Heather Lalli Email & Phone Number

Detroit, Mi, Us

Southfield, Michigan, United States

Currently in training to work hospital accounts receivable for a large out of state health system.

Garden City, Michigan, United States

Worked hospital billing, (UB04 claims) submission, correction and follow up within EPIC. Managed workload with millions of dollars of outstanding accounts receivable, working specialized accounts $25K and up balances and Medicare Managed Care accounts, reviewing payments, denials and unpaid accounts over 30 days old, daily. Worked various payer work queues in EPIC investigating and assisting in claim submission and resolution for all payers including Medicare HMO, Commercial and Medicaid/Medicaid HMOAssisted with special projects when necessary. Analyzed accounts in finding trends to increase efficiencyVerified accurate claim payments using Medicare/Medicaid fee schedules, CMS Web Pricer, and internal contract data.

Detroit, Michigan, United States

Researched and applied critical thinking using plan documents and BCBSM policy to support final determination of appeal, grievance or inquiry. Conducted Managerial-Level Conferences with members when necessary. Managed workflow and incoming case load, including managing reports for workflowAssisted in monitoring the President’s Grievance hotline. Made telephone calls to clarify information regarding appeal or grievance case when necessary whether it be to the member, provider or a third party. Upheld HIPAA and compliance practices along with maintained confidentiality

Sterling Heights, Michigan, United States

Managed all current and aged A/R for physician multiple location practices. Balanced daily postings and incoming revenue for six office locations. Handle escalated patient phone calls regarding a variety of billing issues. Assigned and coordinated work for team of 10 Billing Specialists. Provided training to new and existing team members using Billing Department follow up procedures. Ensured staff are completing assigned tasks in a timely manner. Provided coverage as needed to include performing other staff members duties during their absence

Rochester Hills, Michigan, United States

Maintained financial reports for payment posting and aged receivables for clinic and surgery center. Managed up to 6 million dollars in annual billing, for surgery center on UB04 claim forms and physician billing on 1500 claim forms. Created training documents for billing and follow up procedures and for report running. Posted payments, electronic and manual for all insurance carriers. Created claims for services rendered to go to Commercial, Medicare, Medicaid, Auto insurance and invoices to self- pay patients. Assisted in creating and updating policies to ensure efficiency in the Billing Department and within the Clinic Managed denials and rejection reports . Trained new employees how to use EMR/ Billing system MDRythm for billing and follow up. Opened and scanned all incoming mail, including billing documents for review by billing department and prepare checks for bank deposits. Assisted with paying open invoices for various vendors. Located and posted backlogged electronic and manual payments. Verified and update patient demographics and insurance information when necessary. Identify and post necessary adjustments for no authorizations, timely filing and other various reasons

2700 S. Rochester Rd., Rochester, Mi

Oversee day to day revenue cycle operations for PM&R clinic.

Rochester Hills, Mi

Detroit, Michigan

Reviewed and worked denials for Blue Cross Blue shield and Blue Care Network accounts in work queue or excel reports, to completion for Detroit Medical Center, on UB04 hospital claim forms. Updated demographic errors on patient accounts when necessary. Transferred non-denial accounts with a balance to correct departments. Tracked various denial issues to report for root cause analysis. Determined whether appeals are necessary and refer accounts to coding for review when if needed. Followed up denied authorizations (Evicore, E-Referral, Landmark). Post adjustments for JHVL and other denials. Reason for leaving was the position and department were eliminated by the organization

Bingham Farms, Mi

Managed accounts receivable up to four clients including a Laboratory, Pain Management office and a multiple Surgeons (previous client was Ophthalmologist) on professional 1500 claim form and in some instances on UB04 claim forms,. Pulled payment vouchers/remits from clearinghouse and payer web portals daily for posting and log into spreadsheet. Reviewed and resolved denied and delinquent claims. Tracked various issues with provider offices to resolve ongoing denial issues. Requested re-considerations on denied claims and determine if appeal is necessary . Answered patient phone calls regarding billing questions and other issues. Obtained patient payments over the phone and send to office for processing

Southfield, Mi

Managed up to 17 million dollars in AR, 10M for Nashville, 7M for Jacksonville for hospital accounts in large health system. Corrected adjustments on accounts to bring account balances to the correct value according to remits and payments made. Worked with insurance companies to resolve billing/payment discrepancies when necessary for hospital accounts mainly on UB04 claim forms. Worked escalated patient accounts for Nashville and Jacksonville accounts to resolve outstanding refunds owed to patients. Worked Special projects: distribute weekly Medicare audits, request new vendor IDs for refunds, weekly aged patient refund report

Jackson, Michigan Area

Reviewed and release charges input by providers in designated specialty offices. Edited and release UB-04 and 1500 claim forms (primary, secondary and tertiary) in a timely manner. Reviewed and answer questions from patient financial services HCPCS, CPT and diagnosis codes. Ensured proper documentation is in patient records to validate charges being billed. Verified patients correct insurance and demographic information. Posted charges for Medicare split billing in facility billing system for hospital charges. Verified status on outstanding claims to ensure they are being processed in correct time frames. Made adjustments to accounts when necessary (i.e. corrections, observation hour carve outs, etc.). Sent appeals to insurance companies for claims denied in error. Assigned to worklist of aging and problematic accounts to resolve unpaid claims. Located and obtain requested documentation to send to necessary parties when requested

Jackson, Michigan Area

Facility and professional medical claim submission. Contact insurance companies regarding claim status and claim denials. Designated special projects. Make adjustments on patient accounts when necessary. Verify and update patient demographics when necessary.

Detroit, Mi

Worked follow up on hospital (UB04) claim forms for Inpatient, Outpatient and Infusion billing. Verified status of unpaid Medicaid HMO claims. Verified patient insurance coverage and coordination of benefits when a billing discrepancy occursAssisted in data entry for testing new operating system. Worked patient accounts with credit and debit balances to resolve issues and when necessary, initiate a refunds when necessary. Reviewed lab vouchers, made adjustments when necessary and delegated specific payers to other Patient. Account Reps to review

Allen Park, Mi

Maintain high energy positive attitude. Ensure patrons recieve a high quality casual dining experience. Meet daily sales goals set at the beginning of each shift. Cleaning duties assigned at the beginning of each shift.

Bachelor'S Degree, Health/Health Care Administration/Management

Certificate, Medical Insurance Specialist/Medical Biller

Associate'S Degree, Early Childhood Education And Teaching