SUMMARY

• Detail - oriented with good analytical problem-solving skills
• Excellent computer, time management, organizational and analytical skills with proficiency in Excel and Microsoft Office Suite as well as A/R systems and associated applications.
• Outlook experience
• Ability to work independently, exercising good judgment, and multi-task in a high stress, fast-pace service environment with patients, insurance carriers and leadership
• Excellent customer service skills to communicate effectively with insurance carriers, patients, and colleagues.
• Knowledge of CPT, ICD9 utilized in medical billing and medical terminology.
• Established and demonstrated competency in accounts receivable systems and associated application ( Relay Health Assurance, STAR)
• Ability to maintain professional conduct and good working relationships with staff, management, and payers.
• 10 Years experience in Health care billing and Customer service.
• 1 year in Management of staff - Patient Revenue Realization - IP billing/follow up

PROFESSIONAL EXPERIENCE

Confidential, Melville, NY

In Patient Interim Supervisor

Responsibilities:

• Coordinate the daily activities of the A/R operation ensuring that the aging accounts are reviewed and resolved, collector work files are completed on a daily basis and appropriate actions are taken by staff to ensure timely and correct claim payment’s
• Assists in development of and participates in ongoing staff educational programs
• Communication with Dept Heads for all Inpatient Denials.
• Prepares Monthly spreadsheets for VP’S.
• Prepares Budget reports
• Coordinates Aging reports/ spreadsheets for staff.
• Supervise 28 staff members
• Created two new depts. Within In Patient to better handle volume and accountability
• Help define Work Station criteria for rebuilding of employees Workstation.
• Communication with Directors of all 6 Hospitals to get bills out and for follow up payment
• Monthly meeting with finance to discuss A/R balances.

Confidential, Melville, NY

EDI Specialist

Responsibilities:

• Billing of all inpatient & outpatient facility bills for all 6 hospitals
• Work claims on 277 reports. (denials)
• Research/resolve discrepancies on claims for all payer and patient types
• Communication with personnel and Department heads to resolve processes related to transmission of claims to all payers’
• Creation of reports/spreadsheets of all claims failing in system & communicating with sites to resolve
• Obtain and balance claims transmission data to ensure the claims are received by payers
• Education of staff t assist in avoiding billing delays
• Creation of job aides/procedures to outline specific processes EDI staff needs to follow.
• Building of bridge routines to RELAY (our billing system) to solve billing issues.
• Reviews billing work queues and reports to determine accounts/claims requiring action.
• Ensures claims are crossed over to secondary and tertiary payers and reports any delays in unbilled claims.
• Collaborates with internal departments, external vendors and IT for issue resolution and operational effectiveness.

Confidential, Melville, NY

Patient account representative

Responsibilities:

• Process Workman s comp/NF insurance claims for outpatient accounts using electronic billing system
• Work all reports pertaining to billing of Out Patient Accounts (failed claims, late charge, and dx/da reports, two a day)
• Heavy contact with hospital staff/dept to obtain correct dx, hcpcs, modifiers etc to validate claims in timely manner.
• Knowledge of Medicare, No - Fault and Workman comp rules and regulations
• Proficient in electronic billing system.
• Proficient in Denial and Appeal follow up.
• Proficient in Omni Pro.
• Proficient in Micro Soft Excel
• Excellent interpersonal communication skills