence
- Attended insurance seminars regularly
Colection Manager
Pro-Serve Practice Management
09.1997 - 06.2006
Office Manager
Super 1 Foods
01.1987 - 09.1997
Education
Executive Secretarial School
Dallas, TX01.1986
Pine Tree High School
01.1985
Skills
- Office 365
- Word
- Excel
- Outlook
- Power Point
- Practice Management Software: EClinical Works, HealthPac, ModMed, Greenway, Brightree, Kareo, and Athena
- Teamwork and Collaboration
- Problem-Solving
- Account Management
- Reliability
- Organizational Skills
- Multitasking Abilities
Timeline
Director of Account Management
Voyage Medical Solutions
07.2022 - 04.2024
Account Representative
Pyramid Medical Management SERVICES
06.2006 - 07.2022
Colection Manager
Pro-Serve Practice Management
09.1997 - 06.2006
Office Manager
Super 1 Foods
01.1987 - 09.1997
Executive Secretarial School
Pine Tree High School
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