Experience

TotalMed, Inc.

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

• Claims Liason II

  • Jan 2019 - Present

  • Assigned to Western Sky Community Care with a pending end date of May 31, 2019 • Reviewing claims received from par and non-par providers. • Ensuring all claims meet guidelines set forth by New Mexico Medicaid (HSD). • Communicating with the team about changes in policies and procedures. • Assigned to Western Sky Community Care with a pending end date of May 31, 2019 • Reviewing claims received from par and non-par providers. • Ensuring all claims meet guidelines set forth by New Mexico Medicaid (HSD). • Communicating with the team about changes in policies and procedures.



Livingston Hearing Aid Center

• United States
• Medical Device
• 1 - 100 Employee

• Patient Care Coordinator

  • Jun 2018 - Nov 2018

  • Daily entering and balancing of all transactions and coordination of clinic schedule • Process customer orders/exchanges/returns according to company policies and procedures • Work closely with corporate office to resolve disputed credit items • Provide timely feedback to the corporate office regarding service failures or customer concerns • Partner with clinical staff to meet and exceed customers’ service expectations • Daily entering and balancing of all transactions and coordination of clinic schedule • Process customer orders/exchanges/returns according to company policies and procedures • Work closely with corporate office to resolve disputed credit items • Provide timely feedback to the corporate office regarding service failures or customer concerns • Partner with clinical staff to meet and exceed customers’ service expectations



Genesis

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

• Staffing Coordinator

  • Sep 2017 - Jun 2018

  • Overseeing all staffing needs and operations for the nursing department • Working with recruiting agencies to fill vacancies in a timely manner. • Supporting CNA and Nursing screening and hiring processes. • Overseeing all staffing needs and operations for the nursing department • Working with recruiting agencies to fill vacancies in a timely manner. • Supporting CNA and Nursing screening and hiring processes.



Presbyterian Healthcare Services

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

• Collections Specialist

  • Sep 2016 - Sep 2017

  • Following up on Hospice and Home Healthcare denials • Initiating appeals to the health plans for reconsideration of claims • Researching and noting any billing trends/errors in the Epic billing system • Following up on Hospice and Home Healthcare denials • Initiating appeals to the health plans for reconsideration of claims • Researching and noting any billing trends/errors in the Epic billing system



Accounting Principals

• United States
• Staffing and Recruiting
• 700 & Above Employee

• Financial Specialist

  • Jul 2016 - Sep 2016

  Assigned to Presbyterian: • Following up on Hospice and Home Healthcare denials • Initiating appeals to the health plans for reconsideration of claims • Researching and noting any billing trends/errors in the Epic billing system Assigned to Presbyterian: • Following up on Hospice and Home Healthcare denials • Initiating appeals to the health plans for reconsideration of claims • Researching and noting any billing trends/errors in the Epic billing system



Sansum Clinic

• United States
• Medical Practices
• 500 - 600 Employee

• Managed Care Coordinator

  • Feb 2015 - Jun 2016

  • Prepping HMO insurance medical information and files for nurse and medical director review which includes (but not limited to):o Insurance verification and benefits information (copays/coins/OOP max) o Obtaining authorizations for High Tech Radiology procedures from PPO insurances. o Communicating to the ordering doctors and nurse practitioners of denials of authorization requests. o Complying with Medicare policies regarding HMO denials and authorizations. o Informing patient regarding denials and authorizations in a timely manner. o Assisting and guiding other departments (such as Cardiology, Internal Medicine, etc.)

• Medical Billing Specialist

  • Mar 2014 - Feb 2015

  • Billing and collections for high dollar claims from two major insurances in the Central Coast area. • Keeping track of what accounts were paid and also appealing denials from Blue Cross and Health Net.



Pacific Eye Surgeons

• San Luis Obispo, California Area

• Medical Billing Specialist

  • Aug 2013 - Mar 2014

  • Optometry medical billing and payment posting • Working old A/R reports and medical claims. • Preparing weekly and monthly patient billing statements (over 500 per week), assuring in their accuracy. • Communicating with other contracted providers (such as California Retina of Santa Barbara). • Optometry medical billing and payment posting • Working old A/R reports and medical claims. • Preparing weekly and monthly patient billing statements (over 500 per week), assuring in their accuracy. • Communicating with other contracted providers (such as California Retina of Santa Barbara).