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
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
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
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
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