Experience

NANI - Nephrology Associates Northern Illinois / Indiana

• United States
• Hospitals and Health Care
• 100 - 200 Employee

• Account Representative

  • Oct 2020 - Present

  Oak Brook, Illinois, United States Responsible for the follow up on claim details for all insurance carriers, including commercial, managed care, HMO, Medicare, and Medicaid claims · Accessing multiple insurance portals to obtain claim details · Notifying the billers for claim errors requiring rebills · Resolve denials or partially paid claims through interaction with insurance carriers, patients, hospitals, dialysis units or physicians · Identify payer trends and notify manager of negative… Show more Responsible for the follow up on claim details for all insurance carriers, including commercial, managed care, HMO, Medicare, and Medicaid claims · Accessing multiple insurance portals to obtain claim details · Notifying the billers for claim errors requiring rebills · Resolve denials or partially paid claims through interaction with insurance carriers, patients, hospitals, dialysis units or physicians · Identify payer trends and notify manager of negative trends · Correspond with client to resolve inquiries or concerns in a timely and professional manner · Timely appeals of all denied or delinquent claims for assigned physicians · Familiarity with complex claims denial reasons and how to appeal the denials (i.e. denials due to medical necessity, bundled/global codes & procedures, inappropriate reimbursement per contracted fee schedule, insufficient documentation, etc.) · Daily working of all rejected claims for assigned physicians · Knowledge of claims filing deadlines, reconsideration/corrected claims deadlines, and appeal deadlines for all major insurance carriers · Effectively writing and following up on appeals and knowledge of where to find information needed for appeals · Extensive contact with insurance carriers via telephone and internet regarding claim denial inquiries, claims reprocessing, etc. · Identification of underpaid or overpaid patient accounts and issuing refunds to insurance carriers or patients when appropriate · Review Explanation of benefits for proper reimbursement · Correct and resubmit claims to payers · Verify patient health insurance benefits and assist with patient billing inquiries Show less



Franciscan Alliance, Inc.

• Hospitals and Health Care
• 700 & Above Employee

• Medicaid Billing Specialist

  • Mar 2015 - Sep 2018

  Responsibilities include generating and editing inpatient and outpatient Indiana and Illinois Medicaid claims, verifying coverage and making any necessary changes to coverage. Clearing claim edits so claims can go out clean. Responsible for sending override letters to Illinois Medicaid regarding updates to a patient’s eligibility.



ATI Physical Therapy

• United States
• Wellness and Fitness Services
• 700 & Above Employee

• Cash Application Specialist

  • Apr 2013 - Feb 2015

  Responsibilities include accurately entering payments, manually and electronically, from insurance companies and patients by deposit date, printing batch reports and balancing each batch posted, and identifying any posting errors. Identify any contract issues related to incorrect payments. Communicate with office personnel to ensure accuracy of data within the patient account. Identify payments received in error, and request a refund to be issued.



Practice Management Resource Group

• Senior Billing Specialist

  • Apr 2005 - Jun 2012

  Billing representative for a medical billing and practice management group, my responsibilities included posting payments, charge entry of surgery and office visits, billing paper and electronic claims. Received incoming calls from patients regarding their accounts. Responsible for daily follow up of outstanding balances due from various insurance companies. Responsible for preparing claim reconsideration reviews to 2nd level appeals.



AdventHealth

• United States
• Hospitals and Health Care
• 700 & Above Employee

• Medicare Biller

  • Jun 2004 - Mar 2005

  Responsibilities included generating and editing inpatient and outpatient Medicare claims for billing in order to receive the maximum benefit payable. I was also responsible for secondary billing after Medicare. Responsible for working accounts receivable daily and making follow up phone calls regarding claim status and benefits. Assisted patients with phone inquiries regarding their inpatient and outpatient hospital bills. Responsible for preparing claim reconsideration reviews to 2nd level… Show more Responsibilities included generating and editing inpatient and outpatient Medicare claims for billing in order to receive the maximum benefit payable. I was also responsible for secondary billing after Medicare. Responsible for working accounts receivable daily and making follow up phone calls regarding claim status and benefits. Assisted patients with phone inquiries regarding their inpatient and outpatient hospital bills. Responsible for preparing claim reconsideration reviews to 2nd level appeals. Payment Poster

• Payment Poster

  • Jun 2003 - Jun 2004

  Posted insurance and patient payments for Adventist Health System, which was made up of three hospitals, LaGrange Hospital, Hinsdale Hospital and Glen Oaks Hospital. I posted payments from explanation of benefits received from various insurance companies for inpatient and outpatient services. Responsible for making sure batches balanced according to deposits provided by Harris Bank. I was responsible for recognizing overpayments and incorrect payments and requesting refunds due to the insurance… Show more Posted insurance and patient payments for Adventist Health System, which was made up of three hospitals, LaGrange Hospital, Hinsdale Hospital and Glen Oaks Hospital. I posted payments from explanation of benefits received from various insurance companies for inpatient and outpatient services. Responsible for making sure batches balanced according to deposits provided by Harris Bank. I was responsible for recognizing overpayments and incorrect payments and requesting refunds due to the insurance company or patient.

• Patient Account Representative

  • Jan 2002 - Jun 2003

  Received incoming call from patients and insurance companies regarding inpatient and outpatient hospital bills for three hospitals; LaGrange Hospital, Hinsdale Hospital, and Glen Oaks Hospital. Answered patient calls regarding the type of service they received, and explained the various procedures. I assisted patients in understanding their explanation of benefits received from insurance companies and resolving their balances.