Medical Biller Billing

Cherylene L. Norris

(Medical Biller - (**+ Years Experience)

*** ********* ***** *********, ** 27292-7319

Email ad8bgg@r.postjobfree.com

Cell Phone # 336-***-****

LinkedIn Profile https://www.linkedin.com/in/cherylene Detail oriented & meticulous Medical Biller, who undertakes complex assignments, able to meet tight deadlines & takes pride in delivering superior performance. Extremely knowledgeable with medical billing, insurance & coding regulations/guidelines. Applies strong planning & analytical skills to inform management/superiors of any/all updated billing "trends", to help reduce claim "write-offs". Operates with a strong sense of urgency & thrives in a fast-paced setting. Always willing to cross-train & learn any billing methodology not yet known to myself. Previous Work Experience:

No-Fault & Workers' Compensation Claims Analyst

(100% Remote Position)

RTR Financial Services, Inc.

July 2023 - Present

Software Used: Epic, OnBase, HealthLogic, Boomea, All Microsoft Office Programs/Software Responsibilities:

•Responsible for obtaining the status of hospital/physician's bills (claims) that are sent to Insurance Carriers.

•Made collection calls on a daily basisfor any overdue self-pay balances.

•Exprected to retrieve information from the Insurance company both via online portals & via direct calls to the carrier office(s).

•Responsible for understanding, based on that information, why claims have been denied & finding the best action to rectify the issue at hand.

•Attention to detail & trends are important, as is the ability to communicate said knowledge to upper management when requested.

•Expected to maintain a work quota of at least 30-45 accounts per day - Meaning: following up with carriers, adjusters, attorneys & more.

•Ability to notate clear & concise notes via Epic on each account.

•Responsible for submitting AOB (Assignment of Benefits) regarding all "No-Fault" accounts to either the patient or patient's attorney.

•Knowledge of WCB (Workers' Compensation Board) portal to submit HP-1/DOIs in cases when carriers do not respond to us within the required 45-day timeframe alotted.

•Adequate fluency via telephone communication with carrier representatives as well as attorneys & paralegals.

Insurance & Patient Accounts Specialist

Salem Professional Anesthesia Services - Advance, NC August 2021 to July 2023

Software Used: MacPractice, BB&T for self-pay & VCC payments Responsibilities:

• Posted VCC payments daily.

• Posted insurance payments in MacPractice to each patient's account and date-of-service -- Also includes posting large, bulk insurance payments.

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• Filed appeals to insurance carriers as needed.

• Created orders for any EOBs that weren't paid in full and needed follow-up of any kind.

• Worked the rejected eClaims reports.

• Made collection calls on past due accounts.

• Transferred past due accounts to a third-party collection agency.

• Set patients up for payment arrangements when qualified.

• Interacted with patients to educate them the need of contacting non-contracted insurance carriers for reprocessing of claims for balance billing.

• Kept patients updated via phone or email when requested.

• Participated in conference calls with insurance carriers and patients when needed.

• Contacted third-party pricing vendors for negotiations.

• In charge of checking voicemails daily.

• Providing self-pay Anesthesia and Nerve Block estimates to patients.

• Entering demographics to MacPractice when needed.

• Scanned all EOBs, denial letters, appeal information from insurance carriers, etc. Office Receptionist – Training Position Only

Four Directions Treatment Center - Lexington, NC

February 2020 to July 2020

Coronavirus/COVID-19 caused our offices to close, which led to having to let staff members go. Software Used: DMV systems that cannot be listed due to privacy laws. Responsibilities:

• Direct interaction with NC DMV.

• Obtained all required records from the state.

• Acquired all criminal and non-criminal background checks.

• Collected all payments either via cash or debit/credit card. A/R Representative II

McKesson, Inc - Winston-Salem, NC

June 2015 to February 2020

Software Used: AllScripts & TouchWorks Practice Management Responsibilities:

• Follow-up of all outstanding A/R with all payors - including self-pay and the resolution of denials. Responsible for handling all correspondence/EOBs related to patient accounts.

• Responsible for contacting insurance carriers, patients, & other facilities as needed to get maximum payment on accounts.

• Used Citrix telephone queue software - Received an estimate of 50 calls/day (minimum).

• Used BB&T credit card software to process any payments received via telephone from patients.

• Ran daily A/R reports to work on all outstanding accounts. Cash Posting Specialist

High Point Regional/UNC Healthcare - High Point, NC 2

January 2014 to June 2015

Software Used: STAR & BB&T

Responsibilities:

• Keyed transactions & posted batches into hospital accounting system (STAR) to reconcile outstanding balances.

• Resolved Posting issues identified by other departments.

• Completed daily balancing for accurate accounting. Monitored & resolved unapplied payments monthly.

• Maintained productivity & quality standards at all times.

• Verified all incoming Explanation of Benefits.

Authorizations Analyst

Cornerstone Healthcare - High Point, NC

February 2008 to December 2013

Software Used: AllScripts, AllScripts PM, TouchWorks PM Responsibilities:

• Scheduled all procedures/testing (including diagnostic scans).

• Verified benefits/eligibility for all procedures/tests prior to services being rendered, to help ensure payments would be made by insurance companies.

• Verified medical necessity guidelines, prior-authorization requirements, & pre-determination requirements for every patient/service.

• Attended all insurance meetings to stay up-to-date with medical necessity guidelines.

• Spoke with patients via phone & face-to-face regarding their benefits before tests/procedures were rendered.

• Collected deductible payments, co-payments, out-of-pocket payments, & co-insurance payments upfront before services were rendered.

• Set patients up on payment arrangements/plans as needed & as the office/provider allowed.

• Assisted the office manager with keeping track of "no-shows", as well as sending dismissal letters via certified mail, on a daily basis.

• Stayed up-to-date with ICD-9 coding, ICD-10 coding, HCPCS, & CPT-4 coding.

• Obtained any/all necessary prior-authorizations from patient's insurance companies for prescription medications.

Medical Biller

Bethany Medical Center - High Point, NC

September 2006 to February 2008

Software Used: Medical Manager, AllScripts EMR, AllScripts Practice Management Responsibilities:

• Responsible for posting payments, office charges, nursing home charges, & hospital charges daily.

• Prepared & distributed all monies to the front desk staff.

• Analyzed, researched & resolved billing issues.

• Responsible for gathering month-end reports for monthly staff meetings.

• Worked Medicare, Medicaid, & commercial insurance EOBs/denials. 3

• Responsible for staying up-to-date on all medical coding & insurance guidelines. No-Fault & Workers' Compensation Claims Follow-Up Analyst RTR Financial Services – Remote Position

July 2023 to Current

Software Used: Epic, OnBase, HealthLogic, MS Teams Responsibilities:

• Responsible for obtaining the status of hospital/physician’s bills (claims) that are sent to Insurance Companies.

• Expected to retrieve information from the Insurance company both via online portals and via direct calls to the carrier office(s).

• Responsible for understanding, based on that information, why claims have been denied and finding the best action to rectify the issue at hand.

• Attention to detail and trends are important, as is the ability to communicate said knowledge to upper management when requested.

• Expected to maintain a work quota of at least 30-45 accounts per day – Meaning following-up with carriers, adjusters, attorneys & more.

• Ability to notate clear and concise notes via Epic on each account.

• Responsible for submitting AOB (Assignment of Benefits) regarding all No-Fault accounts to either the patient or receiving from the patient's attorney.

• Knowledge of WCB (Workers' Compensation Provider Portal) to submit HP1/DOIs in cases when carriers do not respond to us within 45 calendar days via EOB/Payment/Denial

• Adequate fluency in telephone communication with carrier representatives. Education:

Certification in Medical Coding

Allied Health Institute

July 2009

Certification in Medical Office Administration

San Joaquin Valley College - Visalia, CA

January 2005 to December 2006

Clinical Medical Assisting

San Joaquin Valley College - Visalia, CA

January 2005 to December 2005

Certified Professional Coder – Online (in progress) AAPC – Online Instructor Led

February 2024 to Current

Skills:

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• EMR (10+ years)

• MS Office (10+ years)

• Sleep Studies (6 years)

• PT (6 years)

• Pain Management (10+ years)

• EOBs (10+ years)

• Prior Authorizations (10+ years)

• CMA (2 years)

• Coding (10+ years)

• Medical Terminology (10+ years)

• Anatomy (10+ years)

• Billing (10+ years)

• Customer Service (10+ years)

• Patient Scheduling (10+ years)

• Medical Billing

• CPC

• Medical Coding

• Medical Insurance

• DME

• Scheduling

• Medical Records

• Insurance Verification

• Microsoft Office

• Filing

• Word

• ICD-10

• CPT Coding

• ICD-9

• Allscripts

• Physiology Knowledge

• Allscripts

• Epic

• ICD-9

• Physiology Knowledge

• Laboratory Experience

• No-Fault Claim Follow-Up

• Workers' Compensation Claim Follow-Up

• Knowledge speaking with attorneys regarding No-Fault/Workers' Comp Claims

• Ability to write clear and concise notes

• Willingness to participate and to be flexible with changing priorities and projects

• Ability to read and understand previous notes on an account to take the accurate next step toward resolution

• Time management skills and a “team player” mentality

• Detailed understanding of medical billing terminology and processes

• Familiarity with payer portals and denials

• Fluency in telephone communication with carrier representatives

• Actively participates in team huddles via Microsoft Teams webcam meetings as needed 5

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