Amber Franklin
Mount Juliet
Summary
Results-driven Senior Medicare Specialist with claims processing proficiency, strong communication skills, and in-depth Medicare knowledge. Proven track record in implementing quality assurance measures and enhancing workflow efficiency.
Overview
23
23
years of professional experience
Work History
Senior Medicare Specialist
Mission Healthcare
San Diego, CA
11.2015 - Current
- Analyzed Medicare claims to ensure compliance with regulations and accuracy in processing.
- Posts daily remittance advices
- Completes all billing for Hospice including Medicare, MSP, Commercial, Medi-Cal, and Room and Board.
- Developed training materials for new staff on Commercial, Medi-Cal, and Room and Board policies and procedures.
- Coordinated communication between departments to streamline patient enrollment processes.
- Implemented quality assurance measures to enhance accuracy of claims submissions.
- Led initiatives to improve workflow efficiency, reducing claim processing time significantly.
- Collaborated with cross-functional teams to resolve complex patient issues related to coverage and benefits.
- Maintained up-to-date knowledge of Medicare regulations, contributing to compliant department operations.
- Improved patient satisfaction by effectively managing Medicare claims and resolving issues promptly.
- Assisted in the development of training materials for new Collection Specialists, fostering a knowledgeable team environment.
- Served as an internal resource for coworkers seeking guidance on complex or challenging Medicare-related situations, promoting a collaborative work environment.
- Handled Commercial Insurance, Room and Board, Medi-Cal, and Medicaid billing.
Accounts Receivable Specialist
VNA California
Riverside, CA
03.2006 - 11.2015
- Processed hospice Medicare billing accurately and promptly on a daily basis. Assisted clinical staff in identifying and rectifying billing discrepancies. Followed up on all claims consistently to ensure resolution.
- Maintains control of claims billed and pending for VNA California’s seven branches to ensure full accountability for all claims.
- Analyzed Medicare electronic remittance advices and explanation of benefits to identify denials and errors.
- Post Payments from Medicare Remittance Advices and apply adjustments as needed.
- Verify Medicare eligibility
- Reviews Credit Balance Report from Medicare each quarter and makes adjustments if needed.
- Work with payer intermediaries, patient services, managers and branch personnel to maintain accuracy and timely collection of accounts
- Assist with special requests from Medicare, i.e. Request for Additional Documentation and Remittance Advice Audits.
Medical Records Technician
VNA California
Riverside, CA
05.2004 - 03.2006
- Processed Start of Care and Recertification packets
- Entered new MD’s into the computer. Check UPIN and licensing as needed.
- Printed updated face sheets and patient chart labels
- Input medications and Oasis data into McKesson.
- Processed discharges and cancelled referrals
- Entered supplemental orders into McKesson
Branch Receptionist
VNA California
Riverside, CA
05.2003 - 05.2004
- Managed front desk operations, ensuring efficient check-in and check-out processes.
- Received and transferred incoming telephone calls to the appropriate person, communicating and taking messages quickly and accurately.
- Processed incoming and outgoing mail.
- Maintained petty cash.
Education
Riverside Community College
Riverside2005
High School Diploma -
White House High School
White House, TN05-2002
Skills
- Claims processing proficiency
- Strong communication skills
- CMS guidelines
- In-depth medicare knowledge
- Reliability
Timeline
Senior Medicare Specialist
Mission Healthcare
11.2015 - Current
Accounts Receivable Specialist
VNA California
03.2006 - 11.2015
Medical Records Technician
VNA California
05.2004 - 03.2006
Branch Receptionist
VNA California
05.2003 - 05.2004
Riverside Community College
High School Diploma -
White House High School