Randi Villa Email & Phone Number

Greater Cleveland

United States

Roundstone Management, Ltd. (“Roundstone”) based in Lakewood, Ohio, is an insurance organization offering an expertise in the captive marketplace coupled with turnkey insurance management services

United States

Brooklyn, Ohio

Cleveland, Ohio

Cleveland, Ohio

Investigate and resolve claims issues regarding duplicate health care coverage in accordance to NAIC and ODI guidelinesCoordinate benefits between Medicare, Medical Mutual, and other payers to ensure proper payment within Medicare and CMS guidelines. Ensure files are loaded accurately to reflect other health insurance coverage to ensure proper claim paymentResearching checks returned from providers for possible overpayment. Call provider, member, and other insurance company as necessary to properly update filesReview divorce decrees to ensure proper coordination of benefits for dependent children with more than one health care insuranceRespond to phone calls, emails, and written inquiries from members, providers, internal requests and other insurance companies to update files with correct informationWork special reports from Management as requestedWork COB Maintenance Queue to ensure timely and correct file updatesSend letters to members for other insurance inquiries and document requestsLiaison for COB department and Operations to ensure proper procedures and correct pending of COB claims

Follow up for insurance medical claimsRequired to work 50 accounts per dayWorked with insurance companies to ensure payment of claimsHandled all reviews and appeals of denied claims and submit necessary documentation to receive paymentPersonally responsible for approximately 1500 patient accountsEnsured the accuracy of all patient accounts and proper reimbursement of medical claimsTrained new hires for position and patient phone callsWorked with coding department to ensure proper coding of claims for payment

Responsible for all daily functions of office.Coding, processing, transmission of medical claims.ICD-9/CPT-4 codingFollow up and appeal of medical claimsPrecertification of all surgeries and deliveries as neededSchedule all appointments and surgeries.Insurance credentialingMedical transcriptionPatient accountingPatient check in, verifying correct insurance information and address. Making necessary changes to patient recordsPatient check out, ordering necessary blood work, sonograms, collecting copays, and scheduling return appointmentsCalling patients with abnormal test results and scheduling next step of treatmentAssist doctor with routine office exams and procedures

Bachelor'S Degree, Business Administration And Management, General, Summa Cum Laude 3.975

Bachelor of Science, Management Indiana Wesleyan University Marion, IN Graduated August 9, 2014 Summa Cum Laude GPA 3.96

Associate'S Degree, Business Administration And Management, General, 3.95

Associate of Science, Business Indiana Wesleyan University Marion, IN December, 2011 3.95 GPA

Certificate In Medical Billing And Coding, Medical Insurance Coding Specialist/Coder

Ohio Business College Lorain, Ohio 2003 Completed Real Estate courses and passed Ohio Real Estate Boards to obtain Ohio Real Estate License.

Ohio Real Estate License, Real Estate, Courses Completed And License Obtained

LCJVS, Oberlin, Ohio 2004 Received Certificate of Completion for courses in Medical Terminology, Introduction to Medical Coding.