Responsible for coordinating billing and collecting payments for national patient accounts. Included significant work in JHH and JHU billing systems. Identified key issues and took appropriate action to ensure revenue maximization on individual accounts. Communicated with patients, physicians, insurance companies and other departments to resolve accounts. Determined appropriate discounts/courtesies based on departmental policy. Interacted with insurance carriers to determine status of payment. Processed weekly and monthly automated transfers and write-offs for old insurance A/R and self pay delinquent accounts. Processed open credits for Medicaid and Medicare. Process HMO receivables. Was a temporary assignment

Selected by management to be a team member of their new Compliance Department. Reviewed clinical medical records and claims for accuracy of services related to clinical standards of practice. Examined, approved, or rejected 485 forms from clients. Verified all authorizations for proper billing. Maintained current knowledge of rules, regulations, and reimbursement issues. Utilized knowledge of billing and coding experience. Tracked external employees’ licensure/certification for validity/expiration and other requirements that expire. Performed scheduled audits. Generated reports and approval schedules. Responsible for office administrative functions including ordering supplies, answering phone inquiries, photocopying , and monitoring incoming/outgoing faxes. Demonstrated excellent communication skills. Required to multitask, while staying organized and paying attention to detail. Worked with minimal supervision. Met deadlines and completed work in an accurate and timely fashion. Used MS Word, Excel, email, web-enabled applications, and performed internet research. Supported a series of branch offices with accounting functions for one of the leading providers of medical staffing, home health and wellness services in the United States. Responsibilities included invoicing corporate clients for services rendered. Billed out to Medicare and Medicaid clients. Reviewed unpaid accounts to determine status and taking appropriate action to ensure payment. Performed collections on Medicare and Medicaid accounts. Contacted corporate clients regarding reimbursement for unpaid accounts over thirty days or more, by researching and following up on denials and requests for additional information. Contacted patients to collect appropriate information or to collect patient balances. Identified and applied cash to appropriate A/R accounts. Researched and resolved unapplied and credit balances. Wrote up adjustments. Processed refund requests. Provided training to new employees.

Generated revenue by negotiating with providers on a variety of claims and maintained clients turn-around time. Resolved Medicare disputes, appeals, and waivers. Established and enhanced relationships with hospital and physician providers. Negotiated claims in a timely and accurate manner while adhering to company guidelines, including those regarding productivity and results. Maintained case notes with status changes and information necessary for Client Services.

Accurately processed mental health and substance abuse claims. Performance required knowledge of CPTand DMS IV codes and attention to detail. Processed claims with a high level of quality and in accordance with claims payment policy and terms of customers/provider contractual agreements. Processed In-patient Medicare claims. Adjudicated claims and adjustments. Resolved claims edits and suspended claims. Maintained and updated required reference materials to adjudicate claims. Provided backup support to other team members in the performance of job duties as assigned.

Timely and accurate processing of claims submitted by providers and insured individuals in accordance with established policies, procedures and contractual rates. Demonstrated excellent attention to detail.Customer Service Representative, September 1997- July 1999Provided exceptional customer service by answering phones and resolving concerns from members, providers, andclient organizations. Demonstrated excellent communications skills. Reviewed/researched problems and worked to reach resolution in a timely manner. Claims Resolution Specialist, July 1999 – January 2002Accountable for accurate and timely processing of adjustments, projects and administrative duties as needed. Adjudicated claims and adjustments. Adjusted Medicare claims for accurate processing. Assisted in providing daily leadership for associates to obtain optimal results. Processed adjustments to include tracking and trending performance of root cause analysis. Identified system/benefit errors, completing protocols and workflows to prevent future errors. Handled all types of requests, inquiries, and complaints accurately and timely. Provided reinforcement training for new associates and on-floor support for existing associates. Responded to written correspondence and phone inquiries from internal and external customers. Sought, gathered, and analyzed data to resolve problems effectively. Demonstrated excellent communication skills. Able to multitask, while staying organized and paying attention to detail. Completed special projects as assigned by management. Provided additional support to other team members. Prepared feedback and review to communicate to managers. Worked with minimal supervision.

Required collating and processing medical, EDI and hospital PPO claims; processed In-patient Medicare claims. Examined claims to qualify eligibility of applicants; analyzed bills to determine coverage; input proper information; monitored for accuracy and legitimacy; interfaced with doctors to clarify questions, completed claims and forwarded to appropriate department; complied with standards of productivity and accuracy; handled medical crossovers; participated in training to upgrade all skills. Additional special projects included processing foreign claims; assisting the Customer Service Department in fielding complaints; investigating doctors and applicants for fraudulent claims.