VIVIAN ANN WRIGHT

Medical Billing Representative

R1 RCM

Milwaukee

03.2008 - 09.2017

Claims review Billing security
Medical terminology medical billing technology
Support, Completed Lock Box, handling of all incoming payments from the payers, 75% balancing lockbox and adding amounts to spread sheets for finance 10%
Assisting department on any projects needed
Biller for Home Health
Billing, follow up from Medicaid, and Commercial payers, credit payments taken from patients 100%
Laboratory Biller, follow up on all commercial payers including HMO's, Medicaid, Medicare, self pays payments for patients. 100%
Completed authorizations for claims when required
Completed appeals for any claims that were paid incorrectly per the coder
Processed medical claims accurately using billing software systems.
Resolved billing discrepancies by communicating with healthcare providers.
Reviewed patient accounts for accuracy and completeness before submission.
Assisted patients in understanding their insurance benefits and billing statements.
Maintained detailed records of all billing transactions and communications.
Collaborated with team members to streamline billing workflows and procedures.
Provided excellent customer service to patients and healthcare professionals alike.
Updated patient information in electronic health record systems regularly.
Resolved any discrepancies or errors in billing documents through research and negotiation with payers.
Completed appeals and filed and submitted claims.
Prepared and attached referrals, treatment plans or other required correspondence to reduce incidence of denials.
Demonstrated analytical and problem-solving skill by addressing barriers to receiving and validating accurate HCC information.
Created invoices for services rendered in order to collect payments from patients directly.
Confirmed patient demographics, collected copays and verified insurance.
Maintained current working knowledge of CPT and ICD-10 coding principles, government regulation, protocols and third-party billing requirements.
Submitted refund requests for claims paid in error.
Reconciled accounts receivable ledgers against bank statements on a regular basis.
Maintained timely and accurate charge submission through electronic charge capture, including billing, and account receivables (BAR) system and clearing house.
Evaluated accuracy of provider charges, including procedures, level of care, and diagnoses.
Meticulously tracked and resolved underpayments.
Remained up-to-date details of patient financial responsibilities, fee-for-service and managed care plans by participating in training programs.
Performed quality control of data entry system to verify proper posting of claims and payments.
Analyzed and interpreted patient medical and surgical records to determine billable services.
Consistently informed patients of financial responsibilities prior to services being rendered.
Billed all lab claims with attached lab slips.
Updated patient demographics such as address changes or insurance coverage updates within practice management system.
Performed data entry of patient information into practice management software.
Assisted patients in understanding their bills and provided guidance regarding payment options.
Generated appeals for denied claims as necessary based on guidelines set forth by the provider's contracts.
Determined customer eligibility for benefit programs and services.
Communicated regularly with patients to ensure timely payment of balances due.
Maintained accurate records of all billing activities in accordance with HIPAA standards.
Prepared and submitted claims to insurance companies electronically and manually.
Provided customer service support by responding promptly to phone calls or emails from providers or customers seeking assistance with billing issues.
Analyzed EOBs for accuracy and compliance with contractual arrangements between provider and payer.
Verified patient eligibility for services through online portals or via telephone contact with insurance companies.
Conducted follow-up calls with third party payers to check on claim status and resolution.
Reviewed and processed medical insurance claims for accuracy, completeness and compliance with insurance regulations.
Interpreted coding instructions according to CPT and HCPCS codes when reviewing claim forms prior to submission.
Processed credit card payments over the phone or internet using secure payment systems.
Reconciled accounts receivable on a regular basis and reported any discrepancies to the supervisor.
Responded to inquiries from providers and managed disputes related to unpaid claims.
Verified proper coding, sequencing of diagnoses and procedures.
Tracked and recorded status of delinquent accounts and sent follow-up letters to request payment.
Documented all efforts made towards collections including letters sent, phone conversations.
Coordinated communications between patients, billing personnel and insurance carriers.
Distributed or posted financial data to appropriate accounts and prepare simple reconciliations.
Applied HIPAA privacy and security regulations while handling patient information.
Communicated with insurance representatives to complete claims processing or resolve problem claims.
Completed and submitted appeals for denied claims.
Reviewed claims for coding accuracy.
Reviewed account information to confirm patient and insurance information is accurate and complete.
Monitored reimbursement from managed care networks and insurance carriers to verify consistency with contract rates.
Input details into accounts and tracked payments.
Handled billing, waivers and claims for private and commercial clients.
Organized information for past-due accounts and transferred to collection agency.
Processed invoice payments and recorded information in account database.
Verified accuracy of information and resolved discrepancies with vendors before entering invoices for payment.
Gathered information to produce accounts payable reports for review.
Answered customer questions to maintain high satisfaction levels.
Collected, posted and managed patient account payments.
Entered procedure codes, diagnosis codes and patient information into billing software to facilitate invoicing and account management.
Performed insurance verification, pre-certification and pre-authorization.
Assessed billing statements for correct diagnostic codes and identified problems with coding.
Executed account updates and noted account information in company data systems.
Accurately input procedure codes, diagnosis codes and patient information into billing software to generate up-to-date invoices.
Trained new team members on company policies and accounting systems to keep team operations productive and efficient.
Performed accurate and fully compliant monthly closing processes, accruals and journal entries.
Checked claims coding for accuracy with ICD-10 standards.
Input statement information, reconciled accounts and resolved discrepancies.
Developed strong professional rapport with vendors and clients.
Charged expenses to accounts and cost centers by analyzing invoice and expense reports.
Reviewed purchase orders, sales tickets and charge slips to compute fees or charges due.
Prepared and posted weekly payments to vendors and suppliers.
Expedited payments by verifying accuracy and currency of vendor information.
Participated in workshops, seminars, and training classes to gain stronger education in industry updates and federal regulations.
Enforced compliance with organizational policies and federal requirements regarding confidentiality.
Computed credit terms, discounts and shipment charges for goods or services to complete billing documents.
Reviewed legal claims for accuracy and issues.
Posted charges, payments and adjustments.

Summary

Overview

Work History

Senior Claim Representative for Payer Solutions

Medical Billing W/Changehealth Care

Medical Billing Representative

Education

Associated Degree - Accounting

Skills

Certification

References

Timeline

Senior Claim Representative for Payer Solutions

Medical Billing W/Changehealth Care

Medical Billing Representative

Associated Degree - Accounting

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