airart
Guru
Ami M. Andrews
609 Bent Tree Ct.
Euless, TX 76039
E-Mail: colormeavontx@yahoo.com (best)
OBJECTIVE:
I am currently looking for a full time remote permanent position only. I am also available to work remote part time evenings or weekends. I am looking to stay in the medical record community coding charts, auditing, reviewing, consulting, or working in Health Information Management. I have worked remote before with Aetna processing medical claims at home for three years.
EMPLOYMENT:
UT Southwestern, Dallas, TX March 2010 ?€“ Present
Account Adjuster ?€“ (Started current position in August 2011) (Current Salary $41,300)
?€? Reviews patient accounts for refund and credit analysis which may include: contacting insurance companies, patients and researching insurance payments to identify and correct posting errors; reviewing credit reports and age reports to identify posting problems and completing charge reversals. All payers including Medicare, Medicaid, Commercial, Managed Care, Workers Comp, International, Individual Agreements, Settlements, and Auto Liabilities.
?€? Issues refunds to patients and insurance carriers for overpayment of duplicate payment.
?€? Identifies and resolves credits posted to patient accounts and corrects overpayment.
?€? Maintains patient account records, files and documentation.
?€? Batches all paperwork and balances all batches.
?€? Transfers payments between invoices and/or accounts using a MRN (medical record number).
?€? Performs other adjustments or corrections to patient accounts as required.
?€? Posts payments to patient accounts.
?€? Perform duties of the Medical Review Analyst for any balances left on invoices as needed.
?€? Performs other duties as assigned.
Medical Review Analyst ?€“ (Position at UT Southwestern, March 2010 ?€“ August 2011)
?€? Reviews and processes insurance claims through the billing system, including Medicaid, Medicare, Managed Care, and third party payers (worker?€™s comp and auto).
?€? Responsible for contacting patients, and/or third party payers to resolve outstanding insurance balances or inappropriately paid claims.
?€? Identifies problems and inconsistencies by using management reports; summarizes findings and makes recommendations to resolve billing issues.
?€? Attach progress notes, operative reports, etc. for pre-certification or medical review as needed by request from the carrier.
?€? Reviews and resolves correspondence from all organizations. Functions as resource person for departmental personnel to answer questions and assists with problem resolution.
?€? Functions as liaison between clinical departments, patients, and third party payers.
?€? Posts deductibles, write-offs and payments as per EOBs, balances receipts according to deposit slips, applies recoupment according to EOB, correctly allocates payments for line item posting, utilizes account information to assist in write-offs for inclusive CPTs by payer, updates job knowledge by participating in educational opportunities, serves and protects sensitive information by adhering to professional standards, company policies and procedures, federal, state, and local requirements, and standards (HIPAA).
?€? Completes special projects as requested, and performs other duties as assigned.
JS&H Orthopedic Supply, Fort Worth, TX November 2007 - March 2010
Appeals & Denials Advocate ?€“ (Salary $13/hr)
?€? Verified benefits and eligibility, greet patients, electronic claims filing, charge data entry, payment posting, patient billing, and collections from patient and insurance both, take orders from patients for DME.
?€? Researched denials for possible appeals or reconsiderations.
?€? Audited coding accuracy.
?€? Group insurance, Medicaid, individual insurance, workman?€™s comp, and Medicare.
Axiom, Houston, TX December 2006 - February 2007 (Contract Worker - Work at Home)
Administrative Support ?€“ (Salary $13/hr)
?€? Assist the Director of Nurses with errands or reports needed on a day to day basis.
?€? Reviewer - Did miscellaneous jobs as needed, enter data, etc.
?€? Coder - Review charts as needed for Workers Compensation Injuries.
?€? Determined whether they are truly a Workers Comp Injury or a Medical Injury and direct the claims to the proper insurance company.
Transamerica, Bedford, TX February 2006 - December 2006 (Salary: $35,360/yr)
Claims Examiner 2 ?€“
?€? Medical Terminology knowledge
?€? Ability to handle multi-task projects, problem solving, team player and work with little supervision.
?€? Knowledge of ICD-9, CPT, HCPC, CMS (HCFA) Forms, and UB92 (UB04) Forms (Paper and Electronic).
?€? Process Long Term Care Insurance bills (Individual policies).
PerotSystems, Plano, TX July 2005 - February 2006 (Salary: $30,000/yr)
Claims Processor ?€“
?€? Medical Terminology knowledge
?€? Ability to handle multi-task projects, problem solving, team player and work with little supervision.
?€? Knowledge of ICD-9, CPT, HCPC, CMS (HCFA) Forms, and UB92 (UB04) Forms (Paper and Electronic).
?€? Processed products such as Traditional, Managed Choice, Elect Choice, and Open Choice plans (Group Policies).
Intracorp (Cigna-Workman?€™s Comp division), Carrolton, TX March 2004 - July 2005
Current Salary: $32,000/yr
Medical Claims Reviewer 2
?€? Worked on a (hospital) team that evaluates and reviews workman?€™s comp claims.
?€? Extensive knowledge of Medical Terminology, Diagnosis Coding, ability to handle multi-task projects, problem solving, team player, and work with little supervision.
?€? Helped associates with technical computer support.
?€? Knowledge of ICD-9, CPT, HCPC, HIPAA, HCFA Forms, and UB92 Forms (Paper and Electronic).
?€? I also mentored and trained others in my area. (Worked part time morning hours only.)
Aetna Inc., Arlington, TX August 1998 - March 2004 Salary: $30,000/yr
Provider Services Team, Rework Processor
?€? Served as a back-up customer service representative.
?€? Extensive knowledge of Medical Terminology, Diagnosis Coding, ability to handle multi-task projects, problem solving, team player, and work with little supervision.
?€? Computer technical support.
?€? Knowledge of ICD-9, CPT, HCPC, HCFA/CMS Forms, and UB92 Forms (Paper and Electronic).
?€? Processed claim products such as Traditional, Managed Choice, Elect Choice, Open Choice, and processing both medical and hospital claims.
?€? Processed claims for NME transplant cases and VIP Claims.
?€? Mentored, trained, and audited others in my division (Group Policies).
COMPUTER SKILLS:
Microsoft Windows older versions plus, NT, XP, Vista and 7, Microsoft Office 95 and 97 including Word, Excel, Access, Power Point, and Exchange, Outlook, Macintosh, Rumba, FirstStepp, Audit Plus, RES, Macess, EZ Claim, Star Office , EPIC Resolute (Professional ?€“ EHR,EMPI/MPI, MRN), GroupWise, OnBase, OAS, Peoplesoft
EDUCATION:
University of Phoenix - Bachelors Degree in Healthcare Administration - Health Information Technology - Graduated December 2011 (GPA 3.68)
Axia College - Associates Degree in Healthcare Administration - Medical Records - Graduated October 2009 (GPA 3.58)
Tarrant County Community College - Advanced Coding CE
North Lake College ?€“ Injury Adjuster Class (CEU)
North Central Texas College - Work Study Classes (CEU?€™s) - On-Site - 2005
Medical Terminology, High Performance Work Teams, Customer Relations, and Leadership Skills
Richland High School
Graduated 1990
LICENSES:
CPC (Member of the AAPC since 2006)
Currently studying to take test for CCS (AHIMA)
REFERENCES:
Available upon request
609 Bent Tree Ct.
Euless, TX 76039
E-Mail: colormeavontx@yahoo.com (best)
OBJECTIVE:
I am currently looking for a full time remote permanent position only. I am also available to work remote part time evenings or weekends. I am looking to stay in the medical record community coding charts, auditing, reviewing, consulting, or working in Health Information Management. I have worked remote before with Aetna processing medical claims at home for three years.
EMPLOYMENT:
UT Southwestern, Dallas, TX March 2010 ?€“ Present
Account Adjuster ?€“ (Started current position in August 2011) (Current Salary $41,300)
?€? Reviews patient accounts for refund and credit analysis which may include: contacting insurance companies, patients and researching insurance payments to identify and correct posting errors; reviewing credit reports and age reports to identify posting problems and completing charge reversals. All payers including Medicare, Medicaid, Commercial, Managed Care, Workers Comp, International, Individual Agreements, Settlements, and Auto Liabilities.
?€? Issues refunds to patients and insurance carriers for overpayment of duplicate payment.
?€? Identifies and resolves credits posted to patient accounts and corrects overpayment.
?€? Maintains patient account records, files and documentation.
?€? Batches all paperwork and balances all batches.
?€? Transfers payments between invoices and/or accounts using a MRN (medical record number).
?€? Performs other adjustments or corrections to patient accounts as required.
?€? Posts payments to patient accounts.
?€? Perform duties of the Medical Review Analyst for any balances left on invoices as needed.
?€? Performs other duties as assigned.
Medical Review Analyst ?€“ (Position at UT Southwestern, March 2010 ?€“ August 2011)
?€? Reviews and processes insurance claims through the billing system, including Medicaid, Medicare, Managed Care, and third party payers (worker?€™s comp and auto).
?€? Responsible for contacting patients, and/or third party payers to resolve outstanding insurance balances or inappropriately paid claims.
?€? Identifies problems and inconsistencies by using management reports; summarizes findings and makes recommendations to resolve billing issues.
?€? Attach progress notes, operative reports, etc. for pre-certification or medical review as needed by request from the carrier.
?€? Reviews and resolves correspondence from all organizations. Functions as resource person for departmental personnel to answer questions and assists with problem resolution.
?€? Functions as liaison between clinical departments, patients, and third party payers.
?€? Posts deductibles, write-offs and payments as per EOBs, balances receipts according to deposit slips, applies recoupment according to EOB, correctly allocates payments for line item posting, utilizes account information to assist in write-offs for inclusive CPTs by payer, updates job knowledge by participating in educational opportunities, serves and protects sensitive information by adhering to professional standards, company policies and procedures, federal, state, and local requirements, and standards (HIPAA).
?€? Completes special projects as requested, and performs other duties as assigned.
JS&H Orthopedic Supply, Fort Worth, TX November 2007 - March 2010
Appeals & Denials Advocate ?€“ (Salary $13/hr)
?€? Verified benefits and eligibility, greet patients, electronic claims filing, charge data entry, payment posting, patient billing, and collections from patient and insurance both, take orders from patients for DME.
?€? Researched denials for possible appeals or reconsiderations.
?€? Audited coding accuracy.
?€? Group insurance, Medicaid, individual insurance, workman?€™s comp, and Medicare.
Axiom, Houston, TX December 2006 - February 2007 (Contract Worker - Work at Home)
Administrative Support ?€“ (Salary $13/hr)
?€? Assist the Director of Nurses with errands or reports needed on a day to day basis.
?€? Reviewer - Did miscellaneous jobs as needed, enter data, etc.
?€? Coder - Review charts as needed for Workers Compensation Injuries.
?€? Determined whether they are truly a Workers Comp Injury or a Medical Injury and direct the claims to the proper insurance company.
Transamerica, Bedford, TX February 2006 - December 2006 (Salary: $35,360/yr)
Claims Examiner 2 ?€“
?€? Medical Terminology knowledge
?€? Ability to handle multi-task projects, problem solving, team player and work with little supervision.
?€? Knowledge of ICD-9, CPT, HCPC, CMS (HCFA) Forms, and UB92 (UB04) Forms (Paper and Electronic).
?€? Process Long Term Care Insurance bills (Individual policies).
PerotSystems, Plano, TX July 2005 - February 2006 (Salary: $30,000/yr)
Claims Processor ?€“
?€? Medical Terminology knowledge
?€? Ability to handle multi-task projects, problem solving, team player and work with little supervision.
?€? Knowledge of ICD-9, CPT, HCPC, CMS (HCFA) Forms, and UB92 (UB04) Forms (Paper and Electronic).
?€? Processed products such as Traditional, Managed Choice, Elect Choice, and Open Choice plans (Group Policies).
Intracorp (Cigna-Workman?€™s Comp division), Carrolton, TX March 2004 - July 2005
Current Salary: $32,000/yr
Medical Claims Reviewer 2
?€? Worked on a (hospital) team that evaluates and reviews workman?€™s comp claims.
?€? Extensive knowledge of Medical Terminology, Diagnosis Coding, ability to handle multi-task projects, problem solving, team player, and work with little supervision.
?€? Helped associates with technical computer support.
?€? Knowledge of ICD-9, CPT, HCPC, HIPAA, HCFA Forms, and UB92 Forms (Paper and Electronic).
?€? I also mentored and trained others in my area. (Worked part time morning hours only.)
Aetna Inc., Arlington, TX August 1998 - March 2004 Salary: $30,000/yr
Provider Services Team, Rework Processor
?€? Served as a back-up customer service representative.
?€? Extensive knowledge of Medical Terminology, Diagnosis Coding, ability to handle multi-task projects, problem solving, team player, and work with little supervision.
?€? Computer technical support.
?€? Knowledge of ICD-9, CPT, HCPC, HCFA/CMS Forms, and UB92 Forms (Paper and Electronic).
?€? Processed claim products such as Traditional, Managed Choice, Elect Choice, Open Choice, and processing both medical and hospital claims.
?€? Processed claims for NME transplant cases and VIP Claims.
?€? Mentored, trained, and audited others in my division (Group Policies).
COMPUTER SKILLS:
Microsoft Windows older versions plus, NT, XP, Vista and 7, Microsoft Office 95 and 97 including Word, Excel, Access, Power Point, and Exchange, Outlook, Macintosh, Rumba, FirstStepp, Audit Plus, RES, Macess, EZ Claim, Star Office , EPIC Resolute (Professional ?€“ EHR,EMPI/MPI, MRN), GroupWise, OnBase, OAS, Peoplesoft
EDUCATION:
University of Phoenix - Bachelors Degree in Healthcare Administration - Health Information Technology - Graduated December 2011 (GPA 3.68)
Axia College - Associates Degree in Healthcare Administration - Medical Records - Graduated October 2009 (GPA 3.58)
Tarrant County Community College - Advanced Coding CE
North Lake College ?€“ Injury Adjuster Class (CEU)
North Central Texas College - Work Study Classes (CEU?€™s) - On-Site - 2005
Medical Terminology, High Performance Work Teams, Customer Relations, and Leadership Skills
Richland High School
Graduated 1990
LICENSES:
CPC (Member of the AAPC since 2006)
Currently studying to take test for CCS (AHIMA)
REFERENCES:
Available upon request
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