Kelley Wise Email & Phone Number

San Diego, Ca, Us

Bloomington, Illinois, Us

-Responsible for Claim submission and remittance reconciliation for Medicare, Medicaid, commercial health insurance, and workman's compensation for over 75 optometry practices -Reviewed explanation of benefits of insurance carrier payments/denials to determine the next actions for resolution of claims. -Identified the reason for underpayments, denials, and cause of payment delay. -Continued monitoring and review of open accounts to identify adjustments, refunds, and changes in receivables. -Submitted detailed appeals to insurance carriers to secure payment in a timely manner. -Reviewed aging reports, including monitoring delays in payments, past due statuses, and projected AR forecasts. -Maintained clear and cohesive notes/documentation related to all open claims. -Demonstrated understanding of medical terminology, CPT and ICD-10 coding and billing forms (HCFA) -Worked with management on several urgent projects as well as routinely to identify, trend, and address root causes of denials. -Coordinated with practices via Fresh Service to obtain and relay information needed to reduce AR aging, was consecutive MVP of RCM-Billing every month by ticket count and speed. -Determined and implemented plan set ups with correct reimbursement amounts to maintain accuracy in billing and receivables to reduce insurance aging for all offices. -Created and used Excel sheets to make receivables more accessible for plan set ups, as well as to review and work outstanding claims. -Vast knowledge of both medical and vision insurances, fee schedules, billing and filing of claims. -Read and interpreted explanation of benefits documents from insurance carriers to determine payment and patient responsibility. -Experience working with various insurance companies including Medicare, Medicaid, BCBS, United Healthcare, Humana, Cigna, Aetna, VSP, Eyemed, Spectera, Superior, VBA, Avesis, and many others.

Bloomington, Illinois, Us

-Responsible for the operational performance of over 75 optometry practices-Coordinated with offices via Zendesk tickets to set up insurance plans and solve other issues with an average 93% one-touch solve rate, 6-minute reply time and 100 tickets a day-Worked extensively in both the back-end admin and point-of-sale sides of Acuity Logic-Determined and implemented plan set ups with correct reimbursement amounts to maintain accuracy in billing and receivables in order to reduce insurance aging for all offices-Created and used Excel sheets to make receivables more accessible for plan set ups-Vast knowledge of both medical and vision insurances, fee schedules, billing and filing of claims.-Developed and implemented systems with easy to interpret fee schedules for employees to be able to determine and collect accurate patient portions at the time of service.-Effectively interpreted and communicated insurance benefits to office team members-Maintained employees’ time and issued payroll.-Ability to read and interpret explanations of benefits from insurance companies to determine payment and patient responsibility.-Immense knowledge pertaining to insurance policies and guidelines.-Experience working with various insurance companies including Medicare, Medicaid, BCBS, United Healthcare, Humana, Medcost, Cigna, Aetna, VSP, Eyemed, Spectera, Superior, and many others.

Kingwood, Texas, Us

Ability to perform a wide range of duties including office administration with a specialization in insurance. Vast knowledge of both medical and vision insurances, fee schedules, billing and filing of claims.Developed and implemented systems with easy to interpret fee schedules in order for employees to be able to determine and collect accurate patient portions at the time of service. Effectively interpreted and communicated insurance benefits to patients, the doctor, and coworkers.Used aging reports in RevolutionEHR to maximize payments on claims. Brought insurance aging down by $40,000 by finding and recuperating missing payments, correcting and resubmitting incorrect claims that had been previously filed. Brought patient accounts receivable down by $7,000 by implementing a monthly billing system and sending statements.Maintained employees’ time and issued payroll. Managed a database of accounts payable in QuickBooks and kept all accounts current. Knowledge of ICD-10 codes, both medical and refractive, and the use of modifiers. Read and interpreted explanations of benefits to determine payment and patient responsibility. Immense knowledge pertaining to insurance policies and guidelines. Experience working with various insurance companies including Medicare, Medicaid, BCBS, United Healthcare, Humana, Medcost, Cigna, Aetna, VSP, Eyemed, Spectera, Superior, and many others. Performed technical and administrative functions related to optometry and clinical office settings including patient registration, insurance verification and filing of claims, appointments and referrals, patient billing, correspondence, employee training and patient relations. Implemented policies to better manage employees, office duties and time. Used DemandForce for reputation management, patient recall, and online appointment scheduling. Extensive experience with EHR, online claim submission, and programs such as RevolutionEHR, GatewayEDI/TriZetto, DemandForce, and Microsoft programs

Vast knowledge of both medical and vision insurances, fee schedules, billing and filing of claims. Used aging reports in OfficeMate to maximize payments on claims. Knowledge of ICD-10 codes, both medical and refractive, use of modifiers. Ability to read explanations of benefits from insurance companies to determine payment and patient responsibility. Brought insurance aging down by $30,000 by finding and recuperating missing payments, correcting and resubmitting incorrect claims that had been previously filed. Implemented a billing system for patient accounts and sent monthly statements. Performed technical and administrative functions related to optometry and clinical office settings including patient registration, insurance verification and filing of claims, appointments and referrals, patient billing, correspondence, employee training and patient relations. Increased contact lens sales and met goals for annual supply sales.Vast knowledge of EHR, and programs such as OfficeMate, ExamWriter, GateWay, TriZetto, SolutionReach, and Microsoft programs. Used DemandForce and SolutionReach for reputation management, patient recall, and online appointment scheduling.

Performed technical and administrative functions related to optometry and clinical office settings including patient registration, pre-testing, comprehensive eye exams, diabetic eye exams, tonometry, retinal photos, lensometry, auto-refraction, insurance verification and claims submission, appointments and referrals, medical billing, collections, employee training and patient relations.Increased contact lens sales and met goals for annual supply sales.

Bachelor Of Science - Bs, Computer Science

Associate Of Science - As, Legal Assistant/Paralegal

Education record