Revenue Cycle Specialist at Cornerstone Healthcare Group Holding (2022-04 – 2023-09)
Resolved complex payment issues and managed insurance claims in electronic billing systems.
- Resolved complex payment issues such as denials, underpayments or incorrect coding
- Correct medicaid claims in electronic billing system for missing or invalid Insurance, or patient information according to procedures
- Outbound calls to insurance companies to verify coverage, eligibility as well as claim status
- Monitor claim status, research rejections, denials, and document related account activities
- Identified and resolved payments issues between patients and providers
- Determine most efficient process to resolve refund requests or credit balance
- Identified and billed secondary insurances engaged in reading RA/EOBs and post payment accurately with great attention to detail
- Recognizes potential issues within claims and collections process and recommends and implements solutions for improvement
- Research missing payments and secure documents needed for posting
- Responsible for managing patient account in processing accounts and working with designated payers to ensure proper reimbursement
- Contacts patient when there is need to update information or COB
- Monitor and Send Claim Files electronically or Paper Claims to Commercial, Medicare and Medicaid
- Track common claims errors, identify and reports inaccurate reimbursement and contractual trends
- Identified billing errors, short payments, overpayments and unpaid claims and resolved them accordingly
- Posts adjustments and collections of Medicare, Medicaid, medicaid managed care and commercial insurance payers
- Contacted responsible payer for status of claim
- Filing appeals for denied claims or claims that requires reconsideration
Revenue Cycle Specialist at Fairview Health Services (2019-05 – 2022-04)
Resolved claim edits and managed healthcare claims through insurance communication and coordination of benefits.
- Resolves claim edits within practice management billing system to ensure successful claim submission
- Daily communication with insurance companies and other commercial insurers to address coordination of benefits and claims resolution
- Reviewed EOBs for correct payment, deductible, adjustments and denials
- Sets follow-up activities based on status of a claim
- Generated receivables reports and offered improvement recommendations
- Reached out to insurance companies to verify coverage
- Work and manage claims from all aging buckets including posting and appeals
- Ability to multitasks and prioritize tasks to accomplish and maintain goals
- Effectively navigate and utilize various healthcare provider software systems
- Ensures compliance with all Health Insurance Portability and Accountability Act (HIPAA) standards
- Resolve healthcare claims through verbal or online inquiries to health insurance payers
- Verify accuracy of insurance and patient information
- Verify insurance data entry along with scheduling, and confirming appointments
- Post adjustments and collections of medicare, medicaid, medicaid managed care and commercial insurance payers
- Read and interpret insurance Explanations of Benefits (EOB)/Remittance Advice (RA) with understanding and take appropriate steps to resolve issues
Revenue Cycle Specialist at Genesis Medical Center (2016-06 – 2019-04)
Identified and resolved payment issues, managed claim edits, and coordinated insurance benefits across multiple service lines.
- Identified and resolved payment issues between patients and providers
- Resolved system billing and claim WQ edits by working closely with clinical departments, coding staff and registration to assure errors are competed correctly and in a timely manner
- Utilize account information to assist in write-offs for inclusive CPTS by payor
- Communication with insurance payers to ensure proper coverage for patients or to ensure timely and accurate reimbursement for services rendered
- Work with payor throughout the resolution process
- Investigate and coordinate insurance benefits for insurance claims across multiple service lines
- Review and interpret payment information from the EOB (explanation of benefits) to accurately apply payment and adjustment when necessary
- Research denied claims to determine reason for denial by contacting the payor and reviewing the EOBS or R&S
Customer Service Representative at Wipro Technologies (2015-02 – 2016-05)
Handled inbound and outbound calls for 401k participants, processed service transactions and resolved member issues.
- Effectively handled inbound and outbound calls on 401k participants
- Accurately and successfully process service transactions and reached resolution on member issues in a timely and effective manner
- Ability to effectively establish rapport, communicate information and diplomatically respond to inquiries from callers
- Ability to multi-tasks including navigating between computer applications while speaking with participants/payers on the phone
- Tactically handles confrontational or stressful interactions with customers
- Handled customer inquiries and suggestions courteously and professionally
- Actively listened to customers, handled concerns quickly and escalated major issues to supervisor
- Answered constant flow of customer calls with minimal wait times
