Experience

Physician Services USA
• Teamlead - Medical Billing Specialist
• Medical Billing Specialist

  • May 2017 - Present

  I respond accurately and timely to all written and oral correspondence, submit claim forms for collecting payments, payment verification on accounts, research with insurance companies and use onsite research tools to ensure accounts are resolved to their entirety. I track and identify financial trends/deficits, review and implement workflow processes and enhancements. Monthly reporting of personal metrics and practice performance is conducted and reviewed with project employees and management. I track, educate and report to provider clients on MACRA guidelines and measures to ensure all provider clients are compliant with CMS guidelines. To complete these daily tasks I actively utilize physician systems such as Health Fusion and eClincials as well as standard support system applications such as Microsoft Excel and Adobe Acrobat. Show less



AMCOL Systems

• United States
• Law Practice

• Insurance Resolution Specialist

  • May 2016 - Mar 2017

  I respond accurately and timely to all written and oral correspondence, submit claim forms for collecting payments, payment verification on accounts, to research with insurance companies and to use onsite research tools to ensure accounts are resolved to their entirety. To complete these daily tasks I have utilized various hospital systems. I respond accurately and timely to all written and oral correspondence, submit claim forms for collecting payments, payment verification on accounts, to research with insurance companies and to use onsite research tools to ensure accounts are resolved to their entirety. To complete these daily tasks I have utilized various hospital systems.



PricewaterhourseCoopers VBOA

• Assistant Manager

  • Jan 2014 - Apr 2016

  The Virtual Testing Center (VTC), on-shore and located in Columbia, SC, provides a scalable solution for script writing and execution. The VTC's flexibility and approach to connectivity allows for quick ramp up. We connect virtually to the client's systems via VPN or Citrix, and work remotely in the assigned production or test environment. As an Assistant Manager in the VTC I clearly define necessary steps for access, logical paths for workflow, and reporting defects in workflow paths. Creates test templates and scripts from the logical workflow paths while providing accurate test data for completion of test templates and scripts. Also, I have completed Quality Assurance checks to verify accuracy of staff’s written testing templates and scripts. I have customized internal systems to monitor quality, productivity and other performance metrics to reflect staff’s progress. To complete these daily tasks I have utilized programs such as Hewlett Packard Quality Center (HPQC), Siemens Soarian, GE Centricity, Citrix, RAS Secure ID Tokens, and VMWare Player. MICROSOFT WORD and MICROSOFT EXCEL have played a role when reporting statistical information or testing defects to the client. Show less



PriceWaterhouseCoopers VBOA

• TeamLead

  • Mar 2013 - Jan 2014

  The Virtual Business Office (VBO), on-shore and located in Columbia, SC, provides a scalable solution for staffing and account resolution. The VBO's flexibility and approach to connectivity allows for quick ramp up. We connect virtually to the client's systems via VPN or Citrix, and work remotely in the assigned client system.As a Team Lead in the VBO I respond accurately and timely to all written and oral correspondence, submit claim forms for collecting payments, payment verification on accounts, to research with insurance companies and to use onsite research tools to ensure accounts are resolved to their entirety. I also conduct quality assurance review, monitor team performance, coach and mentor staff, review financial reports, monthly invoices, monthly client reporting, assists in counselling sessions with low performers, and actively and effectively communicate with management and staff. To complete these daily tasks I have utilized hospital system such as Epremis, DDE/HIQA, SMS Invision, Patcom, AS-400, Siemens Soarian, McKesson, Access Anywhere, Softmed, Meditech, Chartmaxx, HBO Star, and Xactimed. MICROSOFT WORD AND MICROSOFT EXCEL also has played a role in completing tasks. I have also created training manuals and conducted training sessions. Show less

• Medical Billing Specialist

  • Jan 2009 - Mar 2013

  I respond accurately and timely to all written and oral correspondence, submit claim forms for collecting payments, payment verification on accounts, to research with insurance companies and to use onsite research tools to ensure accounts are resolved to their entirety. To complete these daily tasks I have utilized hospital system such as Epremis, DDE/HIQA, SMS Invision, Patcom, AS-400, Siemens Soarian, McKesson, Access Anywhere, Softmed, Meditech, Chartmaxx, HBO Star, and Xactimed.



BlueCross BlueShield of South Carolina

• United States
• Insurance
• 700 & Above Employee

• Project Coordinator II

  • Sep 2006 - Nov 2008

  I coordinated all aspects of Quality Programs reporting, maintenance of policy and procedure manuals and policy submissions for approval. Records quality program meeting minutes and supportive documentation in accordance to URAC Case Management Standards. Prepare divisional monthly and quarterly reporting for key functions, quality activities and cost savings. Prepare and/or create materials required to support Major Group marketing efforts promoting the sale of Disease Management and Case Management Programs and prepare billing statements for the submission to Major Group account billing for Disease Management and Case Management Program Services. To complete these tasks daily I utilized systems such as MICROSOFT ACCESS, MICROSOFT WORD, MICROSOFT EXCEL, ADOBE ACROBAT and several of the company’s internal claims and membership systems. Show less

• Service Assistant II

  • Oct 2004 - Sep 2006

  I handled all inquiries made from attorney’s regarding claims dispositions, coordinate with the legal department to resolve sensitive cases, giving depositions and testifying in court if requested to do so, prepare all appeal cases for review by the medical director and the Claims Review Committee, to respond in a professional manner to the members and providers through written correspondence, and other tasks as assigned by management. To complete these tasks daily I utilized several of the company’s internal claims and membership systems such as RMIH, RMIM,AMMS, CES, ALGS, ITS, PROVIDER LINK, and ON DEMAND. MICROSOFT EXCEL AND MICROSOFT WORD was also used to track all cases as well as to assist in any written correspondence regarding the cases. Show less

• Member Service Representative I

  • Apr 2003 - Oct 2004

  I responded accurately and timely to customer inquiries as well as priority inquiries for management, coordinate with other departments, initiate claim adjustments as needed, and other tasks as assigned by management. To complete these tasks daily I utilized several internal company claims systems such as RMIH, RMIM, ROMS, AMMS, CES, ALGS and ITS.