Experience

VIRTUA HEALTH & REHABILITATION CENTER AT BERLIN INC
• United States
• Hospitals and Health Care
• 1 - 100 Employee
• Billing Representative

  • Dec 2020 - Present


Virtua Our Lady of Lourdes Hospital

• Senior A/R Specialist & Appeals Coordinator

  • May 2018 - Dec 2020

  • Responsible for follow-up of in/out patient claims that fall within a specific denial workflow. Identifying and escalating payment issues to management and Insurance Provider Representatives. Participation in monthly provider meetings either face to face or conference calls to go over the status of the issues that were previously brought to their attention • Working closely with Coding and Medical Records Department as an Appeals Coordinator for DRG audits and downgrades as well as overpayment processes. Send appeals DRG specific appeal to insurance plans and/or Auditors as well as contract these entities for review and processing status. Up keep of a log via excel file for tracking and reporting purposes. • Utilizing a contracting tool that allowed me to pull mass claims when a payment issue is identified. Once claims are isolated, I am able to send projects to Payer Provider Reps. for correction. • Providing assist other team members with understanding payer contracts and claims reimbursement. • Responsible for completion of special projects from management. Show less



Lourdes Medical Associates

• Hospitals and Health Care
• 1 - 100 Employee

• Account Receivable Specialist – Follow-Up Physician Billing

  • Mar 2014 - May 2018

  • Responsible for billing and follow-up for physician claims. Reviewing denied insurance claims and contacting the appropriate Insurance for reprocessing and/or sending out corrected claims. • Responsible for completion of special projects from management. • Contacting Prayer Provider Reps. for payer policy and contract inquires. • Identifying possible payment issues and escalating them to management • Responsible for billing and follow-up for physician claims. Reviewing denied insurance claims and contacting the appropriate Insurance for reprocessing and/or sending out corrected claims. • Responsible for completion of special projects from management. • Contacting Prayer Provider Reps. for payer policy and contract inquires. • Identifying possible payment issues and escalating them to management



OUR LADY OF LOURDES MEDICAL CENTER

• United States
• Medical Practices
• 1 - 100 Employee

• Account Receivable Specialist - Sr. Follow-Up Rep Managed Care

  • 2011 - 2014

  • In addition to the duties listed in my prior position. I provide help to other team members with understanding Payer contracts and claims reimbursement.• Responsible for completion of special projects from management.• Responsible for contacting Prayer Provider Reps. for payer policy and contract inquires. • Responsible for receiving and reviewing unidentified possible payment issues from other team members. Valid payment issues are escalated to management as well as the Payer Provider Rep.• I work in a contracting tool that allows me to pull mass claims once and payment issue has been identified. Once claims are isolated I am able to send projects to Payer Provider Reps. for correction. Show less

• Accounts Receivable Specialist

  • 2008 - 2011

  • Responsible for billing and follow-up of all outpatient claims. Informs team leader of payer trends including payment, non-payment or denials.• Responsible for review and completion of daily report: payment, correspondence and late charges and A/R.



Reaching at Problems Inc

• United States
• Mental Health Care

• Youth Councilor

  • 2004 - 2008

  • Responsible for the all girls that reside in the house. I over see all activates of the girls, i.e. cooking, cleaning, games, movie watching, outside time and outings to public places. • I hand out punishments to those who have not followed the rules of the house. I.e. Writings, timeout, room/house restrictions, restrictions form other girls and TV game (This is when the girl can not watch TV or join in on games.) • Responsible for filling out log books for over the counter medications, prescription medications, phone usage and writings/restrictions. As well as recording events of the day from my shift. Show less