Healtghcare/Insurance Billing

Stacey M. McHugh

125 David Lind Drive

Indianapolis, IN 46217


Objective/Personal Statement:

Friendly, loyal, dedicated individual who has ambition to succeed in any given environment. Although I have extensive experience in the Medical Billing/Denial Management department, I love to learn new skills and I'm always up for a challenge, whatever the situation. I get along well with others, also work efficiently on my own. I'm currently seeking a position where I can develop and excel, while at the same time give my best to an employer for the benefit of our team. I'm hoping to become part of an environment where I can utilize my experience and skills to benefit the organization and at the same time expand my opportunities. With my unique skills due to working behind the scenes at Medicare, ( also known as National Government Services/Wellpoint Inc.) my understanding and capabilities of working an A/R and receiving outstanding accomplishments have been recognized as well as rewarded in my past. I look forward to speaking with you in hopes of setting up a possible interview. It's with much gratitude and appreciation you taking the time to review my resume.

Work Experience:

October 8th, 2013 – August 7th, 2013

Medicare Redetermination Appeals Rep

Smart IT Staffing (Medicare / National Government Services or Wellpoint)

Indianapolis, IN 46260

My primary responsibility entailed reviewing the initial Redetermination request and all documentation submitted by providers and suppliers, towards previously denied claims. Some claims were not initially denied just paid at what the provider or supplier considered to be unfair to the legally documented fee-schedule. Assure the provider and or supplier completed the redetermination request correctly before proceeding with redetermination. If for some reason an item or signature was missing the redetermination was rejected and a letter was submitted to the appropriate individual that submitted the redetermination informing them of the error made on the redetermination request form. Documented in the literature provided to all providers' or provider's is available in the Local Coverage Determination Policy. Most of the claims that were denied were denied for reasons due to the supplier or provider not understanding the requirements of the local coverage determination policy, therefore I would dictate a letter informing the individual who submitted the redetermination of either the error, missing information or why the claim cannot be paid according to the clearly dictated literature of National Government Services. If a supplier or provider has proven either an error on the part of NGS, or submitted documentation to support initial payment or additional payment, I would then forward the claim to the claims payment department, as well as send the individual who initiated the redetermination a letter, letting them know the redeterminaton was Favorable on their behalf. I would override the claim or claims and the supplier or provider should've receive the funds on the next payment cycle (usually within 14 days from the date of the letter sent to the supplier or provider, informing them of the Favorable redetermination). Complete complex tasks, assignments and defined processes with complete level of independence. Multiple assignments worked and completed simultaneously as directed by leadership. Identifies, prioritizes and resolves most questions and issues independently. Answers questions of peers, escalates more complex questions or issues appropriately. Complies with contract requirements, business unit rules and related industry and legal regulations. We received additional training every two weeks reviewing current rules and regulation or learning new ones. The environment I worked in was team driven, considering the work due to the fast paced always changing workload. Written correspondence regarding insurance denials, provider contracts, eligibility and claims were also a daily duty. It was a daily basis to analyzes problems and provide information/solutions. Operate a PC/image station to obtain and extract information; documents information, activities and changes in the database. Always maintains positive customer relations and coordinates with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner. Posses extreme knowledge of company services, products, insurance benefits, provider contracts and claims. Perform some related and unrelated responsibilities, including but not limited to management needs, as well as assistance and either taking on the work load of sick or absent co-worker, or performing of any other department needs at hand. 100 % knowledge of the Medicare and Medicaid policy manual or constant mental update of changes was a must in this position.

December 2010 – July 2012

Medicare Appeals Rep

Orbit Medical (Name has changed sine my employment to Rehab Medical Supply)

Indianapolis, IN 46260

Knowledge in Internet Explorer, Realmed, Microsoft Excel, Microsoft Outlook, Microsoft Office and Microsoft Word (all newest versions at the time as well) were all a must. Job required working numerous systems just to complete one job task at hand. Gathering and analyzing information to either contact Medicare directly to conduct phone review, send Medicare Redeterminaton's, Medicare Reconsiderinations and if possible obtain and compile all documentation required to submitted request for ALJ (Administrative Law Judge Hearing). Ability to effectively present information one-on-on and in either small or large group settings to provide new policy change request and effective dates, Verifying Medicare Advantage Policies prior to delivery of Durable Medical Equipment to assure on date of delivery beneficiary does still have active coverage. This position evolved working all Medicare jurisdictions A,B,C and D as well as Advantage Plan's, therefore 16- 18 hour days were pulled at least twice (2) a month. My motto was if the company is not making or is loosing money then I'm not either getting the raise I work hard for and feel I deserve or the bonuses we were so Blessed to have at times during the year. Simple Data Entry, but always effective as can be, obtaining retro authorizations, contacting patient's for updated addresses to send statement or bill. I always tried to obtain either all of the balance due so the statement did not have to be mailed with either a credit card or check by phone. Contacting of Skilled \Nursing Facilities to assure patient's were not considered part A stays. If I found out the patient (also known and mostly referred to as beneficiaries), I would contact our driver or delivery team as soon as possible and have the delivery of whatever item seized, if at all possible. Working my A/R daily to bring what my goal was and the was the collection of $1,000.000.00. Complete knowledge of in and out of state Medicare and Medicaid policies as well as Medicare Advantage and HMO plans. Extensive organizational skills, team work and denial management skills were a must.

January 2008 – April 2009

Medicare Appeals Rep

Indiana Heart Physicians

Indianapolis, IN 46227

Assisting Front-Dest with checking in/out patient's, adding new patient demographics, verifying insurance to assuring patient's policy was active prior to visit or procedure, obtaining past due balances prior to the patient being seen, or setting up payment arrangements, assisting patient's with financial assistance forms and helping them complete if need be, reviewing documentation to determine if beneficiary qualified for a discount, if beneficiaries were Medicare patient's and had a fixed income I would do my best to set them up on a budget that they could fit into there fixed income (Medicare patient's have to pay deductible and co-insurances, it's against the law to write off a Medicare beneficiary balance), met with patient's to go over balances they did not understand and or called the insurance company with the patient's in the office and did my best to assure the beneficiary knew why he or she owed a balance, worked all the denied Medicare A/R for the last names of A-K for group of 22 physicians, responsible for collecting the balances of the Medicare patient's secondary co-insurance payment as well, made phone calls to commercial insurances and sent copies of Medicare EOB's (explanation of benefits) that somehow did not crossover from Medicare and or contacted the patient and requested immediate credit card payment of set up financial agreement with patient and most patient's had balances with them at there next visit. Proud to say I started working at Indiana Heart Physicians with there Medicare A/R 60 days and over before payment was made. By the time I left Indiana Heart not only did I have the old A/R clean up, my Medicare payments were coming in regularly every 14 days

December 1999 – November 2005

Billing Specialist/Office Manager

Medical Office Outsources

Mooresville, IN 46158

Data Entry, Charge Entry, Payment Posting, Working denials for all insurance companies (Medicare, Medicaid, Commercial Insurance, Workers Comp and Collections on Self pay, patient pay accounts) A/R, A/P, Driving to local physicians' offices to pick up the daily deposits and charge slips, working month and year end reports, collaborating reports for physicians upon there request, attending ISMA meetings, filing, faxing, office organization, training of new employees, preparing patient accounts to send to collection agency after 120 days of non payment or delinquency on payment arrangements, monthly meetings with physicians to address issues they were either unhappy with or inform them of new, updated changes in process/procedure of billing department, updating charge slips when ICD-9 codes and or CPT-4 codes were changed or new codes were added, mailing of patient statements, pulling eob's and sending primary eob with secondary claim for payment, contacting insurance companies to request payment on claims that had not been paid within 30 days of mailing, sending reviews and appeals to insurance companies on denied claims, updating internal office forms when needed, ordering of office supplies, answering phones and speaking with patient's regarding balances, setting up payment arrangements, reviewing of documentation to determine if patient's qualified for discounts towards balances, sending of electronic claims to clearing house and working front end denials, correcting the claims that denied electronically prior to them reaching the insurance company. Working reports of claims the insurance companies denied electronically and manually fixing them if possible, then forwarding them for immediate payment.

  • ID#: 79395
  • Location: Indianapolis, IN , 46217

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