Dallas, TX

Position Desired

Healthcare Finance
Dallas, TX



Professional Experience

DaVita Rx — Coppell, TX 3/09 to Present
Reimbursement Specialist
• Accurately Post Cash Receipts to Patient and Third Party Account Receivables
• Update Cash Posting Tool
• Obtain and Process Electronic Payment Files(635)
• Manually Post any Electronic Payments Exceptions
• Receives and Post Third Part Recoups and Adjustments
• Print Statements and Audits Reports
• Process Backend Third Party Billing claims
• Research and Obtain Explanation of Benefits for Cash Receipts
• Train New Staff on ROP’s departmental Procedures
• Inform Management of Any Escalated Problems Associated with Patient A/R
• Manage, analyze, and facilitate patient Maximum Charge Entry data in SXC and Star Point
• Facilitate Bad Debt adjustments for private pay, third party denials, and deceased patient accounts
• Accurately identify over payments on various patient accounts, to ensure proper refund procedures are followed.
• Analyze Patient A/R for payer denials and or adjustments
• Prepare Lock Box, BOA updating in the Cash Posting Tool to ensure proper download balancing and accuracy
• Analyze patient information, via Missing report for various Third party billing and payment errors or rejects
• Analyze, and summarize reports and operational data to identify trends and ways to improve operational efficiency, productivity, and financial performance;
• Prepare reports/presentations and make recommendations to management.
• Identify trends, variances, aberrant data, and other information as needed.
• Verify and Process payments and denials in FSI for California claims
• Analyze and correct Non-A/R Epogen and Heparin injection accounts for duplication in SXC and FSI billing systems.

UT Southwestern— Dallas, TX
7/05 to 12/08
Senior Revenue Application Specialist
• Performs complex policy analysis for managed care issues by reviewing contracts, writing clause revisions, making recommendations for reimbursement policy changes, reviewing reports and financial data, and analyzing fee schedules, encounter forms, diagnosis, and procedure codes; ensures contracts reflect appropriate business decisions.
• Reviewed and Processed Insurance Claims for Complex Accounts
• Interacted with Insurance Contracting Departments to Resolve Outstanding Account Receivables
• Worked with Clinical Staff to Obtain Necessary Medical Records to Resolve Payment Denials
• Efficiently Work and Resolve Correspondences from Payers and Patients
• Identified Problems and Inconsistencies Utilizing Management Reports
• Research Problems, Summarized Findings, and Made Recommendations as Needed
• Accurately Post Cash Receipts for Third Party and Patient’s Account Receivables
• Provide billing correspondence to various insurance providers for patients secondary and tertiary billing needs
• Provided analytical points of reference to Quality Assurance Analyst revolving around patients unresolved A/R balances
• Reviewed and worked electronic ACH deposits from an outside clearing house
• Documents findings of inquiry and opinion letters. Maintains contract files, and files for research documents.
• Conducts meetings, organizes activities, reviews data analyses and reports, and creates reimbursement policies and procedures.

Med-Synergies— Dallas, TX

4/03 to 06/05
Insurance Analyst
• Posted Medicare and Commercial Insurance Payments via Third Millennium, prepared Month End Reports
• Created and Maintained Production Level Spreadsheet Utilizing Excel spreadsheet
• Maintained Frequent Contact with Medicare Home Base for Texas, Philadelphia, Florida and Arkansas
• Verified Coverage and Payments Received or Denied by Insurance Companies
• Arranged Payment Plans for Delinquent First Party Accounts
• A/R Follow-Up in Conjunction with Appealing and Correcting Claims
• Written and Verbal Correspondence with Patients Regarding Balances Outstanding
• Communicated with Management Regarding Payer Trends and Inconsistencies

Citi-Financial Mortgage — Irving, TX 12/02 to...

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