Anna Wilson
Simi Valley
Summary
Accomplished Medical Billing Specialist with a proven track record at the County Of Ventura - Health Care Agency, showcasing expertise in HIPAA compliance and exceptional patient billing processes. Adept at leveraging Avatar, Cerner, and SmartCare software, with a knack for fostering teamwork and collaboration. Successfully enhanced billing accuracy and efficiency, significantly reducing claim denial rates.
Overview
23
23
years of professional experience
Work History
Medical Billing Specialist III/IV
County Of Ventura - Health Care Agency
04.2024 - Current
- Filed and updated patient information and medical records.
- Collected payments and applied to patient accounts.
- Examined patients' insurance coverage, deductibles, insurance carrier payments and remaining balances not covered under policies when applicable.
- Liaised between patients, insurance companies, and billing office.
- Assist clients with setting up sliding scale financial payments (UMDAP), manual calculations, bill outpatient Medi-Cal, Medicare, and Insurance for mental health services.
- Communicate with insurance providers to resolve denied claims and resubmit.
- Research CPT and ICD-9 coding discrepancies for compliance and reimbursement accuracy.
- Communicate with clients for unpaid claims for HMO, PPO, Medi-Cal, and Medicare accounts and delivered friendly follow-up calls for proper payments to contracts.
- Locate errors and promptly refiled rejected claims.
- Refer clients to other programs for assistance such as Medi-Cal.
- Assist supervisor with Subpoena requests, follow-ups, and record prep for review by county attorneys.
- Participate in counting countywide homeless population.
- Working knowledge of Avatar, Cerner, and SmartCare.
Medical Biller II
County Of Ventura - Health Care Agency
11.2022 - 04.2024
- Liaised between clients, insurance companies, and billing office.
- Filed and updated patient information and medical records.
- Adhered to established standards to safeguard clients' health information.
- Collected payments and applied to client accounts.
- Posted payments and collections on regular basis.
- Reviewed client records, identified medical codes, and created invoices for billing purposes.
- Communicated with insurance providers to resolve denied claims and resubmitted.
- Delivered timely and accurate charge submissions.
- Prepared billing statements for clients and verified correct diagnostic coding.
- Verified insurance of clients to determine eligibility.
- Processed vendor and supplier payments on weekly basis.
- Used data entry skills to accurately document and input statements.
- Collaborated with clients to resolve disputes.
- Responded to clients concerns and questions on daily basis.
- Refer clients to assistance programs such as Medi-Cal.
- Assist clients with setting up sliding scale financial payments (UMDAP).
- Advise prospective clients about our outpatient programs and locations.
- Assist supervisor with subpoena requests, follow-ups and record prep for review by county attorneys.
Clerical Supervisor II
County of Ventura-Human Services Agency
07.2022 - 10.2022
- Coordinated training, evaluated employees' work and corrected problems with clerical team.
- Assigned work and verified completion of assignments.
- Performed one on one conferences
- Attended monthly team meetings
- Monitor reception area for proper coverage to assist incoming clients
- Check in daily with staff to evaluate work assignments
- Participate in Clerical Supervisor Meetings for IHSS and PA
- Participate in workgroups for program changes and/or new policy updates
- Ensure staff have proper tools
- Developed internal requirements and standards to minimize regulatory risks and liability across programs.
- Resolved issues through active listening and open-ended questioning, escalating major problems to manager.
- Delegated tasks to administrative support staff to organize and improve office efficiency.
- Provided backup to front desk to step in to assist with various tasks whenever employee was absent or at lunch.
- Kept high average of performance evaluations
- Monitored shared mailboxes and fax
- Provided support to on-site IHSS Socialworkers
Medical Biller I
County Of Ventura - Health Care Agency
05.2010 - 08.2014
- Analyzed complex Explanation of Benefits forms to verify correct billing of insurance carriers.
- Prepared billing statements for clients and verified correct diagnostic coding.
- Filed and updated client information and medical records.
- Liaised between clients, insurance companies, and billing office.
- Communicated with insurance providers to resolve denied claims and resubmitted.
- Reviewed client diagnosis codes to verify accuracy and completeness.
- Adhered to established standards to safeguard clients' health information.
- Posted payments and collections on regular basis.
- Verified insurance of clients to determine eligibility.
- Referred clients to other programs for assistance such as Medi-Cal
- Working knowledge of Avatar, Cerner and SmartCare
Lead Medical And Dental Examiner
Insurance Overload Systems
09.2001 - 05.2010
- Examined forms to determine insurance coverage and validity.
- Analyzed information gathered from investigations and reported findings.
- Process Manual Calculations of Medical, Dental, Vision, Inpatient and Outpatient, Physical Therapy, Mental Health, Pharmacy (RX) and DME
- Working Knowledge of CRVS, CPT, ICD-9, ICD-10, PDR and HCPCS
- Working knowledge of Medicare, MEdi-Cal, PPO, Fee for Service, Medi-Medi, COB, Graduate Tier Medical and Dental plans, Workers Comp
- Processed 100-150 claims per day
- Follow-up with insurance companies on denials and payments
- Help clients with benefits questions
- explain breakdown of payments
- locate physicians in their areas
Education
Certified Coding Specialist -
Santa Barbara City College
01-2012
General Diagnosis Medical Ultrasound Certification - Ultrasound
Nova Institute
Nova Institute Of Health Technology09-1997
GED -
Simi Valley Adult School
Simi Valley06-1997
Skills
- Files and records management
- Quality-oriented team player
- Patient billing
- Claim submission
- HIPAA compliance
- Avatar, Cerner, SmartCare software applications proficiency
- Medicare and medicaid process
- Disability claims process
- Insurance verification
- Claims review
- Verbal and written communication
- CERNER
- Data entry
- ICD-10
- Teamwork and collaboration
- Customer service
Accomplishments
- Certificate of Approval for Revenue Cycle Trends Shaping 2025
- Certificate of Approval for Embracing Innovation in Patient Billing Support
- Certificate of Approval for Transforming Patient Billing into Revenue Growth
- Certificate of Approval for Preparing for 2025 ICD-10 Code changes
- Certificate of Approval for Recovering Aging Patient A/R
- Certificate of Approval for Strategies to Improve Staff Retention in Healthcare
- Certificate of Approval for 5 New Reimbursement Opportunities to Boost Collections
Timeline
Medical Billing Specialist III/IV
County Of Ventura - Health Care Agency
04.2024 - Current
Medical Biller II
County Of Ventura - Health Care Agency
11.2022 - 04.2024
Clerical Supervisor II
County of Ventura-Human Services Agency
07.2022 - 10.2022
Medical Biller I
County Of Ventura - Health Care Agency
05.2010 - 08.2014
Lead Medical And Dental Examiner
Insurance Overload Systems
09.2001 - 05.2010
Certified Coding Specialist -
Santa Barbara City College
General Diagnosis Medical Ultrasound Certification - Ultrasound
Nova Institute
GED -
Simi Valley Adult School
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