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Summary

Medical Billing & Claims Follow-up, Proficient Administrative Written Communication, Astute Research & Information Collection Skills, Organization, Analyzing Information , Professionalism, Problem Solving, Verbal & Written Communication, Handles Pressure, Data Entry, Word Processing , Thoroughness, Attention to Detail, Decision Making, Informing Others, Results Oriented

Work Experience

January 2018August 2018

Reimbursement Specialist

SyMed Corporation
  • Registered patients and maintained patient demographic/population data for multi-provider contracts: State, mental health, crisis stabilization & ABA clients
  • Navigated multiple interfacing electronic health record and billing systems
  • Maintained work queue and managed personal workflow, meeting priorities hi required deadlines
  • Billing of services/claims; incl. verifying correct coding application & researched coding discrepancies
  • Worked errors, rejections, corrections
  • Posted payments and denials
  • Ran reports to reconcile monthly billing cycles
  • Follow-up on unpaid claims/ accounts receivable
  • Attended meetings and trainings internally & with clients
  • Ran various reports via in-house billing cycle software to manage A/R
  • Expedited appeal returns for denied claims, ensuring time limits not exceeded & escalating 2nd level appeals as appropriate
Aug 2014January 2018

Optometrist Assistant / Office Management

Dr. Lynell Heatley, OD - American Canyon Optometry (FirstSight Vision)
  • Administered optical pre-testing to daily high volume of patients: Auto-Refraction, Visual Fields (Oculus), NCT & Color Vision
  • Calendar set-up / schedule maintenance - updated appointments or accepted walk-ins, depending on availability
  • Distributed patient intake forms & privacy practices - ensured signed compliance of HIPPA acknowledgment etc.
  • Adhered to confidentiality requirements for secure records/data policy
  • Retrieved & fullfilled prescription verification requests / Dept. of VA referrals
  • Insurance: confirmed eligibility status & benefits, determined applicable reimbursement, co-payment & out-of-pocket amounts
  • Entry of correct coding i.e. ICD-10 diagnoses codes per procedure CPT code
  • Completion of HCFA Claim form; followed by claim submission via electronic clearinghouse (Availity), online portals (VSP 20/20, Davis, Spectera), or Fax/mail-in 
  • Acquisition of patient benefit coverage through various In-Network / Out-of -Network Insurance contributed assistance in offering patients additional service options 
Jul 2014Jul 2014

Wine Club Assistance - Temp Assignment

Pine Ridge Vineyards
  • Expedited focus of project to provide main point of contact across multi-level clubs (tiered membership) in coordinating updates for declined credit cards on file
  • Recovered delinquent accounts through implementing call-for-action email template design to create a sense of urgency, which directed attention & motivated response toward resolution
May 2013Feb 2014

Wine Club Assistant / Hospitality Representative

Bouchaine Vineyards
  • Processed multiple club shipments with various additions, promos, exceptions into data system for fulfillment &/or manual import of orders into shipment software to package in-house (*depending on State criteria /permit requirements).
  •  Ran reports to identify pending payments, expired accounts, incomplete/incorrect info
  • Investigated issues using multiple resources: direct contact, correspondence, data files, records, transaction history etc & offered solutions in resolve of standard/complex issues. Pursued completion through team collaboration & ensured resolution through dedicated follow-up.
  •  Input & organization of membership information – incl. setup, update & cancellation of confidential billing accounts.
  • Tasting Room open-close procedures, stocking & inventory counts of wines for club shipments, orders & library. Enticed visitors with winery “story”, shared benefits & special discount pricing of inclusive membership options, driven to provide top service & create an enjoyable experience within a fast paced atmosphere 
  • Provided all visitors with gracious service, optimized club member signups through custom pourings – Used judgement to modify “menu” complimenting preferences. Assisted in all aspects in special/ VIP events.
Jan 2006Aug 2011

Receptionist/ Cashier Expeditor/ Sales Associate

Golden Gate Roofing Co./ C-Casa/ Pac-Sun & Quiksilver Factory Outlets

Technical Competencies

Medi-Cal    Optum    Valley Health Plan   SCC Health Plans   Anthem   Availity   blue shield   Cigna   Kaiser   VSP  Spectera    Symetra    Eyefinity    Eyemed   Sutter / Adventist Health 

HealthNet   Davis Vision   Dept. of VA

drChrono EHR    Doc-me-in   SimpleTrack    E-bridge    Groupwise   Solution Reach

AMS   eWinery    Vin65 ShipCompliant  UPS WorldShip

FedEx Shipment Manager   N.V. POS

MS Office Suite 2003/2007/2008 +

Accurate Database Entry   

Comprising Spreadsheets/Workbooks (Excel)

Intermediate Word Processing

Efficient Email Correspondence 

Internet Explorer / Firefox / Chrome

Micros - POS Cash Register

Certifications

Sep 2009Present

Certificate of Completion - Technology 101: A Small Business Guide

U.S. Small Business Administration- Office of Entrepreneurial Development

Education

20002004

H.S. Diploma

Napa Valley Alternative School

Professional Affiliations/ Community Activities

Suisun Wildlife Center

1171 Kellogg St.

Suisun City, CA 94585

Wildlife Rescue/Rehabilitation - (Volunteer)

Napa Historical Society

The Goodman Library 

1219 First Street 

Napa, CA 94558 

Research Staff - (Volunteer)

Napa County Animal Shelter 

942 Hartle Court

Napa CA, 94558

Kennel Tech - (Volunteer)