12472 LOS PINOS STRRET, VICTORVILLE CA 92392(760) 686-3822 cell Email: hellis5@yahoo.com

HOPE ELLIS

OBJECTIVESeeking a challenging position that offers opportunity for growth and advancement in which I may utilize my knowledge, experience and skills in the Healthcare Industry

EDUCATIONWalnut High School, WALNUT CA – Diploma

WORK EXPERIENCE04/14 - Present LA Care Health plan Los Angeles CACLAIMS EXAMINER IIProcess claims for all lines of business, including complex claims referring to the DOFR for processing

• Processed Outpatient, Inpatient, DME, Dialysis, Injectable, CHDP, Professional, COB, Family Planning, Home Health, High dollar, LTC, and Stop Loss

• Processed UB’s and HCFA claims• I am a SME for the Professional POD• Send out daily work assignments• Train new claim examiners to process claims efficiently and answer any complex

questions• Monitoring itemized billings for excessive charges, duplications, unbundling, and

medical coding• Review claims for required information, pending claims when necessary• Maintain a follow up system, and updating and releasing pending claims when

indicated• Reversal of claims for correct payments, Recoup overpayments• Meet daily required production and quality• Excellent attendance and open for Overtime• Adjustment/Auditing Team on all Line of Business claims

11/11 – 11/13 Kindred Healthcare/Vital Care America Poway CASNF PATIENT ACCOUNT SPECIALIST

• Billed SNF claims for Medi-cal, Medicare, and HMO• Collections of aged claims• Appeals• CIFS• Account Adjustments• Follow up on aged reports up to 120 days

6/11 – 8/11 Temps Unlimited/Victor Valley Hospital Victorville CAINSURANCE VERIFIER

• Responsible for reviewing patient’s case, and insurance coverage information• Take and verify all patients demographic information when registering for

services• Request pre certification and benefits on all patients, both inpatient and

outpatient for surgery• Using DDE, perform verification of Medicare coverage and limits on all Medicare

accounts of inpatients• Verification of all Insurances HMO, PPO, Medicare to determine copay,

coinsurance, deductible, and max out of pocket

03/09 - 4/10 Kforce Temp Agency/Kaiser Permanente Rancho Cucamonga CADEDUCTIBLE PRODUCT SERIVCE TEAM COLLECTOR

• Handled in bound calls• Customer complaint cases• Responsible for resolving outstanding receivables by conducting direct payment• Settlement negations, Appeals, Bad Debit, Write off, revenue skip tracing and

agency assignments for commercial accounts

11/5/ -10/08 San Antonio Community Hospital Upland CABILLING COORDINATOR

• Supervision of staff involved in department billing clerical tasks• Delegate duties monitor policies and procedures within the department• Responsible for Commercial, HMO, Medicare, Workers Compensation, and Self

pay billing• Posting and follow up with EOB’s reviewing correspondence• Work aged report 30-120 days• Assist in preparation of monthly and weekly AR reports• Liaison to finance department with billing and payments • Provide training of new employees and ensure continued education through

cross training

SKILLS• Typing (70wpm)• 10 Key (touch)• Microsoft Excel and Word• Medical Terminology• MHC, QNXT, Meditech, MDX Billing, Diamond, Advanced MD, Allegra, Health

Connect, AS400, Medisoft, Cerner and Emedeon

REFERENCE***Upon Request***