UNITED STATES OUTSOURCING FREELANCER

DESCRIPTION
Work all delinquent claims. Make necessary corrections. Write Appeal letters. Review all claims, catch errors before claims are sent out. Errors are mainly incorrect coding and missing modifiers. Which in turn this cuts down on the turn around time for return payment. When I first came on board with BBAHC a very large amount of the claims were being denied or were outstanding. I have worked very closely with our Provider Representative to get these problems handled. Some of the problems were: too many questionnaires going out for the same diagnosis and related diagnosis. Claims not being processed correctly. Either the professional or the facility fee was not paid. Procedures being denied and modifiers not being recognized. At the present time all of the Blue Cross claims that were outstanding has been corrected and paid. The percentile of outstanding claims is less than it has ever been in the History of the Hospital. Which I am very proud of. Process all refunds either for the patient or Blue Cross.
Contracted as an individual. Work short project for different companies at different locations.
These projects needed clean up on outstanding claims, aggressive collection, appeals written, and claim correction. Refile claims. Audit payments per contract agreement. Did the necessary steps to get claims paid and the A/R out of the red. Work under high stress and limited time.

I wrote my own appeals letters: Which is mostly Medicaid. I have appealed all the way to a Washington Office involving a federal employee to get a claim paid, and it was. Correct and resubmit claims: correction can be from wrong address to truncated codes. Corrected all
coding issues. Work all refunds due to patient or insurance. Corrected
contract errors as well as electronic billing (payer). Examples:
*Medicaid HMO not paying per contract
*Doctors listed as anesthesia when it should be radiology.
*Payments being issued for the wrong Doctor that was billed.
*Medicare HMO not paying per contract.
*Medicaid recoup in error.
*Third party insurance paying out of network in error.
*Audit payments per contract

SKILLS
Contracted on a consulting basis with various hospitals and physicians offices to audit
past-due account receivables. Audit payments per contract. As a Consultant, I would review the accounts to locate problems and make corrections then resubmit claims. Each location had own type of problems. Including coding issues. Use of my problem solving skills is up to date. Upon
completion of the audit, I would design and recommend procedures to eliminate future errors. Types of facilities: Hospitals, walk in Clinics, out patient, etc. Types of claims: Inpatient, out patient, office visits, surgery, MRI, x-ray, mental, ER, etc.

TERMS
Negotiable.

Graduate of Ouachita Parish High School - 1972
Baton Rouge Regional Vo-Tech - Nursing School - 1988
Baton Rouge School of Computers - 1990
Medicaid Seminar - 2000
Medicare Seminar - 2001
Atlantic Coast Institute Medical Insurance CPT & ICD-9 Coding (CE) -
2002
Medicaid Update Seminar 2004
Coding Certification is up to date. CCS
Have experience on all types of billing software.
Examples: IDX 9.0 - TDH 3.0 - HBOC/star - PRIMUS - MEDISOFT - SMART TERM
E-COMMERCE-MEDITECH

LOCATION United States - Dillingham, Alaska EMPLOYEES 1-5 YEARS IN BUSINESS 11+ years CONTACT INFORMATION Register or Login to view the outsourcing service provider contact information.