Experience

ABLM Inc.

• Hospitals and Health Care
• 1 - 100 Employee

• Revenue Cycle Healthcare Consultant

  • Jun 2014 - Present

  Transfer electronic remits using the Claimlogic and Epic Systems. Processed both manual and electronic medical remits. Enter daily productivity and balance reconciliation cash control spreadsheet. Retrieve payments for unidentified outreach sourcing log. Follow up with patient and medical insurance claims and denials. Retrieve and process both patient and insurance lockboxes. Experienced in both PB and HB medical billing. Undistributed and redistributed cash revenue for medical facilities. Scan, copy, fax and email medical documents on behalf of clients. Handled correspondence via Insurance Appeals, Denials, Authorization, Referrals and retrieving medical record numbers. Post payments for Hospital, Physician and Self pay. Research payment to assure that the payment was distributed to the correct provider, (if not) transferred to correct provider and adjust an contractual adjustment that should be adjusted. PIEDMONT HEALTHCARE 2010 – 2014 Payment Poster Processed payments for medical claims using the Epic and Star Systems. Acted as supply clerk for team members. Entered productivity on Excel spreadsheet. Manually posted bad debt accounts in Epic and Star. Retrieved checks from safe for lockbox and bank deposits. Retrieved checks and correspondence from mailboxes, sorted and separated items, then forwarded to the bank. Post Hospital Billing payment to correct carrier. Assist in special projects. Show less



Galen Billing

• Poster

  • Jan 2009 - May 2009



ALLIED CLAIMS ADMINISTRATION

• Medical Billing and Coding Specialist

  • Jan 2008 - Jan 2009

  Processed and updated WC-1 claims for workers compensation. Analyzed HCFA-1500 and UB-92 bills, and corrected as needed. Issued payments and refunds to hospitals and facilities for workers comp claims. Insured network fee schedule rates to individual bills using ICD-9 and CPT. Procedures for accurate payment of workers comp claims. Customer service Rep for incoming and outbound calls. Processed and updated WC-1 claims for workers compensation. Analyzed HCFA-1500 and UB-92 bills, and corrected as needed. Issued payments and refunds to hospitals and facilities for workers comp claims. Insured network fee schedule rates to individual bills using ICD-9 and CPT. Procedures for accurate payment of workers comp claims. Customer service Rep for incoming and outbound calls.



Professional Medical Management Services Ltd

• Medical Billing Specialist/Adjuster

  • Jan 2005 - Jan 2008

  Processed billing utilizing Medicaid Portal and fee schedule to adjust, edit/resubmit and file secondary claims to Medicaid. Adjusted provider write-off on contractual adjustments according to the explanation of benefits for commercial and Medicaid claims. Assisted in researching and processing of patient and insurance refund checks. Served as Team Lead for 11 employees. Trained new employees. Customer service rep for inbound calls. Processed billing utilizing Medicaid Portal and fee schedule to adjust, edit/resubmit and file secondary claims to Medicaid. Adjusted provider write-off on contractual adjustments according to the explanation of benefits for commercial and Medicaid claims. Assisted in researching and processing of patient and insurance refund checks. Served as Team Lead for 11 employees. Trained new employees. Customer service rep for inbound calls.



PHOENIX Healthcare Distribution Ltd

• United Kingdom
• Wholesale
• 100 - 200 Employee

• Medical Claims Adjuster

  • Jan 2002 - Jan 2004

  Analyzed patient accounts and brought them to completion. Adjusted hospital contractual write-offs per explanation of benefits. Processed billing and reimbursement accounts for insurance department. Assist in special projects. Analyzed patient accounts and brought them to completion. Adjusted hospital contractual write-offs per explanation of benefits. Processed billing and reimbursement accounts for insurance department. Assist in special projects.



Blue Cross and Blue Shield of Illinois, Montana, New Mexico, Oklahoma & Texas

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

• Senior Claims Specialist

  • Jan 1998 - Jan 2001

  Processed and adjusted professional and facility claims. Processed special projects involving stop loss and reimbursement reports. Researched Provider contracts and pricing claims. Processed and adjusted professional and facility claims. Processed special projects involving stop loss and reimbursement reports. Researched Provider contracts and pricing claims.



Prudential Healthcare

• Insurance
• 1 - 100 Employee

• Customer Service Representative

  • Jan 1997 - Jan 1998

  Answered inquiries and educated members, prospective members, providers and employers about all aspects of Prudential Healthcare. Handled complaints and found correct closure. Earned various awards for outstanding customer service. METROPOLITAN INSURANCE 1992 – 1995 Customer Service Reviewer Analyzed and approved claims. Verified CPT and ICD-9 codes for processing. Updated Provider profiles. Trained new employees. Answered inquiries and educated members, prospective members, providers and employers about all aspects of Prudential Healthcare. Handled complaints and found correct closure. Earned various awards for outstanding customer service. METROPOLITAN INSURANCE 1992 – 1995 Customer Service Reviewer Analyzed and approved claims. Verified CPT and ICD-9 codes for processing. Updated Provider profiles. Trained new employees.