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Virginia D. Long
4224 W. Charleston # 171 Las Vegas NV 89102 (702) 715-0670 Cell (801) 946-1306 Home OBJECTIVE: To obtain a position with good potential for advancement where my abilities and experience In medical insurance and hospital as Initial Medicaid, Commercial, and Secondary Biller, Administrative Financial Analyst, Claim Analyst, Claim Adjuster and Financial Counselor will be effectively utilized. HIGHLIGHTS OF QUALIFICATIONS: Hard worker, quick learner, detail oriented with a positive attitude that is self-motivated, get along well with others, team player with the ability to assess situations and apply common sense to resolve day today issues. PROFESSIONAL EXPERIENCE: HealthSouth Rehab Hospital of Henderson Nevada 10301 Jeffreys St Henderson Nevada 04/09 to 05/10 Patient Account Representative I am responsible for billing electronic and manually for inpatient claims. I was the primary and secondary insurance biller for Valley View and Henderson hospital. I bill commercial, Medicaid, Workers Compensation, Med Care Solution, Auto Insurance, Tri Care and Self Pay. I was responsible for following-up the accounts with the insurance, calling and billing patient, send a series letter to the patient regarding balance, Review Medicare and Commercial Remittance Advice, post payment, Review credit balance and denial claims, Audit each account to make sure each account is paid correctly, Request refund if insurance or patient over paid the account, request adjustment to true-up the balance on the account if claim paid correctly by insurance or patient to bring the accounts to zero balance. Send the claims to collection, Commercial claims is 90 days, Medicare Claims is 120 days, take credit card payment from patient by phone in enter to Virtual Merchant System, Send claims to Bad Debt if balance is less than $999.00 for Commercial Claims, send claims to Medicare bad debt if Medicare paid more than other insurance allowable, send appeal for reconsideration for retro authorization if no auth on file, review credit balance on each account to make sure each account is paid correctly, review and resolved all the denial claims, fax or email request to medical record department. Computer used Parco System for Collection and Care Medic or Version -11 for Billing. Twin Medical/Med Assist 5900 Fort Apache Las Vegas, NV 04/07 to 03/09 Medical Billing Specialist/Collector ---I was a primary and secondary insurance biller for 12 different hospital manually and electronically Commercial, Medicaid and Workers Compensation. Enter patient demographics and insurance information into the system, send email request to the hospital for patient complete medical records, UB and itemized bill. Create a new color coding files for the new patient, Pull patient record on the records file. Verify Outstate Medicaid eligibility, Request healthy connection # for Idaho Medicaid prior to billing
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claims, Verify authorization (request retro-authorization if no authorization on file), Verify Medicaid and commercial provider tax ID # and NPI number if provider tax id # and NPI # not on file or has not been updated or invalid, Follow-up on billed claims account and denials. Send rebilled to the insurance if claim has been denied by the insurance incorrectly. Work mail correspondence, Verify insurance for under payment claims. Request adjustment for under payment claims. Send appeal to insurance carrier as necessary, returned the claim back to hospital for non billable charges. Request copy of the denial from hospital or to the insurance carrier, update new claim information, Review EOB payment and post payment. HCA Health Care Account Services 2250 S. Decatur Blvd Las Vegas, NV/California 09/01 to 04/07 Medical Billing Specialist/Collector I am responsible for billing primary and secondary claims electronically and manually for in-patient and out-patient. Verify insurance for denied and under payment claims. Mail claims to insurance carrier as required. Work accounts from the hospital bill alert reports on daily bases. I am responsible for posting correct late charges to the accounts and posting payments. I bill Medicaid, Commercial, Tri Care, Health and Welfare, Alaska and Montana for Rehabilitation Treatment Center. Work all billing vendors and edits including Medicare Service Center on daily unbilled reports, Write-off all non covered charges, Verify patient eligibility, Request copy of complete patient medical record, sent adjustment for under payment claims and request refund for the overpaid claims. Mail claims to insurance carrier as required, Update notes on follow up tool system as necessary, (Request retro authorization if no authorization on file). Verify patient correct information on demographic data. I worked for 8 different hospitals for Northern and Southern CA and other Out of State Hospital like Alaska, Wyoming, Hawaii and Idaho. Responsible to follow-up on billed accounts and denied claims using established criteria by contacting the insurance Carriers and or patient by phone or in writing to expedite payments. Update patient Insurance information and resubmit claims as necessary. Bill secondary insurance after primary insurance has paid. Change financial class to private party after all insurance has paid and makes appropriate notes. Answer all written and telephone correspondence from patient and insurance companies in timely manner. Work all correspondence mail daily. Send appeal to the insurance regarding denied claims, Bill patient for non covered charges with attached EOB. Santa Clara County IPA 1165 Triton Dr Foster City, CA 05/99 to 08/00 Medical Claim Analyst/Claim Auditor -- Processed multiple types of claims including Out of state and Out of country claims. I have the Ability to analyze claim issues, and claim problems. Review and audit report on daily bases. Processed and audit multiple types of claims with different cases. Review under payment and over payment claims, Ability to work in a high volume production oriented environment. Community Health Information Service
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1100 Olive Way Seattle, WA 08/97 to 03/99 Claim Analyst/Claim Adjuster -- Analyzed all types of claims with respect to medical policy, members and medical history and appropriateness or services and eligibility to determine payment or denial per policy and established guidelines. Review under payment and over payment claims. Research member and provider eligibility, benefit coverage and limitations prior to authorizing specialists referral, and enter Patient demographics and insurance information, Update and maintain medical referral data into the system. Regence Blue Shield 1800 9th Avenue Seattle, WA 08/88 to 08/97 Claim Adjuster/Customer Service Representative -- Responsible for adjusting and processing claim, Updating patient eligibility and referral into the system. Provides exceptional customer service through claims adjudication, process multiple type of claims (including COB, Vision, Dental, Psych, Chiro, Maternity, Out of state and Out of country claims). Handle and resolved commercial and government claims in different cases. Maintain quality review by identifying and documenting all errors. Interacting with all levels of management with regards of implementing more efficient policies and procedure for claims adjudication. Assist co-worker regarding adjustment problem. Perform as the front-line contact for the health plan members, brokers and providers regarding patient coverage and open enrollment, and authorizing the Pharmacy for patient RX. EDUCATION: Business Computer Training Institute Seattle WA - Study Medical Terminology, Coding, ICD9, CPT, DRG codes and Revenue codes, Medical Billing, Account Receivable/Payable, Processing Claims, Adjusting Claim, Training in telephone Techniques, Customer Service Skills and Word Processing, Spreadsheets, and Excel. Seattle Central Community college ADDITIONAL SKILLS I have Knowledge of Fee Schedules, Case Rate, and Per Diem rate. I have Strong Customer Service Skills. Computer programs that I used from my previous employer, Maces, Facet, Meditech, SSI system for billing claims, Collection system for collection notes, PAS system, Rebill Tool, CUBS for billing, and E-health for billing notes, Patcom System for collection and Care Medic or Version 11 for Billing.

Reference: Upon Request