TASHALEE SIMMONDS
Farmingdale,NJ
Summary
A self-motivated, forward-thinking, innovative Medical Billing Specialist with a proven track record of achievement. Aggressive, decisive, and driven with a solid reputation in client development and creative strategies. Reputation for excellent leadership, interpersonal, analytical, and case management skills. A passion for gaining personal relationships with clients, and able to develop trust in a partnership and incorporate a game plan to ensure the customer's success.
Overview
18
18
years of professional experience
Work History
Senior Medical Billing Specialist
Advanced Orthopedic Sports Medicine
Freehold, NJ
12.2023 - Current
- Analyzed patient accounts for accuracy and completeness of documentation and billing information.
- Developed and implemented processes to ensure accurate coding of diagnoses and procedures.
- Monitored changes in insurance regulations, policies, and guidelines to ensure compliance with all federal, state, and local laws.
- Conducted audits of medical records to verify accuracy of diagnosis codes.
- Performed data entry into electronic health records system for billing purposes.
- Resolved discrepancies between charges billed and payments received from insurance companies or other third-party payers.
- Reviewed claims rejections and denials to determine appropriate action needed for resolution.
- Responded to inquiries from providers regarding claim status, reimbursement rates.
- Maintained accurate accounting records related to medical billings.
- Prepared monthly reports summarizing billing activities.
- Reconciled accounts receivable balances with third party payers on a regular basis.
- Assisted in developing new policies and procedures related to medical billing practices.
- Provided training and support to staff members on medical billing processes.
- Reviewed payment plans with patients according to established protocols.
- Identified trends in denials that can be addressed through improved education or process improvement initiatives.
- Participated in meetings with healthcare providers concerning billing issues.
- Worked collaboratively with the finance team to ensure timely completion of month end closing tasks related to medical billings.
- Coordinated payment with insurance companies and discussed dental benefits with patients.
- Called insurance companies to verify patient benefits.
- Utilized various security techniques to maintain confidentiality of client data.
- Applied HIPAA privacy and security regulations while handling patient information.
- Submitted appeals using provider portals and phone communication.
- Reviewed claims for coding accuracy.
- Coordinated communications between patients, billing personnel and insurance carriers.
- Distributed or posted financial data to appropriate accounts and prepare simple reconciliations.
- Monitored reimbursement from managed care networks and insurance carriers to verify consistency with contract rates.
- Organized information for past-due accounts and transferred to collection agency.
- Answered customer questions to maintain high satisfaction levels.
- Submitted claims to insurance companies.
- Managed all payments processing, invoicing and collections tasks.
- Monitored past due accounts and pursued collections on outstanding invoices.
- Collected, posted and managed patient account payments.
- Entered procedure codes, diagnosis codes and patient information into billing software to facilitate invoicing and account management.
Workers Compensation Specialist
Allied Health LLC
Redbank, NJ
09.2022 - 11.2023
- Investigates claim to determine coverage and whether benefits are due and provides results of investigation to third party administrator adjuster
- Evaluates and responds to third party administrator requests for settlement and reserve authority
- Evaluate claims to determine potential exposure
- Has extensive experience of handling workers compensation claims for large, National clients
- Consults with client to help mitigate their risk
- Investigates claims to determine whether coverage is provided, establish compensability, and verify exposure.
- Reviewed workers' compensation claims to determine benefit eligibility and recommended appropriate action.
- Identified, investigated, and resolved discrepancies in workers' compensation records.
- Assisted employers with the completion of required forms for new hires and terminations.
- Developed strategies to reduce workplace injuries and improve safety procedures.
- Provided assistance to injured employees by providing information on disability benefits or other related benefits.
- Conducted audits of employer's injury and illness reports to ensure compliance with state regulations.
- Investigated employee complaints regarding workers' compensation issues.
Revenue Cycle Specialist/Medical Coding and Billing Specialist
J&S Stark Billing and Consulting Inc
Shrewsbury, NJ
11.2017 - 09.2022
- Process all claims, appeals, and resolve questions and problems about an account
- Review contracts for accurate payments and identifying payer trend issues with payment or codes
- Gather information regarding claims in order to contact insurance companies
- Bill claims to insurance company and make sure coding is accurate
- Resolve all denials on EOB to ensure full payment
- Ensured timely and accurate charge submission through electronic charge capture, including the billing and account receivable system and clearing house.
Medical Billing and Coding Specialist/AR Representative Lead
Med-Metrix
Neptune City, NJ
02.2015 - 10.2017
- Gather information regarding claims in order to contact insurance companies
- Bill claims to insurance company and make sure coding is accurate
- Resolve all denials on EOB to ensure full payment
- Ensured timely and accurate charge submission through electronic charge capture, including the billing and account receivable system and clearing house
- Accurately entered procedure codes, diagnosis codes and patient information
- Timely identify, research, and resolution any issues that may cause delays in payment or account resolution
- Identify and recommend opportunities to improve collections and follow-up activities
- Take actions that will support maximization of collection of balances due or account resolution from all sources
- Thorough knowledge and understanding of insurance plan policy updates including authorization and medical necessity requirements.
Personal Banker/Lead Teller
TD Bank
Neptune, NJ
02.2006 - 02.2016
- Proactively identify opportunities for relationship acquisition and development by cross selling the Bank's products and services in a consultative manner
- Build relationships with clients to help achieve business goals
- Conduct effective outbound communication with clients to educate and inform them
- Ensure all activities, transactions and records are in compliance with operational, security and control procedures of the Bank, preventing fraud and protecting customer assets
- Handle client service issues by taking ownership, conducting research, and following up daily as necessary until full resolution
- Conduct various transactions as needed, including cash handling, at all access points
- Facilitate regular meetings with team to educate and inform
- Supports expense management and overall achievement of Bank and team financial plans and goals
- Recommend the best needs-based solution; deliver solutions directly as well as introduce key partners (i.e., Investment, Mortgage etc.) when appropriate
- On-board and input new loans into loan application system
- Process loan payments and loan payoffs
- Prepare payoff statements and other request forms in writing as needed
- Gather and analyze pertinent information including financial statements to evaluate the acceptability of business risk
- Conduct the daily process in the BSA/AML monitoring system to reconcile currency transactions
- Assist experienced analysts in the research, analysis, and investigation of account behavior and case reviews for potential unusual activities in accordance with the BSA/AML/OFAC monitoring policy.
Education
Certified Billing And Coding Specialist - Medical Coding
Penn Foster Career School
04-2024
Bachelor of Science - Business Administration
Rutgers University
08.2011
Associate of Arts - Business Administration
Brookdale Community College
06.2008
Skills
- Office Management
- Excel
- Word
- Outlook
- Office Suite
- EMR
- EHR
- Greenway
- Cerner
- Epic
- OPS
- Medical Manager
- Athena
- Change Healthcare
- AAthena Client Advisory
- Relationship Building
- Problem-Solving
- Analytical Thinking
- Medical Billing
- Insurance Collaboration
- Claims Review
- Collecting Payments
- Revenue Cycle Management
- Claims Processing
- Commercial and Private Insurance
- Billing and Collection Procedures
- Teamwork and Collaboration
- Account Reconciliation
- Records Management
- Multitasking and Organization
- Claims review
- Worker's Compensation Knowledge
- Insurance Claims
- Invoice Coding
- Work Prioritization
- Account follow-up
- Medicaid and Medicare Knowledge
- CMS-1500 Billing Forms
- CERNER
- Patient Billing
- Reimbursements
- Customer Service
- Critical Thinking
- Claim review
- Electronic Claims
- CPT code modifiers
- Accounts Receivable
- Insurance claims processing
- HIPAA Compliance
- Payment posting
- Patient Collections
- Collections Management
- Medical Terminology
- Medical coding understanding
- Insurance Billing
- Submission of medical claims
- Payer Contracts
Websites
Timeline
Senior Medical Billing Specialist
Advanced Orthopedic Sports Medicine
12.2023 - Current
Workers Compensation Specialist
Allied Health LLC
09.2022 - 11.2023
Revenue Cycle Specialist/Medical Coding and Billing Specialist
J&S Stark Billing and Consulting Inc
11.2017 - 09.2022
Medical Billing and Coding Specialist/AR Representative Lead
Med-Metrix
02.2015 - 10.2017
Personal Banker/Lead Teller
TD Bank
02.2006 - 02.2016
Certified Billing And Coding Specialist - Medical Coding
Penn Foster Career School
Bachelor of Science - Business Administration
Rutgers University
Associate of Arts - Business Administration
Brookdale Community College
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