Bailey Spears Email & Phone Number

Tyler, TX, US

• Analyzes and evaluates Medicaid claim payments provided by payers to determine if the medical provider has been reimbursed in compliance with the applicable state fee schedule for UB04 and CMS 1500 claims
• Researches, requests and acquires all pertinent medical records and any other supporting documentation necessary and then submit with hospital claims to insurance companies to ensure prompt correct claims reimbursement
• Conducts follow ups on unpaid and denied claims, successfully appealing claims to secure appropriate and prompt reimbursement
• Reviews and understands EOBs from all payers to determine next steps and understanding of multiple fee schedules
• Identifies root cause, patterns and trends relative to assigned clients to prevent claim denials
• Assists management with prioritizing work products and tasks

Tyler, Texas, United States

• Completed and submitted CMS 1500 claim forms
• Performed quality control procedures on claims to ensure accurate billing
• Provided prompt customer service to patients, providers, office staff and insurance companies
• Researched and obtained incomplete or additional information for billing requirements for insurance carriers such as Cigna Commercial, Cigna Medicare Supplement, County Indigent Healthcare, Molina Medicare Advantage.
• Reviewed CPT codes, ICD 10 and LCDs for medical necessity per CMS Billing and Coding Policies
• Reviewed and processed weekly TMHP R&S reports

Tyler, Texas, United States

• Accurately and promptly coordinated scheduling, rescheduling, cancellation and appointment confirmation for radiology procedures
• Ensured appropriate documentation is obtained prior to procedure
• Created of new accounts and payment profiles
• Reviewed patient clinicals, built cases with authorization companies, provided clinical information, obtained authorizations and appealed authorization denials for radiology procedures
• Managed a high volume of authorization requests on a daily basis
• Maintained accurate records of authorizations, including dates, approvals, and any necessary follow up actions

Lindale, Texas, United States

• Maintained pharmacy and retail inventory
• Prescription Insurance Verification
• Maintained a safe and clean pharmacy by complying with procedures, rules and regulations
• Daily use of Cardinal Health Ordering System
• Organized medications for pharmacist to dispense by reading medication orders and prescriptions; preparing labels; calculating quantities