Veronica Lightfoot

Train and lead a team of six medical billers. Oversee the monthly invoicing, production, and rebilling of claims (as applicable) for multiple clients. Forecasted the invoice total based on current trends and knowledge of the client. Review the accuracy of Billing Representatives' work, and provide quality feedback in a positive and constructive manner. Generate and deliver accurate, client-facing deliverables on time. Compile quarterly invoicing results for client business reviews. Identify and escalate client rebill, and follow-up trends that impact revenue. Facilitate new-hire training and mentorship for the Reimbursement department.

Investigated, reviewed, and provided clinical or coding expertise in the review of pre-payment claims. Conducted investigations to discover the reasons for unpaid or underpaid claims, or reimbursements. Verified records and documentation, ensuring all required paperwork and supporting materials have been submitted properly. Investigated and resolved all claim types to prevent payments that relate to fraud and abuse. Investigate and pursue recoveries and payables on professional and facility claims to identify payment, overpayment issues, and accuracy. Reviewed medical records to extract diagnoses and procedures.

(Contractor - Evening, Weekend Position) / Responsible for date-stamping, scanning, and data entering claims from a variety of sources in a timely manner to maintain turnaround time regulatory requirements. Kept current with incoming daily receipts, which include date stamping, scanning, and data entry of claims. Entered claim data accurately and in a timely manner; identified when received claims do not have the minimum necessary information required for data entry.

Maintained accurate records of all transactions, including account balances, and payment histories. Provided assistance to team members in resolving complex billing problems. Create weekly financial reports to spot cancellation and overcharge trends. Performed daily reconciliation of cash postings against bank deposits. Collect and post payment in patients' accounts. Resolve partial payments and denials from patients' payment methods, balance batches, and run transaction reports.

Handled customer escalated cases through investigation and case review. Answer requests from doctors and/or patients checking on the status of the case. Identify, document, and submit adverse events during customer contact, or via received documentation. Mediated an effective resolution for complex payer and pharmacy issues. Contacted customers to confirm approval/denials of coverage, co-pays, patient assistance programs, and verification of the specialty pharmacy that will dispense their medication. Successfully completed and recreated the BI/SOP work instructions.

Worked PB, HB, UB04, and CMS 1500 claims. Processed up to 60 to 70 claims a day. Worked on all rejection and payer audit reports within 48 hours of receipt. Performed daily downloads and reconciliation of claims, and transmitted or released claims at a minimum daily. Place inpatient, outpatient, pharmaceutical, and surgical DX codes. Assigned ICD-10 and/or CPT/HCPCS codes to appropriate, and abstracted pertinent information from patient records. Worked on high-dollar claims.