Remote Medical Billing Specialist
All Axis Billing
Total years of experience :14 years, 4 Months
-Follow-up Outstanding Receivables
-Investigate outstanding claims
-Reconcile Claims
-Handles Authorization Request from Insurance Companies.
-Verification of Patient's Eligibilty & Benefits
-Perform Authorization follow-up and check delay of auth approvals
-Manage provider portal
-Calling Workers Compensation Center to find out if a certain patient requires MG2 variance for the treatment
Manage billing processes by adhering strictly to guidelines to ensure smooth processing of claims and avoid unwarranted denials to the maximum possible extent.
Develop and maintain relationships with insurance carriers to keep the department up to date with all billing and processing requirements from outside payers, including revision of pricelists and or amendments of contracts when applicable.
Ensure that pre-authorizations are done and pre-approval are in place and valid at all times to preclude any unnecessary rejections.
Calendarized resubmission of rejected claims and follow-through to ensure that same are done within the agreed cut-off date
Review and reconcile claims and conduct follow-up on claims unpaid, partially paid or denied, including appeals and resubmissions.
Co-ordinate and promote effective communication strategies within the team and maintain interdepartmental liaison where necessary, including escalating issues to Management regarding rejections, payments, etc.
DUTIES & RESPONSIBILITIES
• Manage outstanding accounts receivable and make resolution of same by issuing updated statement of accounts to each company and provide them with other necessary information to support prompt payment.
• Perform collection correspondence, verbal and written with Insurance companies for receivables due from them.
• Coordinate with respective companies for issues/problems relating to collections for immediate resolution.
• Follow-up collections by mail/phone call.
• Receive check payments and review/verify same as to accuracy of posting to respective Insurance or Corporate account.
• Request adjustments on misposted transactions.
• Reconcile payment details with corresponding remittance advices and post same to HMS system.
• Prepares and submits weekly and monthly financial reports.
• Checks/Investigates each invoices in the remittance advices for discrepancy of payments vs. billed amount per system and escalate issues relating thereof.
• Coordinate with Insurance/Corporate companies for missing Remittance advises so that statement of accounts of each companies are updated accordingly.
• Daily checkings of the DHA e-claim link system for recently uploaded RA’s and map same with unreconciled payment details.
• Daily review of Insurance portals for possible settlements made by Insurance company
• Initiates investigations on payments not received and request checkings from companies when was the check/payment collected from their end and who received the check. Same is necessary to trace the whereabouts of collections.
• Escalate unresolved issues appropriately and recommend solutions to minimize future problems.
• Review and checks total invoiced amount per month and request further investigation for any variances by coordinating with billing department for descrepancies.
• Develop & maintain a systematic filing system for easy reference.
The Strip Place, Osmena Boulevard, Cebu City
General Functions:
• Responsible for the daily operations of, and prompt and efficient delivery of service in the tellering, cashiering and ATM sections of the branch.
Specific Duties and Responsibilities:
• Directly supervise the daily activities of the tellers as well as ATM operations of the branch.
• Act as the principal custodian of the cash-in-vault (Peso and foreign currencies) and ATM cash, petty cash fund, working supply of accountable forms and late checks of the branch.\
• Responsible for maintaining cash-in-vault level within the authorized limits and insurable cover. Excess cash should be transferred to the designated cash center or report for approval the amount of excess cash to Retail Banking Group for insurance coverage.
• Ensure that all applicable policies, procedures, and controls are implemented consistently.
• Responsible for verifying the details and accuracy of posted transactions referred by the tellers for signature/approval. For transactions requiring two officers’ approval, shall be jointly responsible with the other approving officer. For transactions requiring single officer approval, shall be jointly responsible with the processing staff.
• Review/prepare, approve and submit branch reports. Ascertains completeness, accuracy, prompt and proper dispatch of documents/reports to concerned units. Ensure that discrepancies are reported or resolved in time.
• Ensure that outward and inward clearing items are accounted for and disposed of in accordance with established rules and regulations.
• Ensure correctness and accuracy of validation of Beginning Cash Vault, Cash Requisition, Cash Deliveries and Vault Ending Cash.
• Responsible for rectifying audit/examination findings and implementing the auditor’s recommendations.
• Facilitate and coordinate problems with the branch’s computer equipment, including the onsite ATM, with the /information Technology unit of the bank for immediate resolution.
• For bills purchased (BP) availment transactions exercise delegated approving authority and perform the procedures outlined in the pertinent bank operation manual, e.g. confirmation of deposited check with drawee bank, if availment is within approved line, eligibility of check purchased, etc.
• Resolve client concerns immediately and satisfactorily in accordance with the bank’s service standards.
• Act as the principal custodian for all alphabetically arranged signature cards (CA/SA/TD/FTD, etc.)
• Investigate, or cause the investigation, of suspected or actual irregularity or fraud in my area of responsibility and subsequently submit report to the Branch Head.
• Ensures that all the staff under my supervision have undergone, or will take, the required training necessary for the efficient discharge of their functions..
• Cause the culling, retention and disposal of files and records of my section.
• Ensure that good housekeeping is maintained in the branch premises to protect the bank’s image.
• Views emails/lotus notes regularly during the day to ensure that all instructions/advices received and requests are promptly acted upon.
• Responsible for ensuring the efficient operation of the automated accounting system. Ensure the timeliness, accuracy, completeness and validity of all posted and uploaded automated entries.
• Manage lobby traffic and ensure costumer’s satisfactions are met.
• Conduct regular sectional meetings with Service Associates for updates on bank policies procedures and about the bank and its products.
• Responsible for processing all over-the-counter transactions on a timely and efficient basis in accordance with established bank policies and procedures and delegated authority limits.
• Verify, approve and process account withdrawals and check encashments in accordance with delegated authority limits.
• Handle the purchase/sale of foreign currency noted and transactions.
• Reponsible for the correctness and completeness of transactions posted in the bank’s tellering system.
• Perform end-of-day balancing of cash transactions by tallying cash count total against the validation list and versus the posting media. Report any discrepancy noted in the manner and format as required in the bank’s policies and procedures.
• Ensure that all cash transfer transactions (from and to the cash vault) including cash transfers to/from Service Head are duly approved, accounted for and documented.
• Ensure that all negotiated checks (from OTC encashments and inward) are accounted and subsequently placed on bank statement envelope.
• Declaration of any cash difference and preparation of Overage/Shortage report to be submitted to immediate supervisor for endorsement and final of the Branch Head.
December 2004 to December 2008 Executive Assistant
Banco de Oro Unibank Inc
BBG - Region 8/ Office of the Region Head
Functions: • Responsible for providing support to the Vice Presidentd in the administration and supervision of branches by assisting in the management of documents and information going into/coming from the region office.
• Responsible in preparing supplementary reports needed by the Region Office.
• Coordinating with other units with respect to the schedule/appointments of the Vice President.
• Provide, manage and control manpower resources
• Review and facilitates request for repairs, maintenance & requisitions of furniture, fixtures, equipment, stationeries and office supplies by coordinating with concerned units and ensures that requests are in accordance with existing guidelines and procedures.
• Monitors and ensures compliance of branches to to internal policies.
• Assist the Vice President in budget preparation and monitoring of branch funds generation and profitability performance.
• Assist RH in the preparation of memos/ circulars/ correspondences, both internal and external.
• Prepares financial highlights reports/ presentation materials and acts as secretariat in the monthly Region/ Branch Managers meetings.
• Coordinates with branches on actions concerning clients' complaints received by the Bank; obtains information/report from the branches to validate complaints for submission to Customer Care and other concerned units.
• Acts as custodian of confidential documents (e.g. BSP Audit Report of Branches, Internal Audit Report of Branches, CIV Reports, Administrative cases, etc.)
• Prepares request for reimbursement of Region Office and Travel Advance and Liquidation Report.
• Performs other duties that may be assigned from time to time by superiors.
• Assist the accounting head in the preparation of various Reports.
• Custodian of Petty cash.
• Ensure that Petty cash requisitions are liquidated at a reasonable time and supported by official receipts.
• Prepares weekly and semi monthly payroll reports.
• Responsible in compiling payroll data, such as hours worked, piecework, taxes, insurance, union dues to be withheld, and employee identification number, from time sheets and other records.
• Review and verify source documents to ensure accuracy of payroll.
• Records changes affecting net wages, such as exemptions, insurance coverage, and loan payments for each employee to update master payroll records.
• Records data concerning transfer of employees between departments.
• Investigate and correct payroll discrepancies and errors
• Addresses employee's pay-related concerns and provide accurate payroll information
• Manage and maintain comprehensive payroll records and exercises timely, accurate and complete submission of reports as may be required by the accounting head.
• Maintains proper and efficient filing, retrieval and safekeeping of accounting records & documents.
Masters Degree: Masters in Business Administration (24 units) University: University of the Visayas Colon St., Cebu City
Bachelors Degree: Bachelor of Science in Accountancy University: University of San Jose - Recoletos Magallanes St., Cebu City
