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Medical Billing & Collections
Dependable, detail-oriented and knowledgeable Certified Healthcare Collections, medical coding, and billing professional with a track record of stellar customer support and strong communications expertise. Eager to contribute advanced communications, medical billing/collections and problem solving skills toward optimizing the goals of a progressive employer. Strong client communications skills, building customer-centric rapport and demonstrating stellar billing and coding initiatives. Proficient in MS Office, CUBS, Meditech, Accuro, Cirrcus, DSG, and ChartMax systems.
Payment Account Representative – Trauma & Stress Recovery Center, San Francisco, CA Insert Date – Date
Directly contacted self-pay patients regarding payment of unpaid medical equipment bills
Proactively followed up regarding submitted workers comp claims by phone
Submitted claims on 1500 HCFA Forms to the Workers Compensation Carrier in an expedited manner
Pulled Patient Files for Insurance Requests
Maintained Doctors Calendar each week before patient visits to ensure appropriate coverage
Payment Account Representative – California Home Medical Equipment, Hayward, CA 3/2011 to 7/2011
Contacted self-pay patients to request and facilitate payment of unpaid medical equipment bills
Utilized patient information to determine which patients received write-offs
Posted payments, adjustments, credits and write-offs with Brighttree Software
Payment Account Representative – Medi-Assist, Hayward, CA 2008 to 2009
Effectively evaluated medically indigent clients referred by contracted agencies for Medi-Cal eligibility.
Assisted clients in accurately completing Medi-Cal application and gathering necessary documentation for submission, once eligibility was verified.
Completed and submitted UB-92 and CMS 1500 forms. CPT coded for hospitals, physicians, DME providers, and transportation providers, and followed up on billing submissions and denials.
Submitted completed applications to the Department of Social Services, and followed up on Medi-Cal applications through the Medi-Cal Point of Service System.
Kept current with insurance companies on claim status, rebilling, invoices, and Medi-Cal and Medicare issues, utilizing Meditech, DSG, CHARTMAX, ACCURO and CIRRCUS programs.
Collaborated with county eligibility workers to follow up on pending applications, and effectively explained Medi-Cal benefits and the application process to clients.
Medical Billing/ Follow–up Specialist (Contract) – (Daughters of Charity), Redwood City, CA 2008
Extensive knowledge of National Government Services Website used to research and determine eligibility, copayments, co-insurance, and claim status.
Electronically submitted the UB-92 to initiate reimbursement, and reviewed Medicare Remittance Advices for accuracy and forwarded adjustments to the posting department.
Accessed POS from Medi-Cal Website, verified eligibility for managed care clients and Medicare eligibility.
Government Services Follow-Up Rep (Contract) – CA Pacific Medical Center, San Francisco CA 2007 to 2008
Managed follow-up on Medicare and Medi-Cal Claims, checked payment status and entered status in account notes.
Updated financial class once payment was received, and verified Medi-Cal Point of Service on Medi-Cal Web site. Pulled Medicare and Medi-Cal RA for adjustment as necessary.
Reviewed Remittance Advice for adjustments and non-covered services, and evaluated denied TARS for appropriateness of denial.
Corrected CPT codes and diagnoses, verified Medi-Cal eligibility through the State of California Web site, and
contacted patients regarding ineligibility and primary insurance carriers.
Referred patients to the appropriate county Ability to Pay Program, and updated POS eligibility on uninsured clients.
Insurance Billing Specialist – CBSJ Financial Corp., San Jose, CA 1990 to 2007
Promoted within first year from General Collections Specialist specializing in commercial, probate, and consumer collections to Insurance Billing Specialist.
Applied knowledge of medical and dental insurance coding and billing procedures to accurately prepare UB 92 and CMS 1500 and other medical billing forms for timely submission to insurance companies.
Evaluated eligibility and determined co-payment status, and successfully collected unpaid co-payments and outstanding balances.
Completed and submitted Workman’s Compensation paperwork for reimbursement, and facilitated communications between attorneys, medical insurance companies, physician medical groups, and consumers to ensure that all parties were current on related cases.
Explained insurance coverage and billing process to consumers, and effectively provided training and support in the medical and the legal aspects of collections and medical insurance billing for coworkers.
Evaluated denials and submitted appeals, contacted patients regarding denials and appropriate next steps.
Consistently exceeded individual and group quotas, and provided Notary Public support, managed probate accounts and supported legal staff.
EDUCATION / AFFILIATIONS
A.A., History—West Valley College, Saratoga, CA – Dean’s List
Software Courses — Mission College, Santa Clara, CA — MS Excel, Word, and Windows Operating Systems.
Paralegal Certificate—West Valley College, Saratoga, CA
The South Bay Civil War Roundtable— Secretary
Lecture in areas of expertise in the Civil War, and frequently attend regional and national events.