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概要
Highly resourceful and Medical Debt Collector having extensive experience of working with billing and credentialing coordinators, expert in identifying discrepancies related to billing & reimbursements and implements corrective actions and adjustments, known for maintaining patient confidence by keeping important information confidential.
Ability to participate in actions to continuously improve workflow standards. Highly personable and engaging specialist who is known for distilling complex intransigent challenges & problems into a set of solvable blocks.
Expert in evaluating medical insurance cases that are denied coverage and researching whether the case merits an appeal, supporting the billing department in meeting expectations regarding efficiency and privacy maintenance
Ability to initiate follow-up phone calls on accounts following departmental policy and procedure and best practices. Reviews patient accounts to determine relevant information sharing, identify and report payer denial, payment; recoupment trends and out of network errors with carriers to designated associate.
Proven mettle in managing the flow and evaluation, research and processing of all appeals, grievances and provider review requests according to payer specific guidelines.
Conducts appropriate investigation of all appeals and interacts with payers to resolve denied claims issues, sends statements and makes collection calls, also prepares appropriate written documentation and maintain necessary files.
项目
工作经历
Supervioser
Designed and devised action plans to identify key clients, key targets, and priority service lines, handle client accounts through entire lifecycle, execute contracts, provide customer service, and guide return growth from services provided.
· Developed cordial relationships and customer partnerships to capitalize on opportunities and maximize business success, built synergies & appropriate communication bridges between patients, billing personnel& insurance carriers.
· Attended key customers at national conferences to identify business development techniques and new revenue streams.
· Rendered a keen eye for details to identify and tap institutions and market sectors with potential for expansion of operations, networking with key partners and individuals to build awareness of company within key demographics.
· Solved complex incidents and problems impacting management and business direction; partnered with account executives to penetrate new accounts, identify potential customers and coordinate product demonstrations.
Account Receivables Specialist
Researched numerous verticals to stay abreast with HIPAA regulations benefits claims processing and medical terminology, leveraged keen insight to analyze pending claims to identify and resolve problems blocking auto-adjudication.
· Served as a resource in all efforts to accurately process a large volume of medical claims every shift. Inputted data into the system, maintaining accuracy of provider coding information and reported services.
· Tracked differences between plans to correctly determine eligibility and assess claims against benefits and data entry requirements. Sent clinical request and missing information letters to obtain incomplete information.
· Performed duties as a technical overlay to document all file notes clearly and concisely in ECW, Cure cloud and Athena. Called insurance companies to ascertain pertinent information regarding policies and payment benefits for patients.
Delivered full sterling support to the new policyholders with processing claims; Based payment or denials of medical claims upon well-established criteria for claims processing
Authorization Specialist
Relayed messages from patients to physicians about concerns, condition updates or refill requests to facilitate treatment.
· Secured and updated patient information and maintained patient confidence by completing and safeguarding medical records. Efficiently performed insurance verification and pre-certification and pre-authorization functions.
· Provided subject matter expertise on key initiatives for batch-scanning and indexing patients’ charts to improve data availability while maintaining security; interviewed patients to obtain medical history, chief complaints, and vital signs.
Performed preliminary physical tests to accurately record results in patient history summary, also measured the patient peak flows to improve workflow efficienc
