Description :

1. Administered comprehensive health benefit programs, including insurance enrollments and claims processing.
2. Managed COBRA program data, ensuring accuracy in claims and self-billings.
3. Maintained patient files with a focus on compliance and confidentiality.
4. Conducted research on payer contracts and policy coverage for specialty products.
5. Evaluated insurance plans for therapy coverage, clarifying site-specific coverage components.
6. Identified pricing and reimbursement options for patients and healthcare providers.
7. Provided consultative support to drug manufacturers on product dispensation.

Experience

2-5 Years

Level

Junior

Education

B.S. Health Admin.

Description :

1. Mentored a team of 65 on performance metrics and program processes, ensuring adherence to program standards.
2. Assessed individual and group training needs to enhance team performance.
3. Trained new and current team members on standard operating procedures and addressed inquiries.
4. Conducted quality reviews of patient accounts to implement improvements in customer service.
5. Engaged with associates to provide mentorship and resolve queries effectively.
6. Developed new approaches to enhance service delivery and operational efficiency.
7. Documented business requirements and provided consultative support for data utilization.

Experience

2-5 Years

Level

Junior

Education

B.S. in HA

Description :

1. Evaluating and processing enrollment applications in accordance with program eligibility criteria.
2. Completing detailed insurance benefit verifications through commercial and government payers.
3. Facilitating access to appropriate support services, including Reimbursement counseling and nursing hotline support.
4. Resolving patient and provider requests in a timely and accurate manner.
5. Conducting follow-ups via phone, mail, and fax regarding all missing enrollment information for processing.
6. Maintaining frequent phone contact and professional interaction with patients and providers.
7. Scheduling and coordinating shipments to patients' homes through specialty pharmacies and to provider offices through program clients.

Experience

10+ Years

Level

Senior

Education

B.S. Health Admin.

Description :

1. Conduct comprehensive benefit investigations and verify insurance coverage for patients, ensuring accurate processing of claims.
2. Manage prior authorization requests, successfully obtaining necessary approvals to facilitate patient access to treatments.
3. Maintain meticulous records in the client database, ensuring data integrity and compliance with regulatory standards.
4. Collaborate with healthcare providers and insurance representatives to resolve billing discrepancies and expedite claim processing.
5. Participate in strategic discussions with client management to enhance reimbursement strategies and service delivery.
6. Serve as a primary point of contact for patients, guiding them through the reimbursement process and addressing concerns promptly.
7. Monitor and report on outstanding claims, implementing follow-up procedures to ensure timely resolutions.

Experience

7-10 Years

Level

Management

Education

B.S. Health Admin

Description :

1. Verify insurance coverage, negotiate reimbursement rates, and secure necessary authorizations for services.
2. Monitor accounts for timely payments and escalate issues regarding payer discrepancies to management.
3. Maintain accurate patient records in compliance with legal and regulatory standards, ensuring confidentiality and adherence to HIPAA.
4. Oversee billing data for up to 400 patients and payroll for 18 clinical staff using CaseMatch software, ensuring accuracy and timeliness.
5. Review and validate information in databases to ensure compliance with federal healthcare regulations and company policies.
6. Assist in the preparation of compliance documentation for internal audits and external regulatory reviews.

Experience

10+ Years

Level

Senior

Education

B.S. Health Admin.

Description :

1. Accurately processed and posted all cash, checks, credit cards, and electronic payments to patient accounts.
2. Conducted thorough research to resolve reconciling items, collaborating with internal teams to correct discrepancies.
3. Created and posted adjusting entries to clear outstanding reconciliations efficiently.
4. Audited and processed patient refunds, ensuring timely identification of overpayments based on established policies.
5. Led the transition from paper batch posting to digital CashPro imaging, enhancing processing speed.
6. Played a key role in integrating GE Groupcast practice management, ensuring proper electronic remittance acceptance.
7. Managed banking reports and monthly reconciliations, providing accurate financial data to stakeholders.

Experience

2-5 Years

Level

Junior

Education

B.S. Health Admin.

Description :

1. Utilized provider guidance and eligibility processes to update internal systems for enrollment into Express Scripts Prescription Drug Plan.
2. Served as the primary contact for internal clients and members during the enrollment process.
3. Managed outbound and inbound communications with physician offices, patients, and potential clients regarding member eligibility.
4. Exercised independent judgment to resolve complex or critical issues efficiently.
5. Collaborated with eligibility analysts and account managers to ensure seamless client support.
6. Identified and escalated recurring issues for prompt corrective action.
7. Maintained thorough documentation of all interactions to enhance process integrity and mitigate legal risks.

Experience

2-5 Years

Level

Junior

Education

B.S. in HA

Description :

1. Support practice management by managing patient records and ensuring accurate billing information.
2. Gather and verify insurance details for diagnoses and procedures rendered to patients, providing essential information to healthcare providers.
3. Leverage extensive knowledge in billing and reimbursement to accurately document medical records.
4. Foster collaborative relationships with departments, payers, and business partners to advocate for the interests of patients and the practice.
5. Minimize rejected claims by meticulously reviewing medical documentation to confirm insurance coverage for treatments.
6. Conduct outbound calls to insurance companies to verify patient benefits and eligibility.
7. Proactively address compliance-related matters by ensuring CPT and ICD coding accuracy according to regulatory standards.

Experience

5-7 Years

Level

Executive

Education

B.S. Health Admin.

Description :

1. Managed accounts receivable for a Joint Commission accredited medical equipment provider, enhancing cash flow and reducing outstanding balances.
2. Directed all facets of billing and collections, ensuring compliance with insurance regulations and timely payment processing.
3. Reviewed claims pre-billing for accuracy and completeness, achieving a 98% first-pass resolution rate.
4. Gathered and validated necessary documentation for claims submissions, reducing denial rates.
5. Specialized in Medicare billing, maintaining over an 80% success rate in appeals at the ALJ level.
6. Ensured compliance with Medicare Supplier Standards, enhancing operational integrity.
7. Maintained and updated insurance contracts and fee schedules, optimizing reimbursement rates.

Experience

10+ Years

Level

Senior

Education

B.S. in HA

Description :

1. Collects and reviews patient insurance benefits information according to program SOPs.
2. Assists physician office staff and patients in completing and submitting insurance forms and applications.
3. Submits necessary insurance forms and electronic claims to ensure timely processing by third-party payers.
4. Researches and resolves electronic claim denials effectively.
5. Investigates and addresses claim denials or underpayments to ensure accurate reimbursements.
6. Utilizes multiple collection methods, including phone, fax, mail, and online channels.
7. Delivers exceptional customer service to internal and external clients, resolving inquiries promptly and escalating issues as necessary.

Experience

5-7 Years

Level

Executive

Education

BSHA

Description :

1. Identified and explored additional revenue opportunities for hospital-based physician earnings.
2. Analyzed financial transactions and provided variance analysis identifying trends and solutions affecting revenue.
3. Maximized cash collections through efficient processes, revenue identification, and timely collection of receivables.
4. Monitored insurance carrier reimbursement trends to inform forecasting strategies.
5. Tracked and analyzed key financial metrics for optimal revenue results.
6. Created and maintained financial databases for senior management and physician review.
7. Followed up on outstanding accounts, reviewed medical claims for accuracy, and managed aging reports, resulting in an additional $1.9 million in recoveries.

Experience

2-5 Years

Level

Executive

Education

B.S. in HA

Description :

1. Evaluated and processed claims for the Bayer Pharmaceutical Diabetes patient assistance program, ensuring eligibility and compliance.
2. Managed inbound inquiries from healthcare professionals and patients regarding insurance and reimbursement issues.
3. Documented payer and billing information accurately in operational systems to maintain up-to-date records.
4. Served as a liaison between providers and sales representatives to resolve prior authorization inquiries and appeals efficiently.
5. Conducted comprehensive research on payer policies to ascertain coverage benefits for patients.
6. Maintained and updated databases reflecting changes in payer policies to ensure compliance.
7. Prepared detailed reports for management, summarizing reimbursement trends and patient access outcomes.

Experience

7-10 Years

Level

Management

Education

B.S. Health Admin.

Description :

1. Managed claims processing and follow-up for corporate clients, ensuring timely reimbursement.
2. Analyzed unpaid accounts to determine status and initiated appropriate actions for payment recovery.
3. Collaborated with corporate clients to resolve reimbursement issues, enhancing client relationships.
4. Established effective communication with account managers and accounts payable departments to streamline billing processes.
5. Reviewed contracts and policies to ensure compliance and accuracy in billing cycles.
6. Conducted thorough research on payment discrepancies to facilitate cash applications across multiple accounts.
7. Oversaw accounts exceeding $1 million in weekly revenue, ensuring optimal financial management.

Experience

2-5 Years

Level

Executive

Education

B.S. Health Admin.

Description :

1. Reviewed and processed patient information for collections and insurance claims.
2. Communicated effectively with patients, providers, and insurance companies to resolve billing inquiries.
3. Accurately recorded daily cash and credit transactions, ensuring all vouchers and EOBs were posted.
4. Managed monthly payment reconciliations and coordinated with collection agencies.
5. Examined insurance claims to guarantee accurate reimbursements for patients.
6. Maintained strong attention to detail while adhering to office processes and procedures.
7. Ensured timely payments according to insurance contracts and agreements.

Experience

2-5 Years

Level

Junior

Education

B.S. in Health Admin.

Description :

1. Managed communication with healthcare professionals, patients, and sales representatives regarding reimbursement inquiries.
2. Provided expert assistance in medical and pharmaceutical reimbursement requests, ensuring timely resolution.
3. Delivered accurate billing and coding information for specific products, including CPT and ICD-10 codes.
4. Verified patient insurance benefits and conducted thorough payer research to optimize claims submissions.
5. Collaborated with insurance payers and healthcare professionals to resolve prior authorization issues and appeals.
6. Developed reimbursement tools and program SOPs in alignment with program manager requirements.
7. Prepared comprehensive reports using MS Word, PowerPoint, and Excel to support program management efforts.

Experience

7-10 Years

Level

Management

Education

B.S. in HCA

Description :

1. Provided application support for revenue cycle management systems, ensuring optimal performance.
2. Audited and maintained databases to enhance claims processing accuracy.
3. Trained staff on billing software and best practices for claims management.
4. Developed and updated policies to improve operational workflows.
5. Researched and resolved outstanding Medicare and commercial insurance accounts.
6. Managed accounts receivable reports, focusing on timely collections.
7. Collaborated with healthcare providers to ensure accurate billing practices.

Experience

2-5 Years

Level

Junior

Education

BSHA

Description :

1. Managed electronic billing for Pharmacy Medical claims to ensure timely and accurate submissions to major insurance carriers and Medicaid/Medicare.
2. Ensured accurate entry of charges in compliance with services rendered, enhancing claim approval rates.
3. Obtained and verified eligibility information to confirm coverage for submitted claims.
4. Secured necessary authorizations for claim processing to avoid delays in reimbursement.
5. Reviewed Medicaid DRG charts to validate correct billing of procedures.
6. Investigated and resolved billing discrepancies, collaborating with patients and insurance carriers.
7. Analyzed payer denial patterns to implement strategic improvements in billing methodologies.

Experience

2-5 Years

Level

Executive

Education

AAS HIT

Description :

1. Established strong relationships with key stakeholders, ensuring seamless communication and trust in claims processing.
2. Conducted thorough reviews of unpaid accounts, implementing strategies to secure timely payments.
3. Analyzed daily billing edit reports to identify and rectify discrepancies in electronic claims.
4. Proactively contacted payers to resolve issues related to unpaid accounts, following up on denials and additional information requests.
5. Engaged with patients to gather necessary information and address outstanding balances effectively.
6. Processed and recorded weekly revenue, ensuring accurate financial reporting.
7. Collaborated with healthcare teams to support patient access to necessary services and therapies.

Experience

7-10 Years

Level

Executive

Education

AAS

Description :

1. Delivered exceptional customer service while maintaining respectful relationships with patients and insurance providers.
2. Responsible for timely processing and submission of insurance claims, ensuring accuracy and compliance.
3. Reviewed electronic claims and submission reports to identify discrepancies and resolve issues.
4. Effectively resolved rejected claims through thorough analysis and resubmission.
5. Generated daily and special reports, managing unlisted invoices and aging accounts.
6. Communicated with patients and insurance companies to gather necessary information for accurate billing.
7. Responded to inquiries from insurance companies regarding claim statuses and additional information.

Experience

7-10 Years

Level

Management

Education

B.S. HCA

Description :

1. Verified insurance eligibility and provided accurate information to patients and providers.
2. Obtained and documented patient coinsurance and deductible responsibilities for procedures.
3. Handled pre-authorizations and pre-certifications, ensuring compliance with insurance requirements.
4. Maintained adherence to policies and procedures during meetings and operational activities.
5. Followed HIPAA guidelines to ensure patient confidentiality and data security.
6. Contacted insurance carriers for follow-up on underpaid claims, achieving timely payments.
7. Reviewed account specifics to strategize follow-ups on aged claims, facilitating prompt resolution.

Experience

2-5 Years

Level

Junior

Education

B.S. in HA