Experience

Ashton Benefits

• United States
• Insurance
• 1 - 100 Employee

• Director of Member Services

  • Sep 2018 - Present

  Maintain monthly spreadsheet for Executive Clients. Work collaboratively with other departments, including operations and to improve the process and results of claims with our Claims Specialist team to ensure accuracy and timely. Researched and resolved most of delinquent accounts and determined the action to resolve the issue from the EOB denials, rejections including appeal and negotiating discounts for the Clients. Act as a liaison between the insurance carriers and Human Resources Managers for all Clients Knowledge in CRM, SalesForce System, Microsoft Word and Excel.



BiologixTx

• Totowa, NJ

• Medical Reimbursement Specialist

  • Jun 2017 - Sep 2018

  Maintain daily and monthly productivity goals to maximize cash flow for Infusion Processes claims accurately and timely, collections calls and persistent with aging accounts Work collaboratively with other departments, including operations and managed care to improve reimbursement process and results Responsible for the billing and collections of all claims for various home health branches from billing, third party commercial and government insurance to first party collection and private pay claims Researched and resolved most of delinquent accounts and determined and initialed action to resolve claims from EOB denials, rejections and provider calls Knowledge of HIPPA, Collection Act, Cobra and CMS billing existing operating procedures Work effectively to reach revenue goals



BioScrip, Inc.

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

• Reimbursement Specialist II

  • Apr 2014 - Jun 2017

  Maintain daily and monthly productivity goals to maximize cash flow for Infusion and Enteral Accounts Processes claims accurately and timely, collections calls and persistent with aging accounts Work collaboratively with other departments, including operations and managed care to improve reimbursement process and results Assists month-end closing as scheduled to assure timelines Responsible for the billing and collections of all claims for various home health branches from billing, third party commercial and government insurance to first party collection and private pay claims Researched and resolved most of delinquent accounts and determined and initialed action to resolve claims from EOB denials, rejections and provider calls Managing conflict and recommending solutions with insurance companies and customers Working with Insurance Network Manager and provider representative Knowledge of HIPPA, Collection Act, Cobra and CMS billing existing operating procedures Work effectively to reach revenue goals



Community Surgical Supply

• United States
• Medical Equipment Manufacturing
• 100 - 200 Employee

• Collection Specialist

  • Sep 2012 - Apr 2014

  Maintain daily and monthly productivity goals to maximize cash flow for Infusion and Enteral accounts. Work daily denials and resubmitting insurance claims. Response to patient billing and statements inquiries. Research and resolve incorrect payments. Follow up with insurance carriers in a timely manner. Resolved an ongoing payer issue within four months of taking over the accounts. Primarily responsible for all branches of Horizon BCBS; also assisted with the collections of other payers. Assist to maintain daily, weekly and monthly spreadsheets.



Arcadian/PromptCare Home Infusion, LLC

• Intake/Collector

  • May 2009 - May 2011

  Daily follow up with insurance companies and Workers Compensation for status of unpaid accounts. Appeal submission for denied/underpaid claims Follow up calls to patients on outstanding balances and negotiating payouts to the highest level rates Utilization ICD -9, CPT, HCPS codes Daily follow up with insurance companies and Workers Compensation for status of unpaid accounts. Appeal submission for denied/underpaid claims Follow up calls to patients on outstanding balances and negotiating payouts to the highest level rates Utilization ICD -9, CPT, HCPS codes



Dr. Nabil El-Rafei

• Wayne, New Jersey

• Insurance Coordinator

  • Sep 2008 - Apr 2009

  Insurance verification including initial authorization and pre-authorizations Obtain clinical documentation; retrieval, transfer and disposal of patient records. Perform administrative duties; general billing and appointment scheduling Insurance verification including initial authorization and pre-authorizations Obtain clinical documentation; retrieval, transfer and disposal of patient records. Perform administrative duties; general billing and appointment scheduling



American Infusion

• Pine Brook, New Jersey

• Reimbursement Specialist

  • May 2006 - Sep 2008

  Daily follow up with insurance companies, private pay and Workers Compensation aging Negotiating payout to the highest level rates Appeals submission for denial and underpaid claims Follow up calls to patients on outstanding balances Utilizing ICD-9, CPT & HCPCS Codes Daily follow up with insurance companies, private pay and Workers Compensation aging Negotiating payout to the highest level rates Appeals submission for denial and underpaid claims Follow up calls to patients on outstanding balances Utilizing ICD-9, CPT & HCPCS Codes



MidAtlantic Home Infusion

• Fairfield, New Jersey

• Insurance Administrator/Collector

  • Nov 1995 - May 2006

  General billing/collections; including third party and private pay Compile documentation for Insurance Companies and State/Federal Assistance Programs Worked with Discharge Planners, Doctors and Case Managers to obtain authorization and clinical documentation Preparation of contracts; negotiated with insurance companies, hospital and clients Analyzing account with Director of Finance as well as the collection agency Actively participated in the preparation of Healthcare Organization (JACHO) in the years of 1996, 1999, 2001 & 2004