Resume Charlotte,NC - Hire IT People

SUMMARY:

Bill and appeal professional claims for Cardiology, Primary Care, Urgent Care/Durable Medical Equipment, Radiology, Laboratory Testing and Physical Therapy.
Improved revenue received from Medicaid by 100% for Depo Provera
Improved reimbursement rate from claims submitted to Medicare by 43%
Improved reimbursement from insurance company (Americas First Choice) for labs by 28% due to comprehensive understanding of the Clinical Laboratory Improvement Amendment.
Obtain Explanation of Benefits from various insurance websites for posting payments.
Experienced in 7 different modules in Epic (including Charge Entry)
Experience in working the Charge Review, Claim Edits and in Patient Workques
Trained employees on medical practice software and medicare guidelines.
Examined claims to make determination to either pay or deny depending on medical necessity and policy exclusions.
Obtain Pre - Auths/Pre-Certs/Referrals

PROFESSIONAL EXPERIENCE:

Confidential,Charlotte,NC

Patient Account Representative

Responsibilities:

Review Explanation of Benefits and determine corrections on denied claims. Audit chart notes to determine if a procedure is medically necessary; work with physicians and nurses to assure correct coding/sequencing of Procedure/Diagnosis. Correct coding in Epic (dimension)workques. Assist patients with questions about billing statements/assure customer satisfaction. Make sure patients fill out Release of Information forms before disclosing PHI to Lawyers, Family members etc. Assured appointments were made according to physician scheduling preferences. Track trends in denials to assure quick resolution of problems. Obtain missing Explanation of Benefits from insurance websites for posting.. Train new employees on E-MD, Epic (dimensions) systems When needed, work front desk/scheduling. Verify currency, checks and credit card payments taken each day and reconcile each employee’s work from previous day. Compile daily deposits for courier pickup.

Confidential,Charlotte, NC

Patient Account Representative

Responsibilities:

Responsible for all Medicare (Primary Claims) and all supplemental and secondary claims. Ensured claims were paid according to contract; when necessary, wrote appeals with additional documentation. Researched chart notes to determine correct coding and when necessary, corrected claim to reflect documentation and additional reimbursement due to missing Diagnosis/sequencing/modifiers. Pulled Reports to detect errors due to payer error/clearinghouse error/new or old guidelines. Analyzed denied claims and made sure they were paid correctly due to the LCDs/NCSs/NCCI. Researched estate information to obtain additional revenue. Contacted patients and arranged payment plans. Trained new employees on GEMMS-Ecis system.. Pulled reports to determine aging, trends. Use the Medicare Listserv to stay current on changes.

Confidential,North Haven CT

Claims Examiner

Responsibilities:

Researched policies to enable adjudication, denial or payment of claims for out of state. (National Business Unit) Worked with BCBS customer service representatives to obtain additional documentations needed for review through online inquires.

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Charlotte, NC

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