AR Rep/Insurance Follow Up (Remote)
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Individual with extensive medical experience working in Human Resources, Workman's Compensation, Medical Billing/Coding, Medical Records, Reception, Verify insurance/eligibility, initiate/review authorizations, multi physicians, specialty physicians, nursing home and rehab facilities.
Skills and knowledge utilized: Insurance Verification, Insurance Follow-Up, Insurance Billing. Authorized to work in the US for any employer.
AR Rep/Insurance Follow Up (Remote) - RCM360 - Brooksville, FL
(2024-10)
Responsible for work comp and Auto claims. Review AR, review EOB's against HCFA and progress note that denial is valid. Work denials, initiate and submit reconsiderations and appeals on all levels. Take work comp adjustments as needed, review EOB's to ensure claim was processed correct.
Insurance Follow-up Specialist - Professional Billers - Rockledge, FL
(2024-06 - 2024-09)
Contact insurance company for claim status, scrub claims prior to submission, fix errors in clearinghouse. Review denials, work rejections submitting appeals and reconsiderations. Work AR keeping it 90 days or less.
Office Manager - Gary M Weiss, M.D., P.A. - Palm Bay, FL
(2023-07 - 2024-01)
Physician retired, I attended to all unfinished business of closing the practice. Review attorney cases daily for status and updates, negotiate attorney settlements, track settlement amounts, review patient account balances, negotiate patient account settlements, initiate patient payment plans, process all medical records requests, submit referrals, bill claims, do adjustments and write offs, post patient payments. Created numerous spreadsheets for patient monthly payments, and ongoing status of attorney cases with the final outcome.
Follow-Up/ Denials Specialist - Champion Home Health - Melbourne, FL
(2023-02 - 2023-07)
Bill claims to insurance, fix errors in the RCM and resubmit using EDI, 834 process to clearinghouse. Contact insurance for claim status, review denials, initiate appeals and reconsideration, submit documentation for claim processing including proof of timely filing. Review correspondence and work claim accordingly, download the 835 and check the amount on the form against amount applied to account, track all re-works and outcomes on spreadsheets. Verify insurance and eligibility.
Medical Records Manager - Atlantic Shores Nursing & Rehab Center - Melbourne, FL
(2022-01 - 2023-02)
Review and audit resident charts upon admission, perform 12, 24, 72 hr chart audits in addition to ongoing monthly audits. Note deficiencies on audit tool submitting those to department head for correction, re-audit chart to ensure corrections have been made. Review chart for resident personal information accuracy; Advance Directives, diagnosis, physician orders are present/current.
Perform audits on physician orders & visit frequency are within MCR guidelines. Close out charts within 30 days of discharge from facility, audit while closing chart to ensure discharge documentation is charted.
Onboarding Coordinator-Contract - HHS/Acuity International - Cape Canaveral, FL
(2021-09 - 2021-12)
Review and upload candidate information electronically into system, request missing documentation via phone or email, check drug screen and background checks for status, research and analyze documents and client information, update and maintain client records, navigate between multiple databases and spreadsheets.
Claims Biller/Coder-Temp - Brevard Walk In Clinic - Merritt Island, FL
(2021-03 - 2021-07)
Bill and review claims ensuring CPT & ICD codes entered are compatible with the encounter form and computer assigned diagnosis and is appropriate for procedure or services performed. Process claim through RCM for errors, fix errors and submit via EDI, 834 to clearinghouse. Query physician regarding conflicting information, scrub claims and make corrections prior to submitting to clearing house.
Perform follow-up on claim status, review denials, submit appeals, resolve issues with claims. Verify amount on the 835 is amount applied to appropriate accounts, verify insurance eligibility and benefits, request authorizations, post patient and insurance payments, submit requested documents to insurance for review & payment. Provide customer service pertaining to billing.
Medical Claims Insurance Billing Specialist - Fl Eye Consultants - Melbourne, FL
(2020-01 - 2021-03)
Capture CPT and ICD codes for claims, review claims ensuring computer assigned diagnosis is appropriate with procedure code, ensuring all compliance measures are present notifing provider of any noncompliance found. Query physician regarding conflicting information, scrub claims through the RCM making corrections prior to submitting via EDI 834 to clearing house, follow-up on claim status, review denials, submit appeals, resolve issues with claims, verify eligibility and benefits, request authorizations, view 835 amounts were posted to correct account, post patient payments, submit requested documents to insurance for review & payment, review correspondence, provide customer service to patients regarding their account, work aged report.
Medical Claims Billing Specialist - Spherion Staffing Svc-Temp Agency - Melbourne, FL
(2019-06 - 2020-01)
Bill mental health/ Behaviour health claims while company transitions to new billing system. Enter and review CPT and ICD10 codes per documentation and computer assignment, scrub claims through RCM prior to submitting to clearing house via EDI 834, perform chart audits to include HEDIS compliance. Follow-up on claim status, review denials, submit appeals, resolve issues with claims, verify eligibility and benefits, request authorizations, view 835 and ensure correct amount(s) posted were to correct account, post patient payments.
Resolve coding or billing issues, document deficiencies, incomplete charts or errors to providers for correction, track insurance carrier and claims billed to insurance to determine number of outstanding charts left to bill.
Insurance Claims Biller/Follow Up Specialist - The B.A.C.K. Center - Melbourne, FL
(2018-06 - 2019-03)
Follow-up on claim status, review denials, initiate appeals, submit documentation necessary for claim reimbursement, resolve billing issues with insurance companies. Submit claims to secondary insurance, assist patients with billing questions. Additionally submitted, worked and followed up on AR claims for Work Comp, Auto, VA, Tricare claims with office notes or other documentation as required or needed for claim processing and payment. Track claims on spreadsheet.
Medical Coder I - Jess Parrish - Titusville, FL
(2015-03 - 2018-06)
Code Inpatient and outpatient charts. Assign appropriate diagnosis based on documentation and computer assignment, scrub claims prior to submitting to clearing house. Query physicians when information is lacking or conflicting. Track missing charges on physician spreadsheet, perform chart audits for HEDIS measures and compliance, notify providers of noncompliance issues. Maintain and update individual physician spreadsheet against daily signature report.
Office Assistant I - Health First Private Duty - Melbourne, FL
(2010-06 - 2015-02)
Assigned to various offices to assist with daily operation (HR, Benefits, Medical Records, Coding, Auditing. Marketing/Public Relations, Work Comp). Review Medical Records for accuracy and completeness to physician documentation, signatures and orders; review ER paperwork for accuracy and completeness of notation, signature, discharge instructions /orders and follow up instructions are documented. Additionally merge duplicate charts and scanned all facilities' hard charts into electronic charts.
Patient Account Rep/Claims Follow Up Specialist - Osler Medical - Melbourne, FL
(2007-04 - 2009-12)
Follow up on claim status, submit Work Comp, Auto, VA, Voc Rehab and Tricare claims, submit notes and/or documentation with claims, resolve billing issues with insurance companies, obtain authorization and referrals, review denials, initiate appeals, submit claims to secondary insurance, assist patients with billing questions, set up patient payment plans.
Certificate - Medical Billing & Coding - Keiser College (2000-01 - 2000-06)
A.S. - Business Administration - Herzing University (1997-04 - 2000-06)
