Stacey Wilds
Spring Hill
Summary
Experienced Claims Specialist skilled in medical billing and claims adjudication. Expertise in CPT coding and collaboration drives timely resolution of complex claims. Strong analytical abilities enhance claim detail analysis and policy navigation. A proactive team member focused on effective communication and problem-solving to achieve positive outcomes.
Overview
14
14
years of professional experience
Work History
Senior Claims Specialist (remote)
Knowtion Health
Boca Raton
06.2017 - Current
- MVA billing and collections with auto insurance carriers as well as attorneys including Med Pay, Personal Injury Protection, Third Party Liability and Bodily Injury claims.
- Attorney settlement review and negotiations.
- Responded to inquiries from patients, attorneys, and auto claims adjusters, ensuring timely resolution of billing questions.
- Distributed billing statements and medical records to relevant parties, supporting efficient claims management.
- Contact auto insurance adjusters and/or attorneys for claim status and payment.
- Contacted patients to gather auto accident details and claim policy information, facilitating accurate claims processing.
- Consistently met monthly quotas to ensure efficient billing and collections processes.
- Assisted with special projects assigned by supervisor to support team goals.
Insurance Collector
Accelerate Revenue Management
Murrieta
05.2014 - 04.2017
- Billing and collections done for Physical, Occupational and Speech therapy
- Commercial, Medicare and Medicaid Claims follow up calls
- Online claim status follow ups (Availity, One Health Port, UHC, Group Health, Veterans Administration Provider One)
- Online patient benefits and eligibility verification
- Motor Vehicle Accident, Personal Injury Protection, Worker’s Compensation - Attorney/ Adjuster calls for claim/case status and settlements.
- Prepared and submitted provider disputes, reconsiderations, and appeals to resolve billing discrepancies.
- Processed contractual write offs adjustments and insurance payment posting to maintain accurate accounts.
- Ensured accurate patient demographics and insurance information for billing.
- Reviewed patient statements for accuracy to ensure timely collection and minimize errors.
- Review Letters of Representation from attorneys for HIPAA accuracy
- Electronic claims submissions (Office Ally, Zirmed)
- Achieved and exceeded company goals and standards in all tasks.
Insurance Collector
Progressive Management Systems
West Covina
04.2013 - 03.2014
- Conducted follow-up calls on insurance collections to track status of claims and appeals.
- Collect on the following hospital accounts: Long Beach Memorial, St. Francis Medical Center, City of Hope Medical Foundation, and Memorial Care Imaging.
- Review and investigation of claims and contracts to establish offsets/write-offs.
- Prepared 1st and 2nd level provider disputes/appeals to ensure timely filing and address medical necessity and underpayments.
- Reviewed medical records and chart notes to assess medical necessity and verify accurate claims billing.
- Review insurance contracts for appropriate claims payments
- Use of hospital billing systems to retrieve necessary patient demographics and billing information.
- Meeting and exceeding monthly company production goals.
Health First Medical Group Externship
Everest College
Santa Fe Springs
08.2012 - 09.2012
- Executed coding for medical procedures and equipment (CPT and HCPCS), maintaining adherence to coding standards.
- Processed claims and adjustments for worker's compensation and physical therapy, ensuring accuracy and compliance.
- Conducted timely follow-ups with payers to expedite payment processing.
- Posted electronic payments accurately to financial records.
- Scanning and inputting documents to ensure proper records are kept.
Education
Diploma - Medical Insurance Billing and Coding
Everest College
Industry, CA01.2012
High School Diploma - All required
Booker High School
Sarasota, FL01.1998
Skills
Medical billing
- Interpersonal skills
- CPT coding
- ICD-9 CM coding
- CMS-1500 billing
- Claims adjudication
- Benefit verification
- Effective communication
- Claims investigation
- Teamwork and collaboration
- Multitasking
- Data entry
- Detail orientation
- UB04 claims billing
- Insurance collections
- EPIC hospital claims billing software
- Claim Gear
- HCPCs
- Dentrix
- Electronic payment posting
- Benefits verification
- HMO billing
- PPO billing
- Government and commercial insurance
- Medical terminology
- Verbal communication
- Written communication
- Appointment scheduling
- Telephone etiquette
- Insurance collection follow-up
- Claim status
- Claims appeals
- Medical Coding
- Medical Insurance
- DME
- Revenue Management
- Insurance Verification
- Speech Therapy
- ICD-10
- Athena Health
- Microsoft Office Applications
- EMR Systems
- Bookkeeping
- Fast typing skills
- MediSoft
- Microsoft Word
- Excel
- PowerPoint
Awards
- Everest College Awards, 06/01/12
- Honors Award
- Ambassador Igniter Program
- Perfect Attendance
- Consecutive Student of the Module Awards
Personal Information
Title: Medical Billing Revenue Specialist
Timeline
Senior Claims Specialist (remote)
Knowtion Health
06.2017 - Current
Insurance Collector
Accelerate Revenue Management
05.2014 - 04.2017
Insurance Collector
Progressive Management Systems
04.2013 - 03.2014
Health First Medical Group Externship
Everest College
08.2012 - 09.2012
Diploma - Medical Insurance Billing and Coding
Everest College
High School Diploma - All required
Booker High School