Tabatha Demers
Dartmouth,MA
Summary
Medical biller with over 35 years' experience in the medical billing field, with experience in a variety of medical professions in multiple states. Strong working knowledge of medical office procedures and policies including the ability to communicate with all customers in a professional manner, accurately release charges, post payments for multiple medical offices as well as surgical claims, electronic claims submissions, insurance verification, and month end reporting to providers. Work directly with providers and office staff on current insurance guidelines, and office policies. Strong organizational skills, with ability to multi-task, prioritizing and completing tasks in a timely fashion, works closely with associates on coding and compliance, Works well with others, strong communication with a positive attitude
Overview
35
35
years of professional experience
Work History
Team Leader Accounts Receivable
SouthCoast Physician's Group
01.2015 - Current
- Electronic Claim submission run and review EDI reports
- Work with Clearinghouse to resolve claim submission issue
- Met with EPIC team weekly to discuss system issues and create edits
- Oversee Accounts Receivable for both Government and Non Government Payers
- Built relations with provider representative for all payers by presenting claim issues on bi-weekly calls
- Work with management to resolve payer issues
- Supervised team of 25
- Ran monthly payer reports to research denial trends
- Worked with team to identify areas of improvement and devised solutions based on findings.
- Conducted training and mentored team members to promote productivity, accuracy, and commitment to friendly service.
- Conducted training and mentored team members to promote productivity and commitment to friendly service.
- Established open and professional relationships with team members to achieve quick resolutions for various issues.
- Managed leave requests and absences and arranged covers to facilitate smooth flow of operations.
- Evaluated staff performance and provided coaching to address inefficiencies.
- Empowered team members by delegating responsibilities according to individual strengths and areas of expertise.
Biller II
Emerson Practice Associates, Inc
01.2020 - 01.2023
- Review Patient Demographics for accuracy and completeness
- Review CPT & diagnosis with accuracy to ensure swift payment from insurance
- Prevent payment delinquencies by working closely with managers and providers to resolve billing issues
- Work with coders to ensure proper billing guidelines are being followed.
Billing Specialist
MedPro Medical Management
01.2010 - 01.2015
- 3rd Party billing for multiple specialists
- Reviewed and release charges for office visits and surgeries
- Reviewed surgical notes for appropriate coding and modifier placement
- Electronic claim submission, reviewed EDI reports for rejections
- Pulled insurance EFTs from clearinghouse and bank lock-box
- Posted all insurance and patient payments ran daily close reports for balancing
- Worked all claim rejections and submitted corrected claims and or appeals when necessary
- Ran and worked monthly AR
- Review payment against provider contracted fee schedule to ensure claims are paid at full potential
- Work closely with office staff on any billing or insurance issues that are preventing claim submission
- Run monthly schedule report to ensure all schedule office and surgery patient's billing has been submitted for payment
- Provide weekly status reports to providers and office staff to review for billing issues
- Run patient statements, review and work closely with providers on collections placement
- Answer patient phone calls and resolve any billing questions/concerns with in a professional manner
- Respond to third-party inquires, including legal requests and other health care professionals, providing necessary documentation as required in order to expedite claim processing
- Maintain HIPPA confidentiality of all patient/doctor records
- Work closely with office coder to ensure coding compliance is in place
- Review medical policies when billing for specialist surgical procedures
- Run monthly reports, prepared reports in Power Point and supplied to providers at month end
- Strong computer knowledge of multiple software's; ADS, Lytec, Health Fusion, Total MD, NexTech, Allmeds, and ECW
- Skilled in Microsoft office, Microsoft Word, Microsoft Excel, and Power Point
- Strong customer service.
Billing Specialist
E-Practice Solutions
01.2005 - 01.2010
- 3rd Party billing for multiple Optometric Practices
- Posting of insurance and patient payments as well as daily deposits for all locations
- Staff training on proper coding to ensure fast turn around of claim reimbursement
- Submission of claims to all insurances with EDI support
- Follow-up and reconciliation of billed accounts with insurance companies and patients
- Resolved problem claims and denials
- Prepare and maintain month-end financial reports and AR reports for each practice.
Front End Manager/ Billing Specialist
Michael J. McCarty, OD
01.2001 - 01.2005
- Handled patient data entry for multiple offices
- Patient scheduling, check-in and patient check-out
- Maintained accurate recording of patient medical records
- Schedule and confirmed daily appointments to include surgical evaluations
- 3rd Party billing for three locations as well as follow up of claims and denials
- Order patient frame and contact lenses and maintained inventory
- Customer Service.
3rd Party billing for multiple Cardiologists
New Bedford Medical Associates
01.2000 - 01.2001
- Maintained hospital billing and patient follow–up
- Reviewed physician's hospital log to ensure all billing was entered
- Customer Service
- Phlebotomy billing.
3rd Party billing for 5 optical center locations
Eye Health Vision Centers
01.1993 - 01.2000
- Handled all claims submissions paper and electronic
- Posted all insurance and patient payments
- Follow up and reconciliation of billed accounts with insurance companies and patients
- Manual submission of patient statement
- Handled patient phone calls and resolved any issues or concerns in a professional manner
- Resolved denied claims and electronic claim rejections
- Run daily reports from clearinghouse to work and claim rejections
- Worked with administration to review recurring claims issues
- Ran reports for multiple opticians for monthly financials.
Front end manager
Oxford Family Eye Care
01.1989 - 01.1993
- Assisted optometrist in contact lens training and dispensing
- Worked with new contact lens wearers on proper care and handling of product
- Maintained contact lens inventory
- Ordered all supplies and contact lens orders for patients
- Worked with opticians on eyewear dispensing
- Handled all 3rd party optical claims
- Received Optician's License
- Took in prescriptions for new optical orders
- Dispensed eyewear with care on proper fit of eyewear as well as proper care
- Worked in lab reading eyewear to be sure prescription is accurate
- Edged lenses to put into frames while maintaining prescription is accurate
- Ordered lenses and frames for patient orders
- Maintained frame inventory
- Reviewed inventory with manager to go over frames that need to be replaced due to lack of patient interests.
Education
Business Management
Bristol Community College
Fall River01.2001
Business Curriculum -
Fairhaven High School
Fairhaven, MA01.1989
Skills
- Strong EPIC Knowledge
- Medical Terminology
- Medical Insurance
- Microsoft Word
- Microsoft Excel
- 3rd Party Billing
- 85-90 WPM
- Medical Office Procedures
- ICD -10 and CPT Coding
Timeline
Biller II
Emerson Practice Associates, Inc
01.2020 - 01.2023
Team Leader Accounts Receivable
SouthCoast Physician's Group
01.2015 - Current
Billing Specialist
MedPro Medical Management
01.2010 - 01.2015
Billing Specialist
E-Practice Solutions
01.2005 - 01.2010
Front End Manager/ Billing Specialist
Michael J. McCarty, OD
01.2001 - 01.2005
3rd Party billing for multiple Cardiologists
New Bedford Medical Associates
01.2000 - 01.2001
3rd Party billing for 5 optical center locations
Eye Health Vision Centers
01.1993 - 01.2000
Front end manager
Oxford Family Eye Care
01.1989 - 01.1993
Business Management
Bristol Community College
Business Curriculum -
Fairhaven High School
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