Experience

Tower Behavioral Health

• United States
• Hospitals and Health Care
• 1 - 100 Employee

• Collection Specialist/ Medical Billing

  • Feb 2021 - Present

• Collection Specialist/ Medical Billing

  • Feb 2021 - Present

  Prepare and monitor monthly billing and collection process utilizing established policies, procedures and tracking systems.• Compile appropriate information for refunds, bad dept write offs and adjustments.• Initiate calls, letters, and or faxes to patients, insurance carriers and otherresponsible parties in pursuit of getting a claim resolved.• Handle and interpret medical documentation such as UB04 claim form, 1500 claimforms and EOB’s.• Write and prepare appeals to insurance carriers to overturn denials.• Manage an extensive amount of claims by prioritizing and organizing time effectively.• Participate in monthly AR reviews with management team and provide status on alloutstanding AR Show less



Pyramid Healthcare, Inc.

• United States
• Hospitals and Health Care
• 500 - 600 Employee

• Collection Specialist/ Medical Billing

  • Jul 2019 - Feb 2021

  • Responsible for collecting on unpaid claims by calling the insurance company and utilizing Navinet or other electronic systems. • Follow up on and correct denied claims • Submit appeals to payer on denied claims • Work EDI transactions and ERA files including reconciling carrier submissions edits and rejection reports. • Work with commercial, managed care, Medicaid and Medicare providers. • Communicate with clinical staff and or clients to ensure all information is accurate for proper billing. • Support phone queue when assigned. Show less



Mercy Health Systems

• United States
• Medical Practices
• 1 - 100 Employee

• Accounts Receivable Specialist/Physician Billing

  • Dec 2018 - Jul 2019

  • Responsible for completing high dollar review in compliance with department standards/policies within a specified time frame. • Create effective emails, detailing payer/registration issues so that the management team is able to forward information to the appropriate party. • Perform billing and follow-up prior to "timely filing deadline" • Check status and reprocess claims via the appropriate payer systems (Navinet, Promise, etc) • Responsible for completing high dollar review in compliance with department standards/policies within a specified time frame. • Create effective emails, detailing payer/registration issues so that the management team is able to forward information to the appropriate party. • Perform billing and follow-up prior to "timely filing deadline" • Check status and reprocess claims via the appropriate payer systems (Navinet, Promise, etc)



Independence Physician Management (IPM)

• United States
• Hospitals and Health Care
• 1 - 100 Employee

• Claims Specialist/Physician Billing

  • Jun 2017 - Dec 2018

  • Responsible for accurate and timely resolution of professional billing claim and clearinghouse edits as well as payer rejections. • Meet or exceed established performance targets (productivity and quality) established by the billing supervisor. • Perform root cause analysis and identify edit trends to minimize lag days and mitigate large volume claim submission delays. • Communicate effectively with IPM coders to handle an accurate and timely resolution of coding-based claim edits. • Responsible for accurate and timely resolution of professional billing claim and clearinghouse edits as well as payer rejections. • Meet or exceed established performance targets (productivity and quality) established by the billing supervisor. • Perform root cause analysis and identify edit trends to minimize lag days and mitigate large volume claim submission delays. • Communicate effectively with IPM coders to handle an accurate and timely resolution of coding-based claim edits.



Physio

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

• File Maintenance Administrator

  • Aug 2011 - Nov 2015

  • Responsible for adding new clinic accounts and library builds to the NextGen Healthcare billing system. • Maintenance of existing file and library builds including but not limited to, Payers, Providers, Procedure Codes, Diagnosis Codes, and Claim Edits. • Utilize claim edit reports to locate File Maintenance billing errors . Presents resolution to File Maintenance Manager for approval. Initiate a plan to include itemized actions with completion dates and ownership. • Partnering with the Contracting Department evaluating new provider enrollment/set-up and new payer contract set-up in NextGen • Routine analysis of EDI clearinghouse reports identifying claim denials by either the clearinghouse or payer. Produce information showing the volume/percentage of denials, reasons, and the steps towards reduction. • Research and resolve issues with credentialing individual and group providers. • Assist with solutions for events negatively impacting revenue. • Provide support to individual clinics and the Billing Team by addressing NextGen modification issues. Show less



BioTelemetry Healthcare, formerly CardioNet/Mednet

• Conshocken, PA

• Customer Care Specialist/ Patient Admissions Coordinator

  • Apr 2008 - Aug 2011

  • Placed outbound calls to physician offices and insurance companies to obtain pre-authorization and/or pre-certification as needed for cardiac monitoring devices • Confirmed financial data and benefits from insurance payers and good order review of cardiac monitoring scripts/ order forms • Performed all aspects of initial patient enrollments by entering patient data from various sources into the appropriate business applications as required for coverage and payment • Responsible for working with Management, department staff, Physicians, Account Executives, and patients regarding initial processing of referrals • Reviewed documentation and claims in a timely manner to provide the billing staff members a bill-ready case in accordance with the Federal and Insurance guidelines • Prompt contact to patients to confirm demographics and arrange delivery of cardiac monitoring kit Show less



Quest Diagnostics

• Norristown, PA

• CUSTOMER SERVICE BILLING REPRESENTATIVE II

  • Dec 2006 - Apr 2008

  • Responsible for inbound calls dealing with patient concerns regarding their bill status • Reviewed written correspondence received from clients and Sale Representatives and resolved issues accordingly • Performed adjustments, bill type transfers, refunds, and collections to Quest Billing System • Maintained productivity and quality metrics established for the department while utilizing excellent customer service skills • Researched and resolved issues with processed medical claims in accordance with established procedures Show less