wendy hill

Review, evaluate, and investigate medical bills for compensability of medical services in compliance with the Texas Workers’ Compensation Act, Medicare payment regulations, and departmental procedures with direct guidance. Review medical reports/documentation for usual and customary treatment, appropriate CPT coding/billing for services performed and causal relatedness. Identify abusive billing practices and treatment that falls out of the usual/customary norms based on diagnosis. Assist in answering telephone inquiries from providers, adjusters, and injured employees. Input required data from health care provider bills into the software system as needed.

Efficiently and accurately process medical bills compliant with the Texas Workers Compensation Act and rules and guidelines of DWC by means of review, evaluation, and investigation. Able to justify relationships between medically acceptable treatment and injuries sustained, as well as determining reimbursement decisions. Proficient in medical and anatomical terminology, CPT, HCPC, and ICD9 medical coding. Proficient in the Medicare fee schedules and its compliance and practice criteria with regard to Texas Workers' Compensation.  Dedicated to the SORM account; follow client’s special instructions and requests in a timely and accurate manner.

Billed for services and collected payments from responsible parties. Reviewed patient accounts, researched and made adjustments as needed. Maintained effective communication with funding sources to obtain necessary information in regard to outstanding claim status, billing instructions, etc. Reviewed and maintained Accounts Receivable aging. Filed, organized, and retained documentation supporting patient accounts. Applied incoming payment to patient accounts. Performed daily bank downloads and organized accordingly in spreadsheets. Familiarity with McKesson Horizon Homecare application.

Efficiently and accurately processed medical bills compliant with the Texas Workers Compensation Act and rules and guidelines of DWC by means of review, evaluation, and investigation. Able to justify relationships between medically acceptable treatment and injuries sustained, as well as determining reimbursement decisions. Communicated directly with onsite claims adjusters to resolve claimant issues and billing inquires. Met pre-established quotas and timely filing guidelines. Proficient in the electronic processing of medical bills. Utilize CPT, HCPC, and ICD9 medical coding on a daily basis.

Handled incoming calls and/or correspondence, and directed them to appropriate personnel/departments. Processed incoming software rebate requests on a daily basis. Handled office supply inventory and associated purchase orders.

Recommended and provided product solutions to customers through designated channels. Entered sales order and shipping data in to MRP system (Syteline). Communicated directly with clients regarding the status of orders, and resolved client issues in a timely manner. Prepared memorandums and sales reports, filed documents, and provided general clerical and administrative assistance as needed. Handled incoming calls/correspondence, outgoing payroll and invoice checks on a daily basis, and organizing corporate meetings.

Efficiently and accurately processed medical bills compliant with the Texas Workers Compensation Act and rules and guidelines of DWC by means of review, evaluation, and investigation. Able to justify relationships between medically acceptable treatment and injuries sustained, as well as determining reimbursement decisions. Communicated professionally and provided service for internal and external customers regarding claim issues, and contacted providers regarding submitted claims for additional information when necessary. Research physician credentials and license information, and request entry of providers’ information into the companies’ proprietary database as required. Proficient in medical and anatomical terminology, CPT, HCPC, and ICD9 medical coding. Proficient in the Medicare fee schedules and its compliance and practice criteria with regard to Texas Workers' Compensation. Other duties, when necessary, include handling incoming calls and/or correspondence, and greeting in-office visitors.