Spring McCurry

Specialized in labs, oncology, radiation, radiology, regimens for a high volume of third-party claims. Code, prepare and submit clean claims to insurance companies via electronic and paper submissions. Monitor insurance claims by running appropriate reports and contacting insurance companies to resolve claims that are not paid in a timely manner. Identify coding or billing problems from EOBs and work to correct the errors in a timely manner. Identify payor issues and trends and resolve recoup issues. Update demographic information in the patient account record and identify actions taken on the account. Provide thorough, efficient, and accurate account updates/notes in computer system for each call made. Follow-up on patient accounts to assure claims for patient charges submitted to insurance companies are paid in a timely fashion. Processing appeals Analyze and research denials Processing refunds and understanding of EOB’s Knowledge of CPT and diagnosis coding requirements.

Handled a high volume of third-party claims and ensures that accurate information is submitted to payers via the clearing house and/or payer intermediary in a timely manner to ensure prompt payment. Initiated the actions necessary to correct problems that prevent claims submission and/or contacts the individuals that are responsible for taking the corrective action to expedite claims processing. Documents all follow up activities on accounts in a clear and concise manner. Identified and reports the trends of claim edits, denials, and rejections to the supervisor for further review. Performed a variety of duties necessary to resolve individual patient balances. Keeps abreast of the changes to federal, state, and insurance regulations as well as maintains a general knowledge of billing and payment methodologies/guidelines. Understands the Professional Billing Revenue Cycle and how it functions.

Monitored status of outstanding accounts and identifies those requiring late charge postings. Identifies those accounts that are past due, and follows-up for payment to third party payors, patients, or others. As required processes refund transactions to insurance companies, governmental payors, or others for overpaid accounts. Processes billing functions for assigned workload, which could include primary billing, secondary billing, psychiatric billing, and professional billing. Assists in monitoring the accuracy of claim submission to third party agencies to improve cash receipts. Responsible for keeping assigned A/R within established benchmarks. Prepares spreadsheet for discussion with provider representatives. Performs 1st level appeals. Utilizes web-based products for billing status and follow-up. Processes correspondence and suspensions/rejects for assigned workload. Takes appropriate action to work accounts as necessary to secure payment. Assists in the review of requests for new procedure items. Meets performance expectations for Customer Service, Teamwork, Resource Utilization, Staff/Self Development and Job Responsibilities as outlined in performance review. Keeps current on contract knowledge and refunds. Performs other duties as assigned or directed to ensure smooth operation of the department/unit.

Improved patient experiences by efficiently managing appointments and maintaining organized medical records. Enhanced clinic efficiency by assisting physicians with routine procedures and diagnostic tests. Facilitated seamless patient care with thorough and accurate documentation of medical histories, vital signs, and medications. Ensured patient safety and comfort during examinations, effectively addressing concerns and answering questions. Streamlined office operations by managing inventory levels, ordering supplies, and organizing storage areas. Reduced wait times by swiftly processing insurance claims, verifying coverage, and obtaining pre-authorizations when necessary.

Verified payments done by insurance companies were accurate and according to contract guidelines. Verified and created claim numbers by communicating with various insurance companies. Updated patient accounts and information daily. Successfully handled 50 to 70 bills per day. Contacted insurance providers to verify correct insurance information and get authorization for proper billing codes. Reviewed and explained insurance plans to patients to guarantee full understanding of payment policies and procedures. Researched aging reports including reimbursements which were 90 days in arrears status. Performed regular telephone contact with providers to discuss status of rebilling and reimbursement process to ensure account resolution. Handled, processed, and distributed confidential patient information. Improved timely paying of bills by developing flexible payment plans for patients. Coordinated admission processes and prepared medical records and agreement packets. Contacted patients regarding unpaid and underpaid accounts.