analyzing Client's specialty benefit requests and inputting data into RxClaim to maintain specialty benefitsialty benefitPerformed monitoring activities to ensure compliance with state and federal regulations, client requirements, internal processes and procedures as well as validation of compliance with NCQA and URAC requirements

• Solely responsible for handling the scanning, data entry & uploading 90% of DFW Airport’s financial records, over34,000 annually.• Provided DFW Airport’s IT Department with insights on invoicing procedures for the implementation, testing, andproduction of the Oracle Fusion cloud database• Trained on best practices and procedures in working in Oracle Fusion, Invoice Scan Queue, creating Requisitions, and creating Requests for Payments.• Performs research of invoices and other related financial records identifiable information (PII) and security sensitive information (SSI) are protected• Created and maintained a variety of training guides, procedures, and documents that include:- correspondence dealing with financial records, responses to outside vendors, guides on purchase requisitions, instructions on requests for payments, memos with crafted instructions for interdepartmental personnel, & instructions on acquiring and handling departmental assets. - Maintaining retention and destruction standards per Texas state law for all financial records- Classifying and archiving both electronic and hard-copy versions of financial records.- Converting documents of all formats to ensure the best quality control of records- Contributed DFW Airport’s IT Department with the testing, creation, and production of the Invoice ScanningQueue (ISQ) applicationImaging Specialist • Prepared, scanned, & completed data entry on operation and maintenance manuals, files and other related documents.• Performed optical character recognition (OCR) on the electronic records then analyzed and indexed records intoselected databases for long-term retention archives.• Prioritized tasks by using records management best practices regarding issues with records and images along withidentifying solution strategies.• Prepared, analyzed, indexed, updated, processed, and scanned employee travel documents and images for retentioninto Records Management databases.

● Managed provider data across multiple systems, ensuring compliance with legal andorganizational standards.● Conducted detailed audits and implemented database improvements, enhancing theaccuracy and reliability of provider information.● Played a key role in resolving system issues, leading to improved operational efficiency anddata integrity.

Identified and resolved outstanding claims, reducing accounts receivable aging and improvingcash flow.● Developed and generated comprehensive reports to analyze patient account discrepanciesand implemented corrective actions.● Acted as a liaison between customers, external vendors, and internal teams to ensure timelyclaim resolutions and client satisfaction.

● Generated and managed client invoices, utilizing Excel for data analysis and Oracle forinvoicing.● Resolved cash payment discrepancies, supported branch employees, and collaborated withcorporate analysts to streamline billing processes.● Oversaw event creation, invoicing, and closure, ensuring accurate revenue and expensetracking.

Processed and resolved Edit, rejections, EODCharged entry specialty billing MRI, Xray, and LabsBilled data and revised any errors timely filing or billing issuesMaintained manuals logs and other required documentationProcessed all related account maintenanceBenefit decisions and verificationsAnswered and resolved patient billing inquiriesFollowed up on insurance and patient aging

Input, reviewed and prepared patient and insurance data into the charge master system. Research and verify accuracy of billing data and revise any errorsReviewed and retained hospital records in order to compute fees and charge totals.Reviewed and retained records in order to assist in maintaining manuals, logs and other required documentation as required.Ensured daily work balances, print daily charge report and file.Demonstrated and understanding for patient confidentiality to protect the patient and the clinic/corporation.Posted charges from encounter forms and hospital charges within 24 hours.Check figures, postings, and documents for correct entry, mathematical accuracy, and proper codes.Operate computers programmed with accounting software to record, store, and analyze information.Debit, credit, and total accounts on computer spreadsheets and databases, using specialized accounting software.Classify, record, and summarize numerical and financial data to compile and keep financial records, using journals and ledgers or computers.Operate 10-key calculators, typewriters, and copy machines to perform calculations and produce documents.Reconcile or note and report discrepancies found in records.Perform financial calculations such as amounts due, interest charges, balances, discounts, equity, and principal.Perform general office duties such as filing, answering telephones, and handling routine correspondence.Prepare trial balances of books.

Ensured office practices are in compliance with HIPAA regulations PQRI system recallsWorked with the representative to communicate status of rejection reports.Verified eligibility for clients and completed updates.Processed and resolve errors or rejectionsSystems and Managed Care enrollment error reportsMonitored charts to identify problems.Processed all related account maintenance tasks.Operate computers programmed with accounting software to record, store, and analyze information.Classify, record, and summarize numerical and financial data to compile and keep financial records, using journals and ledgers or computers.Code documents according to company procedures.Operate 10-key calculators, typewriters, and copy machines to perform calculations and produce documents.Reconcile or note and report discrepancies found in records.Perform general office duties such as filing, answering telephones, and handling routine correspondence.Monitor status of loans and accounts to ensure that payments are up to date.

Effectively and accurately enrolled newly acquired practitioners and healthcare providers in health plans with software vendorCompleted EFT and ERA applicationsKnowledge of payer EDI enrollment, medical billing, credentialing and multi-state Medicaid and commercial payer enrollmentClaim research and analysis to resolve claim edits daily related to responses from the payer rejection reports, 276/277 transactions and 835/EOB CAS codesNavigated insurance carrier websites and facilitate/organize client enrollment processesPrepared necessary applications online or on paper, obtain provider signatures and track outstanding itemsReconcile electronic payments by retrieving electronic bank files for each client and matching paymentsCompleted rejection reports, send to client; work with the client representative to communicate status of the client’s Accounts Receivable (A/R) and resolve errors or rejectionsUtilized state enrollment systems and managed care enrollment systems.Verified eligibility for clients and completed updates of Managed Care System.Monitored all enrollments to identify any processing problems.Processed all related account maintenance tasks.Partner cross functionally with various operational business units while supporting departmental objectives within company and regulatory guidelines.Accomplished daily enrollment/ disenrollment operationsCheck figures, postings, and documents for correct entry, mathematical accuracy, and proper codes.Operate computers programmed with accounting software to record, store, and analyze information.Comply with federal, state, and company policies, procedures, and regulations.Code documents according to company procedures.Operate 10-key calculators, typewriters, and copy machines to perform calculations and produce documents.Perform general office duties such as filing, answering telephones, and handling routine correspondence.Monitor status of loans and accounts to ensure that payments are up to date.

Posted and reconciled insurance and patient paymentsRetrieved Electronic Remittance Advice (ERA’s)Accurately applied payments to patient accountsResearched and resolved incorrect payments, EOB rejections, and other issues with outstanding accountsImproved revenue for most recent provider over 32% with same patient loadExperience billing for Pathology and Gastroenterology specialtiesEnsured claims are entered and submitted within 48 hours of receiptEnsured accuracy of insurance claimsVerified correct ICD-9 and CPT codes for a variety of specialtiesSet up new patient accountsAssigned ICD-9 to physician’s diagnosis and ensure correct level of service and various other CPT codes, PQRI, NCCI, MUE and LMPR codesSent secondary claims upon processing of primary insuranceAnswered and resolved patient billing inquiriesFollowed up on insurance and patient agingRe-submit insurance claims as necessaryKnowledgeable in timely filing restrictionsEnsured office practices are in compliance with HIPAA regulationsCheck figures, postings, and documents for correct entry, mathematical accuracy, and proper codes.Operate computers programmed with accounting software to record, store, and analyze information.Debit, credit, and total accounts on computer spreadsheets and databases, using specialized accounting software.Calculate, prepare, and issue bills, invoices, account statements, and other financial statements according to established procedures.Code documents according to company procedures.Access computerized financial information to answer general questions as well as those related to specific accounts.Operate 10-key calculators, typewriters, and copy machines to perform calculations and produce documents.Perform financial calculations such as amounts due, interest charges, balances, discounts, equity, and principal.Perform general office duties such as filing, answering telephones, and handling routine correspondences Prepare trial balances of books.