Account Resolution Specialist – Physicians Surgery/Anesthesia - Children's Healthcare of Atlanta - Atlanta, GA
(2021-01)
- Facilitates office hours with coordinators to help resolve difficult accounts where they need guidance.
- Facilitates monthly recap for surgery and anesthesia to discuss trends, discuss current issues, workflow procedures, coordinator feedback, CMO/A news.
- Leadership report and feedback monthly with leadership
- Serves as a resource for resolution of accounts while coordinator is working accounts.
- Approve adjustments for first tear to ensure required information is noted, checking quality of notes, sending feedback to coordinators to make any adjustments or changes.
- Help to maintain team morale with activities, team events.
- Superuser – provide important feedback and provide updates and training.
- Review A/R for possible projects for A/R coordinators.
- Demonstrate strong communication, organizational and interpersonal skills via folder meetings, huddles, and team events.
- Support my supervisor.
- Managed payor issue work ques for Medicaid and CMO payors acting as a liaison between A/R coordinators and payors.
- Liaison between coding, practices, charge integrity team and other departments for the team as needed.
- Help to maintain the provider enrollment files in Cactus by communicating with the Managed Care Department
- Taking initiative by continuing my growth via classes provided by Children's and Linkin
- Proactively review outstanding A/R for team members for special projects
- Work and maintain assigned medical payers' denial and no response work queues such as Blue Cross Blue Shield, Kaiser, Aetna, Cigna, Humana, CareSource, and all other mom and pop payers to resolve any denied or rejected claims via various methods, to include submitting an appeal, address any billing issues via websites, or with payer representatives as necessary.
- Troubleshoot any denial trends and report finding to Team Lead and Supervisor to insure prompt and accurate reimbursement of claims.
- Work with leadership to develop training material for the team.
- Meet and exceeds department collection performance expectations. Complete assigned duties in a timely manner to assure prompt and accurate payments of claims.
- Utilize varies payer websites to electronically submit appeals, disputes and medical records,
- Resolved denied or rejected claims via FinThrive.
- Train new collectors as well as train and support all staff in use of software and proper collection procedures. Also, serves as a mentor for other teammates.
- Complete assigned projects designated by Team Lead and Supervisor.
- Always available for fellow coworkers regarding billing issues and assistance as needed.
A/R Coordinator – Physicians Surgery - Children's Healthcare of Atlanta - Atlanta, GA
(2019-10 - 2021-09)
- Work and maintain assigned medical payers' denial and no response work queues such as Blue Cross Blue Shield, Kaiser, Aetna, Cigna, Humana, CareSource, and all other mom and pop payers to resolve any denied or rejected claims via various methods, to include submitting an appeal, address any billing issues via websites, or with payer representatives as necessary.
- Troubleshoot any denial trends and report finding to Team Lead and Supervisor to insure prompt and accurate reimbursement of claims.
- Meet and exceeds department collection performance expectations. Complete assigned duties in a timely manner to assure prompt and accurate payments of claims.
- Utilize varies payer websites to electronically submit appeals, disputes and medical records,
- Resolved denied or rejected claims via FinThrive
- Train new collectors as well as train and support all staff in use of software and proper collection procedures. Also, serves as a mentor for other teammates.
- Complete assigned projects designated by Team Lead and Supervisor.
- Always available for fellow coworkers regarding billing issues and assistance as needed.
Lead Medical Billing Specialist - Medical Management Solutions - Peachtree City, GA
(2003-05 - 2019-12)
- Responsible for facilitating problem resolution, collaboration, implementing and ensuring adherence to billing policies and procedures.
- Partner with billing manager to interview, hire, and train team members for medical billing and collections.
- Review and resolve denied claims by corresponding with insurance companies via phone/website/fax to file appeals, provide medical records, and submit corrected claims.
- Oversee billing for all skin grafts by verifying units and charges, invoice reconciliation, and follow up with skin graft representatives to ensure timely payment.
- Review physician notes and claims for accuracy and completeness prior to claims submission.
- Research and correct insurance and clearinghouse rejections.
- Regular contact with physicians and clinic staff regarding office notes, clinic charges, durable medical equipment acknowledgement forms, advanced beneficiary notices, insurance referrals and authorizations, etc.
- Accurately post outpatient wound care charges into EHR system.
- Research and retrieve all missing electronic remittance advices as it pertains to outstanding claims.
- Verify patient eligibility, claims status, and filing order with insurance agencies.
- Manually post insurance payments as needed.
- Responsible for office supply orders and maintaining inventory.
- Keep management apprised of matters regarding insurance denials.
- Remain current on coding changes and assist physicians and staff with coding questions.
- Identify and resolve patient billing complaints.
