Linda Y. Jones

Linda Y. Jones is highly experienced, pro-active, multi-dimensional medical billing specialist with excellent communication, interpersonal and organizational skills. The ability to manage projects independently from inception to completion in a timely, professional manner. More than 30 years of experience in handling Medicare, Medicaid, EDI electronic billing front and back end. Working knowledge of HIPPA regulations.

Skills:

• Working knowledge of HIPPA regulations
• Computer skills: HBOC, HBOCstar, IDX, ADS-400, RX-Home, Premise, Medical Manager, HBOCpathways, Meditech, Medisoft, Excel and Word

Experience:

• Preparing and submitting clean FQHC (federally qualified health center) claims electronically or paper to various insurances
• ICD-9 and CPT-4 coding prior to posting hospital charges
• Post cash, insurance payments/remittances
• Reconciles claims denials - Process claims in Promise system
• Checks Navinet or insurance websites for eligibility, referrals and payments
• Review and mail patient statements
• Rebill or transfers balances to do secondary billing
• Follow-up and collection calls to all insurance companies
• Answer patient phone calls daily
• ICD-9 and CPT-4 coding prior to charge entry
• Processes paper claims for 1st / 3rd party, MVA and Workmen's Comp carriers
• Reduces receivables
• Reconciles claims to payment in full
• Post cash in the Medisoft system
• Insurance verification, enter all demographics prior billing
• ICD-9 and Cpt-4 coding prior to charge entry for Gastroenterology billing
• Process electronic and paper billing for all insurance carriers in Perfect Care
• Extensive telephone contact with insurance carriers and patients
• Checks Navinet system for referrals, claims status and payments
• Reconcile claims to payment in full
• Post cash and reduces receivables
• Processed Workmen Comp and physical therapy charges into Medisoft
• Researches all coding problems effecting reimbursement
• Extensive telephone contact with all insurance carriers and attorneys
• Post and reconcile payments to patient accounts
• Organizes the processing of charges into the Next Gen billing system
• Monitors all charge entry audit journals for accuracy
• Researches all coding problems effecting reimbursement
• ICD-9 and CPT-4 coding experience. Research and respond by telephone-in writing to patients inquires regarding billing issues and problems
• Improved processes for all inaccurate information in the computer registration system
• Process 500 claims a week
• Extensive A/R recovery on outstanding accounts 180 days and older for home health  agencies and hospitals
• Prepares and maintains daily productivity logs
• Tracks accounts and updates tracking logs
• Reports directly to CEO/CFO on a weekly basis regarding results of the A/R project
• Extensive telephone contact with all insurance companies
• Advance knowledge of Workmen comp, electronic billing for Medicare, Medicaid, Blue Cross, Managed Care and Commercial carriers, ICD-9, CPT-4 codes, calculated auto claims, ambulance billing , long term care and attorneys.
• Comprehensive experience in insurance contracts and health care pricing
• Responsible for obtaining pre-cert and authorizations for hospital billing
• Telephoned insurance carriers for pre-cert and authorizations for Durable Medical Equipment and Infusion products
• Verified insurance coverage for all orders
• DME division closed
• Performed a wide range of tasks associated with claims processing, follow-up and collections
• Liaison between hospital and managed care carriers
• Posting adjustments and rejections; ensuring fulfillment of contract requirements regarding  reimbursement; completing daily productivity logs to ascertain status of billing deficiency;  interacting with patients,staff and performing various assignments required
• Participate in development of procedures and update of forms and manuals

Affiliation/Certification:

• Certified Coding Specialist, physician based, through AHIMA       
• Certificate of Completion Medical Billing /Insurance Claims
• Certificate of Completion Medical Records Coding