Works with appropriate revenue cycle staff when performing account resolution functions. Investigates and researches credit and undistributed balances on hospital and physician accounts, working those balances through to resolution. Initiates refund requests as appropriate to third party payors and/or patients, which includes obtaining appropriate documentation and accurately recording proper refund information into the hospital or physician billing system. Identifies unclaimed property amounts and initiates the unclaimed property process.Reviews patient accounts for possible reversal of administrative, courtesy, or contractual adjustments. Maintains a working knowledge of common billing and account resolution practices and requirements for hospital and/or clinic billing. Communication with insurance and/or patients as appropriate during the resolution process. Keeps updated on applicable payor policies, federal and state regulations, laws, and procedures.

Highlights of Expertise Serving as company liaison with customers concerning quality control documentation. Recipient of Performance Recognition Awards for going above and beyond to achieve customer satisfaction .Microsoft Word, Outlook and Excel. Knowledge of Good Manufacturing Practices.Lean Six Sigma Yellow CertificationJD Edwards Software Strong oral and written communication skills. Pilgrim Software. Responsible for performing required regulatory functions such as document issuance, review and retrieval. Searched electronic sources such as data bases or repositories, or manual sources for information. Monitored regulatory activity to maintain compliance with records and document management laws.Kept abreast of developments in document management technologies and techniques by reviewing current literature, talking with colleagues, and participating in professional organizations or conferences. Implemented scanning or other automated data entry procedures, using imaging devices and document imaging software.Documented Change Controls for Batch Records. Reviewed and implemented quality contract requirements. Communicated with internal and external customers to answer questions and disseminate or explain information. Operated office machines such as photocopiers and scanners, facsimile machines, voice mail systems, and personal computers.

Possessed technical proficiency to handle complex claim issues. Acted as claims resource in customer service operations. Promoted from Claim Examiner to Claim Service Adjustment Specialist. Processed adjustments to the Computrak System as a result of a phone call to customer service. Conducted in-depth research and consulted with other departments and customers to resolve inquiries.

Processed Medical and Dental claims in accordance with contract provisions using established policies. Served as mentor to new trainees. Met accuracy and productivity targets outlined in current year's performance standards. Processed customer referrals and claim adjustments within 24 hours of receipt. Analyzed and researched claims to determine correct payment or denial process.