Sarida Emola
Cedar Lake,IN
Summary
Achieved accurate Medicare billing through meticulous attention to detail. Promoted patient privacy by strictly following HIPAA guidelines. Proactively managed job responsibilities to ensure all tasks were completed on time.
Overview
29
29
years of professional experience
1
1
Certification
Work History
Patient Financial Services Specialist II (Remote)
Beloit Health Systems
09.2021 - Current
- For this position I am responsible for all Medicare institutional and professional claims, Medicare Advantage Replacement, third party and Supplemental payers. Daily, I correct errors in Nthrive incomplete folder and transmit those bills out, or, if needed re-assign to coding. Now we have Experian/Claim source we work out of and tag team leads when necessary. In Cerner we have many work ques Technical Denials which include, additional info needed, reimbursement, benefit, sub billing errors, prior authorization and other. Coding updates, Edit failure, Late charges, Eligibility/Cob, Corrected claim, Referrals, Record request from payer, Appeals decisions, Credit balance and we work that daily per Beloit's requirements. For reports as mention Credit report, Hold report, RTP report, 180 day report or whatever report is needed at that time. For the insurance portals we access weekly; for example United Health Care we must send edits and Track It, for Availity/Humana medical management records, and also Anthem in Availity. We are monitored very closely we have to meet a quota weekly on how many claims we complete which is 275 claims. We also get audits done on our work progress and if something is incorrect we are made aware of it to educate us going forward. We have to attend weekly morning meetings with management and team leads thru Microsoft Teams. I have also done extra work for our team when people are absent or when we are under staffed.
Clerk Typist II
Northwestern Medicine Palos Community Hospital Home Health/Hospice Care & Palliative Care
10.2005 - 09.2021
- On October 29, 2018 I transferred back to Home Health Care to accept the Medicare Biller job and I do all of the Medicare Replacement insurances. I am responsible for all of the PCR (pre-claim review) entry and all of the E-letters that we receive from Palmetto E-Services. As of 1-1-21 I do the NRP (no pay raps) for Medicare in which we need to have these raps in by 5 days within the start of care of recertification or Medicare deducts 1/30 of the payment from the final bill. I do all of the RTP (return to provider) within the DDE (direct data entry) system and I call Medicare when necessary. I check the DDE system daily for ADR's, I do appeals with Medicare and Billing Disputes when needed. In the Epic system I have many work queue's that I'm responsible for completing. I cover for Insurance Verification for only the Home Health when needed. I do all of the payment downloads for every insurance daily. I am on a rotation to cover for the receptionist along with my other co-workers.
Professional Biller
Palos Community Hospital
08.2017 - 10.2018
- I'm currently in a new position at Palos Medical Group as a Professional Biller in the Business Office. I transferred to this job on August 22, 2017. My responsibilities are to bill claims out of Epic and Claim Source and completing follow up working the work queues and calling insurance companies. I print out the paper claims and mail those out also completing errors out of Claim Source daily and transmitting corrected claims. Answer patient and or insurance phone calls daily collect payment information when needed and answering questions regarding statements or bills. I complete incoming mail issues from any insurance company and scan document information as needed. I'm also am the backup for cash posting and help out when I'm asked, or needed.
Palos Community Hospital
10.2005 - 08.2017
- Responsibilities include cash application to each patients account, and retrieving Medicare vouchers thru the Ability System now Epic System. Verifying all payments is posted and correct to each account. I prepare weekly bills to be processed and sent to accounting for payment at the hospital. Back up for the Medicare biller and utilizing CMS system and Claim Source e-care. Receiving all logs and notes from therapy (P.T., S.T., O.T.) verifying all information match, signed, dated and are correct. After entering in Remote the note is scanned into Epic Hyperspace. Have experience with 3M computer system, currently working with AllScripts and now on our new system Remote and Epic Hyperspace. Rotating coverage for the receptionist area for morning and lunch time on average of once every 8 weeks.
Medicare Specialist
Advocate Christ Medical Center
10.1998 - 10.2005
- Daily responsibilities include import and transmitting of Inpatient/Outpatient claims, reports, and calculating days for admits for inpatient stay, and billing. Weekly duties include Medicare Vouchers verifying payments are correct and working non-payment claims. Working quarterly Medicare credit reports aged trial balance and ADR's, ensuring all needed medical records are available. Sending appeals to Medicare when it is necessary. Attending Medicare Seminars yearly regarding updates.
Biller, Follow up with insurances
Gencare Health Services, Inc.
02.1997 - 07.1998
- Responsibilities include billing for Medicare, Public Aid and commercial insurances. Reviewed frequencies on all therapy visits. Used the Florida Share System to transmit and adjust Medicare bills. Tracked Public Aid due dates for approvals and United Health Care insurance and mailed bills weekly. Followed up on the receivable report collecting from insurance companies only. Type on 10 key by touch, currently working with InfoMed and Windows-95.
Education
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Moraine Valley Community College
Palos Hills, IL06.2014
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Prairie State University
Chicago Heights, IL12.1998
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ATTC Vocational School
Oak Forest, IL12.1993
Skills
- Achieved seamless CMS (DDE) Medicare RTP and electronic billing through effective use of Waystar and Experian ClaimSource Delivered accurate hospital inpatient and outpatient billing for SNF and hospice services, enhancing revenue cycle management Generated eligibility reports and managed data through Connex and Allscripts, improving operational efficiency Streamlined insurance verification processes with UHC, Humana, and Availity, resulting in faster claim resolutions Enhanced patient records management using Epic Remote and Epic Hyperspace, increasing accessibility for healthcare providers Optimized medical records processing with Cerner Encoder and PowerChart, ensuring compliance with regulations Utilized NThrive and various online insurance tools to drive billing accuracy Demonstrated strong multitasking and decision-making capabilities, contributing to overall team success Maintained a high level of reliability in all tasks
Certification
Medical Billing
CRCR Certificate
- Area of certification, Company Name - Timeframe
Timeline
Patient Financial Services Specialist II (Remote)
Beloit Health Systems
09.2021 - Current
Professional Biller
Palos Community Hospital
08.2017 - 10.2018
Clerk Typist II
Northwestern Medicine Palos Community Hospital Home Health/Hospice Care & Palliative Care
10.2005 - 09.2021
Palos Community Hospital
10.2005 - 08.2017
Medicare Specialist
Advocate Christ Medical Center
10.1998 - 10.2005
Biller, Follow up with insurances
Gencare Health Services, Inc.
02.1997 - 07.1998
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Moraine Valley Community College
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Prairie State University
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ATTC Vocational School