Melissa K. Email & Phone Number

Independently review accounts and apply billing follow up knowledge required for all insurance payors to insure proper and maximum reimbursement. Prebilling/billing and follow up activity on open insurance claims exercising revenue cycle knowledge. Accurately enters and/or updates patient/insurance information into patient accounting system. Appeals claims to assure contracted amount is received from third party payors. Complies and maintains KPI (Key Performance Indicators) for assigned payers within standards established by department and insurance guidelines.

Support the Buying Director to oversee the product life cycle of a sub-group of products. Request, organize and manage product samples from suppliers. Understand commodities and provide recommendations to direct leader based on market knowledge. Manage multiple projects at once by prioritizing, setting deadlines, and coordinating the flow of information internally and externally. Strategize effectively to solve problems with vendors and product issues. Utilize various computer applications for database management, report generation and tracking spreadsheets. Serve as the primary liaison between internal and external parties in coordination with direct leader. Provide training to new staff and contributes to committee or teamwork. Provide recommendations for changes or improvements on operating or training procedures and seeks further training on areas if needed.

Work assigned accounts through the collections system, analyzing them for appropriate action; access and utilize external computer systems. Identify and request all appropriate adjustments to accounts assigned, following payer/department payment guidelines. Initiate process for any further billing required on accounts after the primary portion is resolved. Recommend aged or rejected accounts for write off to collection agency; process refunds to third party payers, as required.

Provide timely and accurate billing of claims to insurance companies for healthcare reimbursement. Responsible for ensuring claims are accurately priced, placed on appropriate hold status, resolve payer rejected claims, identify, and prepare adjustments or write offs while maintaining quality and productivity requirements.

Ensures claims are processed accurately to secure timely payment. Responds to inquiries, questions, and concerns from patients regarding the status of claims in a clear, concise, and courteous manner. Conducts follow-up and submits reimbursement appeals for unpaid and/or inappropriately paid claims; ensures appropriate documentation of billing, follow-up, collection, and appeal efforts are recorded on accounts. Identifies, researches, and ensures timely processing of billing errors and corrections as they relate to claims; actively participates in problem identification and resolution and coordinates resolutions between appropriate parties.

Obtain complex financial information regarding patients from various sources, notify insurance companies and assist with obtaining insurance authorizations. Handles and tracks payments, special package plan agreements, financial assistance paperwork; assists with obtaining Medicaid applications, alternative financing and verifying coverage from other third-party payers in a variety of hospital settings. Secures payment for balances on inpatient and outpatient accounts. Assist Supervisor and Lead with the monitoring of patient financial issues and audit registration regulatory forms for accuracy daily or by shift.