VICTORIA JACKSON
Macon
Summary
MEDICAL BILLING MEDICAL CODING PATIENT ACCOUNT REPRESENTATIVE Polished professional manages multiple tasks, utilizes electronic medical record systems, and provides excellent customer service to patients and staff. Adheres to medical records policies and procedures to comply with HIPAA regulations. Track record of effectively troubleshooting issues and maintaining patient confidentiality. Disciplined individual skilled in collecting and verifying patient demographic and insurance information and preparing and maintaining medical records. Proficient in using medical terminology and classifying diagnostic procedures, treatments and medications. Dedicated to providing highest quality care to patients.
Overview
40
40
years of professional experience
1
1
Certification
Work History
Insurance Claims Specialist
BURTON MEDICAL GROUP
01.2023 - Current
- Handle confidential patient files and medical records and carry out necessary and relat4ed functions in an extremely professional and discreet fashion
- Ensure timely filing, follow-up and collection of insurance claims complex in nature, according to established policies and procedures, including claims from workers compensation, commercial, managed care, federal and state agencies, and other third-party payers
- Work claims and reports assigned in a timely manner
- Review CPT and ICD-10 codes for accuracy using Medicare Guidelines, CCI, AAOS and other medical carriers
- Enter conclusions, actions taken, conversation detail, patient data into the practice management system with great efficiency and accuracy
- Follow all corporate and business office procedures and policies
- Detail-oriented paying close attention to accuracy.
- Maintained high standards of customer service by building relationships with clients.
- Processed eligibility and benefits verification and authorization requests.
- Maintained confidentiality of patient finances, records, and health statuses.
- Followed up on denials, late payments, extensions and other special circumstances.
- Worked with claims adjusters and examiners to expedite processing in alignment with procedures.
- Evaluated and settled complex insurance claims in strict timeframes.
- Followed up with customers on unresolved issues.
- Provided advice to customers regarding claims, rights and insurance processes to prevent disputes.
- Reviewed insurance and claims documents to verify required information and secure any missing data for settlements.
Medical Billing & Coding
Mercer Medicine
12.2020 - 09.2021
- Evaluate medical record documentation
- And charges with coding to optimize reimbursement by ensuring that diagnosis
- And procedural codes & other documentation
- Accurately reflect and support the outpatient visits
- Support the outpatient patient visits
- Provide technical guidance to physicians and others
- Identifying and resolving issues or errors
- Daily input of patient information
- Patient follow-up/ posting patient payments made to their accounts
- Entering daily charges received from the facility in which the patient had their encounter for inpatient, outpatient, and Nursing Home charges.
Medical Billing & Coding Manager
Maria Cavaliere, MD Internal Medicine
09.2018 - 12.2020
- Timely coding and submission of claims for the office visits
- Posting payments from patients and insurance companies
- Appeal denied claims
Medical Record Administrator
- Preparing and mailing patient statements on monthly basis
- Completion of al FMLA paperwork and similar forms
- Precertification of diagnosis testing such as CT scans and MRI
- Obtaining Authorizations/referrals for HMO’s and Tricare Prime Clients
- Verifying coverage and benefits on patients
- Contract negotiation as needed for individual payers.
Medical Biller
Lifeline Home Health
08.2013 - 01.2014
- Verified accuracy of billing data and revised any billing errors
- Prepared invoices for warehouse for shipping to be adequate
- Prepared itemized statements, bills, and claims for insurance providers
- Compiled and computed necessary changes complete daily task for the billing process
- Performed bookkeeping work – posted data and kept shipping records.
Patient Accounts Representative/ Collection Specialist
The Medical Center of Central Georgia
07.2000 - 06.2005
- Arranged for debt repayments via insurance providers
- Located and notified patients of balances due as coinsurance or copayments
- Answered patient inquiries and conferred with Insurance providers
- Worked a weekly aging report from 30, 60, 90 and 120 days
- Billed for secondary payments required after primary insurance company payments were received
- Created CMS 1500 claim forms when billing for reimbursement
- Corrected CMS 1500 claim forms when errors occurred
- Read providers contracts to obtain adequate reimbursements
- Collected additional reimbursement from insurance providers after thorough follow-up had been accomplished
- Utilized fee schedules for Medicare payers
- Consulted with customer service representatives when needed.
Data Entry/ Processor/Overpayment Analyst
Aetna US Healthcare
04.1984 - 10.1998
- Processed incoming insurance claims
- Assisted the Nurse Case Manager for the Nursing Department with secretarial needs – scheduled meetings, also coordinated documents and nursing schedules
- Contacted physician offices to clarify errors in recapping reimbursements
- Filed claims and made data entries when corrections were required
- Recovered additional payments from provider payers.
Instructor
American Professional Institute
11.2005 - 01.2010
Program Manager
American Professional institute
- Enforced administration polices and rules governing students, observed students’ performances and records relevant data to access their progress
- Prepared lesson plans according to the standard accreditation rules
- Analyzed information and evaluated results to choose the best solutions
- Presented subject matter to students under the direction and guidance of teachers, using lectures, discussions or supervised role-playing methods
- Developed teams encouraging and building their trust, respect and cooperation among team member, students, and instructors
- Discussed and assigned duties with classroom teachers to coordinate instructional efforts.
Medical Billing Specialist
Courageous Home Care
Macon COBRA Administrator/ Customer Service Representative
Secure Health Plans of
Macon Medical Biller
Kidney Specialist of, Adams
- Billing Company Medical Biller
- Maulding and Jenkins CPA Firm Medical Biller/Specialist in Medicare and Medicaid Payers
Insurance Billing Specialist
TALLAHASSE ORTHOPEDICS CLINIC
02.2021 - 08.2022
- Processed payment via telephone and in person with focus on accuracy and efficiency.
- Responded to customer concerns and questions on daily basis.
- Used data entry skills to accurately document and input statements.
- Produced and mailed monthly statements to customers and assisted with related requests for information and clarification.
- Collaborated with customers to resolve disputes.
- Handled account payments and provided information regarding outstanding balances.
- Monitored outstanding invoices and performed collections duties.
Education
Associate - Science Degree – Medical Billing & Coding
Ultimate Medical Academy
2016
Medical Records, and Reimbursement Systems. -
CERTIFICATION Certified Professional Coder – Hospital (CPC-H) Certified Billing and Coding Specialist (CBCS) Certified Professional Coder (CPC) CMP Billing & Consultants Certified Patient Account Representative (CPAR / CPAR Advanced) the Medical Center of Central Georgia -
Skills
- Knowledge of
- Microsoft Office Applications (Word, Excel, and PowerPoint) – Type 55 WPM
- KEY QUALIFICATIONS
- Medical Billing
- Medical Coding
- ICD-9-CM
- HCPCS
- CPT
- ICD-10-CM
- Medical Terminology
- Electronic Health Records (EHR)
- Electronic Medical Records (EMR)
- Greenway
- Managed Care (HMO, PPO, and POS)
- Government Payers
- Third Party Payers
- Worker’s Compensation
- Centers for Medicare and Medicaid
- CMS 1500
- CMS 1450 (UB-04)
- Tricare
- EOBs
- Payment Posting
- Revenue Cycle Management
- Scheduling
- Meaningful Use
- Insurance Verification
- Insurance Billing Procedures
- Insurance Claim Processing
- Practice Management
- Medical Office Procedures
- Anatomy & Physiology
- HIPAA Compliance
- Co-Payments
- Deductibles
- Co-Insurance
- Superbills
- Reimbursement Methodologies
- Fee Schedules
- Outpatient / Physician
- Inpatient / Facility
- Microsoft Dynamics
- Computerized Time Management Systems
- Medical Records and Documentation
- Professional Relationships
- Legal Requirements
- Industrial Tools
Affiliations
Career-qualified, top performing professional who combine 25 years of medical industry experience with strong management, customer service, collections, and data entry skills to illustrate value and level of competence. Ensures accurate and prompt processing of payments, adjustments, and denials for assigned payers to include any necessary follow-up. Attention to detail essential in generating revenue for the medical practice.
High Academic Honors Recognition / Dean’s List.
Certification
CPC -CERTIFIED PROFESSIONAL CODER
Timeline
Insurance Claims Specialist
BURTON MEDICAL GROUP
01.2023 - Current
Insurance Billing Specialist
TALLAHASSE ORTHOPEDICS CLINIC
02.2021 - 08.2022
Medical Billing & Coding
Mercer Medicine
12.2020 - 09.2021
Medical Billing & Coding Manager
Maria Cavaliere, MD Internal Medicine
09.2018 - 12.2020
Medical Biller
Lifeline Home Health
08.2013 - 01.2014
Instructor
American Professional Institute
11.2005 - 01.2010
Patient Accounts Representative/ Collection Specialist
The Medical Center of Central Georgia
07.2000 - 06.2005
Data Entry/ Processor/Overpayment Analyst
Aetna US Healthcare
04.1984 - 10.1998
Medical Record Administrator
Program Manager
American Professional institute
Medical Billing Specialist
Courageous Home Care
Macon COBRA Administrator/ Customer Service Representative
Secure Health Plans of
Macon Medical Biller
Kidney Specialist of, Adams
Associate - Science Degree – Medical Billing & Coding
Ultimate Medical Academy
Medical Records, and Reimbursement Systems. -
CERTIFICATION Certified Professional Coder – Hospital (CPC-H) Certified Billing and Coding Specialist (CBCS) Certified Professional Coder (CPC) CMP Billing & Consultants Certified Patient Account Representative (CPAR / CPAR Advanced) the Medical Center of Central Georgia -
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