Billing/AR/AP/Admin. Clerical

Simone M. Foy                                                                                                                                                                                                                 S.Foy1111@Outlook.com

 

 

SUMMARY 

 

 Self-motivated service-focused professional with multiple disciplines seeking a career opportunity in the health care    industry that will leverage both experience and education as a medical billing specialist. Detail oriented and organized individual, who exemplifies professionalism, and an ability to manage multiple projects and tasks. An established record of successful financial management and Administrative service focus initiative, while maintaining a positive company image. Possess leadership qualities and the ability to work with individuals from various backgrounds, while promoting team values.

 

 

EXPERIENCE:

 

Nov 2013 – Feb 2014                   Xerox Corporation                          Indianapolis, IN

Insurance Associate – Claims Processor

  • Utilizing the Adelra software to process claims
  • Utilized KWIK software to request additional documentation/ information
  • Utilized dual monitors for effective processing time
  • Priced/Repriced various types of claims such as, Anesthesia, DRG and other claims
  • AR/Adjusted claims according to adjustment guidelines
  • Researched provider/member claims and bring resolution to AR internal/external  inquiries and discrepancies
  • Reviewed aging claims and released or rejected claim payment(s) within company guidelines
  • Reprocessed various incorrectly processed/suspended claims  an over paid claims to members and providers
  • Referred unresolved payment issues to designated departments for further investigation
  • Obtained documentation for claim(s) processing and medical review while observing HIPPA regulations
  • Updated benefits for  the accounts, procedures and diagnosis codes
  • Worked indecently, and manage multiple tasks within deadlines in a high volume conditions/deal with change constructively
  • Performed other special projects as assigned
  • Maintained and verified fee schedule updates for correct payments
  • Establishes proof of loss by studying medical documentation; assembling additional information as required from outside sources, including claimant, physician, employer, hospital, and other insurance companies; initiating or conducting investigation of questionable claims

 

Feb 2011- Present                    Discount Mattress                           Indianapolis, IN

Office Administrator/Human Resource (Part time)

  • Oversee opening and closing of store accounting/balancing
  •  daily deposit
  • Utilized Genesis System to access protected documents regarding distributor quoting, etc.
  • Handled store sales advertisements/ Responsible for in store  inventory stock
  • Checking inventory, process and receive payments, e-mail, system data entry, ten key and strong communications and problem solving skills.
  • Implementation of deliveries and product quality assurance
  • Scheduled delivery to customers and or returns
  • Handled all  furniture distributor purchase orders and pickups
  • Maintained bi-weekly in  store inventory
  • Expedited daily invoices on sales/ customer lay-a-ways
  • Up keep of employees files
  • Ran weekly submissions on all employees payroll and commission reports
  • Maintained all furniture distributors financings
  • Tallied daily customer/distributors invoices and purchases
  • Responsible for all distributor’s financing up keep
  • Entered numerical data into database in a timely and accurate manner

 

 

 

 

 

 

 

Simone M. Foy                                                                                                                                                                 Page 2

 

 

Jun 2007 – Sep 2010                     ITT Technical Institute                           Carmel, IN 

Administrator of Records Coordinator for Regulatory/Academic Affairs - Compliance 

 For 211 Online – 212 Hybrid Instructor’s Division

  • Pursued, tracked/follow-up with new Instructor’s throughout hiring/ enrollment process by sending requests for all completed college transcripts/or partial completed transcripts along with completed remaining new hire paper work
  • Worked indecently, and manage multiple tasks within deadlines in a high volume
  • Create and maintain all data entry on all computerized and paper records on each instructor within 211-212 divisions
  • Maintained all paper work/ electronic files regarding all adjunct online instructors for 211 – 212  divisions
  • Responsible for the upkeep /data entry and corrections regarding  ITT Technical Institute facility catalog of all courses /course descriptions  for all 211-212 online/campus  divisions requested by (Headquarters Wendy Kendal manager of Regulatory Affairs) with both 211-212 divisions instructors listed
  • Created excel spread sheet on all requested   financial currency used to pay for all foreign/domestic and out of state transcripts on both 211-212 online divisions new  hires /updated transcripts while maintaining input of all transactions
  • Responsible for both/all internal/external HR  new hires  transcripts/completed paper work requests for both 211-212 online divisions (Jeanna Dallas of human resource)
  • Created/maintained  a detailed financial excel spreadsheet expense report for HR (Jeanna Dallas) on all  new hires, internal  and external employees transcripts request for both  211-212  ITT Technical Institute divisions 
  • Created and  maintained all input/data entry updates on all new hires within multiple Excel Spreadsheets on 211 – 212 online division regarding each individual instructor and course approvals
  • Audited/maintained all 211-212 online division instructor files to ensure that each file/record contains all the necessary documentation according to Accrediting Council for Independent Colleges and School 
  • Follow through with appropriate contacts to 211-212 online division instructors to  obtain any needed file documentation
  • Completed and initiated all presentable applications forms regarding new course programs and curriculum changes within established programs to Accrediting Council for Independent Colleges and School from headquarters for accreditation approvals for (Headquarters Wendy Kendal manager of Regulatory Affair)
  • Submitted all requested  information from Regulatory /Academic Affairs as requested by (Headquarters Wendy Kendal Manager of Regulatory Affairs)
  • Responsible for the upkeep of numerous online Faculty Development & Compliance department files  on all  211-212 online division  instructors’ according to the state, Accrediting Council for Independent Colleges and School
  • Received/assigned various Administrator /Regulatory duties  from multiple head quarter personnel
  • Ran a daily reports to ensure  instructors were completing all internal courses assigned by ITT 
  • Create Certificates for all instructors whom  completed/attended quarterly mandatory meetings assigned
  • Assisted with receptionist duties, file organization and research and development.
  • Outlined the appropriate process and procedures necessary to fulfill and complete inquiries for instructors
  • Organized forms, made photocopies, filed records and prepared correspondence and reports 
  • Scanned documentation and entered into the database
  • Added new material to file records and created new file records on instructors
  • Perform other special projects as assigned

 

Mar 2006-Jun 2007                                    Lincare, Inc.                                  Indianapolis, IN 

Patient Accounts Coordinator

  • Utilized AS400 application software system to close out/suspend patient accounts
  • Rebilling  of and on all mishandled DME claims (Durable Medical  Equipment)
  • Maintained/Verified the upkeep on current Patient(s) Insurance policy information
  • Handled incoming /returned outgoing calls to patients and insurance billing departments/providers
  • Ordered supplies for patients in home/portable equipment
  • Create delivery tickets on patient equipment pick up and deliveries
  • Insure balance are paid out by insurance/Patients
  • Responsible for reviewing assigned system work files or to identify billing issues 
  • Responsible for daily track of all A/R accounts received and pay outs
  • Performed daily research on processing of front end rejections and all payer denials
  • Maintained documentation on all incoming payments from patients, CMS and insurance parties
  • Work daily correspondence work files and response(s) to inquiries and or follow-up(s) requests insurance companies and insured parties 
  • Handle/processed TPA claims and payments
  • Maintained and verified fee schedule updates for correct payments
  • Priced Durable Medical Equipment  utilizing AS400 system
  • Research and resolve accounts receivable issues with members of the billing department
  • Ensured/maintained  all data entries of patients insurance companies deductibles, co-pays and maximum payout  were update within the AS400 system
  • Perform other special projects as assigned

 

 

 

 

Simone M. Foy                                                                                                                                                                 Page 3

 

 

May 2003- Sep2006                                            Anthem/Wellpoint                             Indianapolis, IN                                          

Claims Processor II/Appeals Clerk                                                          

  • Processed/priced Medical, Prescription, DME and Dental Claims utilizing Nasco EEC claims recovery system
  • Processed all various claim types such as, Anesthesia, Medicare, Medicaid, VA, Hospice, along with HMO and PPO plans, Third Party Insurances.
  • Adhere to the billing requirements for commercial, managed care, Medicare, Medicaid, Blue Cross/Blue Shield payers 
  • Utilized the Nasco EEC claims recovery system to efficacy and characteristic meet daily/weekly production quota
  • Communicate with insurance companies via insurance company websites and telephone for status on outstanding claims and to resolve billing issues 
  • Reviewing anesthesia reports for utilization on correct usage of modifiers
  • Maintained/Verified the upkeep on current Patient(s) Insurance policy information
  • Apply strong problem solving skills to identify unique billing situations (high dollar payouts to members) that would require the attention of management
  • Processed Domestic/International Claims along with converting foreign currency
  • Responsible for reviewing assigned system work files or reports to identify billing issues
  • Requested medical documentation of services rendered to members from providers for claim payments
  • Researched provider/member claim inquiries
  • Work daily correspondence work files and response(s) to inquiries and or follow-up(s) requests insurance companies and insured parties 
  • Establishes proof of loss by studying medical documentation; assembling additional information as required from outside sources, including claimant, physician, employer, hospital, and other insurance companies; initiating or conducting investigation of questionable claims
  • Adjusted/corrected suspended claims for re processing of correct payments according to members insurance plan
  • Maintained/Verified fee schedule updates for correct payments
  • Performed daily research on processing of front end rejections and all payer denials
  • Reprocessed various incorrectly processed claims /over paid claims to members and providers
  • Reimbursed members/insurance companies on  under paid claims according to members insurance policy(s)
  • Assist team members and Customer Service Representatives with claims
  • Floater/assist other National Business Units
  • Worked Levels I & II provider and member appeal with minimum supervision
  • Researched/prepared appeals for Appeals Representatives
  • Prepped and loaded all incoming members/provider written appeals into Nasco system
  • Returned member/Provider and insurance companies calls
  • Process and follow-up on appeals to insurance companies
  • Escalated issues, if needed, to the various departments or management
  • Perform other special projects as assigned

 

                                                                   Administar Federal                                      Indianapolis, IN                                     

Administrative to the Virtual Call Center Manager

  • Transcribed daily meeting minutes
  • Scheduled and set up all meetings( Jag meetings)
  • Supported more than 200 customer service representatives in the 1-800-Medicare call center
  • Created a GT-X downtime production form for all five virtual sites
  • Composed and assisted Marlin Boothby (Contract Admin. /Gov. Liaison) with SADBUS telephone directory/projects
  • Produced and researched a monthly virtual turnover term counts report for CMS.
  • Maintained the upkeep of all the Universal Data Forms that is used throughout the virtual sites
  • Supported the Content team on all feedback closing from CSRs throughout the virtual sites
  • Assisted with receptionist duties, file organization and research and development.
  • Perform other special projects as assigned

 

 

 

 

EDUCATION:  

 

Associate Degree, Remington College – Houston, TX, 2000

Insurance Billing & Coding Specialist, Herzing University (Online) - Present 

 

 

 

 

  • ID#: 84270
  • Location: Indianapolis, IN , 46219

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