Provider Data Analyst

• May 2019 - Present

Configuration of provider information, adding health plans, contracts and pay to information in QNXT system. Corrections of provider edits on incoming claims. Knowledge of configuration of health benefits in QNXT system in regards to benefit plans, policy administrator, sponsors and original work policy and correction benefit edits in claims module. Configuration of provider information, adding health plans, contracts and pay to information in QNXT system. Corrections of provider edits on incoming claims. Knowledge of configuration of health benefits in QNXT system in regards to benefit plans, policy administrator, sponsors and original work policy and correction benefit edits in claims module.

Hospital Business Specialist II

• Jul 2016 - May 2019

Billing facility and physician claims using MDX including billing to Medical, Medicare, Senior HMO, Workers Comp, Commercial insurance and Managed care. Reviewing patient accounts in STAR that proper codes and charges are correctly represented on claim in MDX before billing out. Followed up on patient claims first four months starting at Kern Medical, working reports as well as follow up on claims under Medical, Kern Health Systems, Healthnet IMG, noncontracted insurances… Show more Billing facility and physician claims using MDX including billing to Medical, Medicare, Senior HMO, Workers Comp, Commercial insurance and Managed care. Reviewing patient accounts in STAR that proper codes and charges are correctly represented on claim in MDX before billing out. Followed up on patient claims first four months starting at Kern Medical, working reports as well as follow up on claims under Medical, Kern Health Systems, Healthnet IMG, noncontracted insurances, Medicare and Senior HMO and commercial insurances by online access or calling, pulling denials, EOBs when needed. Additional programs knowledge of DDE, Craneware. Help other coworkers with programs and shared my knowledge of billing to others. Show less Billing facility and physician claims using MDX including billing to Medical, Medicare, Senior HMO, Workers Comp, Commercial insurance and Managed care. Reviewing patient accounts in STAR that proper codes and charges are correctly represented on claim in MDX before billing out. Followed up on patient claims first four months starting at Kern Medical, working reports as well as follow up on claims under Medical, Kern Health Systems, Healthnet IMG, noncontracted insurances… Show more Billing facility and physician claims using MDX including billing to Medical, Medicare, Senior HMO, Workers Comp, Commercial insurance and Managed care. Reviewing patient accounts in STAR that proper codes and charges are correctly represented on claim in MDX before billing out. Followed up on patient claims first four months starting at Kern Medical, working reports as well as follow up on claims under Medical, Kern Health Systems, Healthnet IMG, noncontracted insurances, Medicare and Senior HMO and commercial insurances by online access or calling, pulling denials, EOBs when needed. Additional programs knowledge of DDE, Craneware. Help other coworkers with programs and shared my knowledge of billing to others. Show less

Medical Biller-Accounts Receivable

• Oct 2013 - Jul 2016

Reviewing and posting of electronic and paper remittance advice. Forwarding coinsurance,copay or deductibles to secondary insurance or to patient balances. Working on denials and correcting of claims. Billing of Physician claims such as office visits, in office procedures, office consults, pre and post op visits. Reviewing and working claims for accurate coding and edits on billing programs such as Prognocis, Collaborate, Office Ally and Eclinical Also reviewing patients… Show more Reviewing and posting of electronic and paper remittance advice. Forwarding coinsurance,copay or deductibles to secondary insurance or to patient balances. Working on denials and correcting of claims. Billing of Physician claims such as office visits, in office procedures, office consults, pre and post op visits. Reviewing and working claims for accurate coding and edits on billing programs such as Prognocis, Collaborate, Office Ally and Eclinical Also reviewing patients encounters on Practice Fusion and EMR to obtain information for billing. Familar with HMOs ,PPOs, Kern Family, IMG Healthnet. Verifying patients insurance online or calling to verify correct information and updating system to have timely billing of claims. Posting of patients co-payment. Show less Reviewing and posting of electronic and paper remittance advice. Forwarding coinsurance,copay or deductibles to secondary insurance or to patient balances. Working on denials and correcting of claims. Billing of Physician claims such as office visits, in office procedures, office consults, pre and post op visits. Reviewing and working claims for accurate coding and edits on billing programs such as Prognocis, Collaborate, Office Ally and Eclinical Also reviewing patients… Show more Reviewing and posting of electronic and paper remittance advice. Forwarding coinsurance,copay or deductibles to secondary insurance or to patient balances. Working on denials and correcting of claims. Billing of Physician claims such as office visits, in office procedures, office consults, pre and post op visits. Reviewing and working claims for accurate coding and edits on billing programs such as Prognocis, Collaborate, Office Ally and Eclinical Also reviewing patients encounters on Practice Fusion and EMR to obtain information for billing. Familar with HMOs ,PPOs, Kern Family, IMG Healthnet. Verifying patients insurance online or calling to verify correct information and updating system to have timely billing of claims. Posting of patients co-payment. Show less

Fulltime Homemaker

• Dec 2009 - Oct 2013

Patient Account Representative

• Jul 2001 - Dec 2009

Exclusively Medicare billing of all Dignity Health accounts. Reviewing of patient accounts through Meditech System. Implemented accounting protocols. Maintained Medicare claims submission and resolution verifying documentation that was necessary for timely billing and resolution of patient accounts. Including reviewing claims for accuracy and performed edits as needed. Including verification of completion of claim forms, and accurate CPT and ICD-9 coding and working edits on… Show more Exclusively Medicare billing of all Dignity Health accounts. Reviewing of patient accounts through Meditech System. Implemented accounting protocols. Maintained Medicare claims submission and resolution verifying documentation that was necessary for timely billing and resolution of patient accounts. Including reviewing claims for accuracy and performed edits as needed. Including verification of completion of claim forms, and accurate CPT and ICD-9 coding and working edits on the billing program including split and interim billing. Knowledge of Medicare Coordination of Benefits. Show less Exclusively Medicare billing of all Dignity Health accounts. Reviewing of patient accounts through Meditech System. Implemented accounting protocols. Maintained Medicare claims submission and resolution verifying documentation that was necessary for timely billing and resolution of patient accounts. Including reviewing claims for accuracy and performed edits as needed. Including verification of completion of claim forms, and accurate CPT and ICD-9 coding and working edits on… Show more Exclusively Medicare billing of all Dignity Health accounts. Reviewing of patient accounts through Meditech System. Implemented accounting protocols. Maintained Medicare claims submission and resolution verifying documentation that was necessary for timely billing and resolution of patient accounts. Including reviewing claims for accuracy and performed edits as needed. Including verification of completion of claim forms, and accurate CPT and ICD-9 coding and working edits on the billing program including split and interim billing. Knowledge of Medicare Coordination of Benefits. Show less