1. 12472 LOS PINOS STRRET, VICTORVILLE CA 92392
(760) 686-3822 cell Email: hellis5@yahoo.com
HOPE ELLIS
OBJECTIVE
Seeking a challenging position that offers opportunity for growth and advancement in
which I may utilize my knowledge, experience and skills in the Healthcare Industry
EDUCATION
Walnut High School, WALNUT CA – Diploma
WORK EXPERIENCE
04/14 - Present LA Care Health plan Los Angeles CA
CLAIMS EXAMINER II
Process claims for all lines of business, including complex claims referring to the DOFR
for processing
• Processed Outpatient, Inpatient, DME, Dialysis, Injectable, CHDP, Professional,
COB, Family Planning, Home Health, High dollar, LTC, and Stop Loss
• Processed UB’s and HCFA claims
• I am a SME for the Professional POD
• Send out daily work assignments
• Train new claim examiners to process claims efficiently and answer any complex
questions
• Monitoring itemized billings for excessive charges, duplications, unbundling, and
medical coding
• Review claims for required information, pending claims when necessary
• Maintain a follow up system, and updating and releasing pending claims when
indicated
• Reversal of claims for correct payments, Recoup overpayments
• Meet daily required production and quality
• Excellent attendance and open for Overtime
• Adjustment/Auditing Team on all Line of Business claims
11/11 – 11/13 Kindred Healthcare/Vital Care America Poway CA
SNF PATIENT ACCOUNT SPECIALIST
• Billed SNF claims for Medi-cal, Medicare, and HMO
• Collections of aged claims
• Appeals
• CIFS
• Account Adjustments
• Follow up on aged reports up to 120 days
2. 6/11 – 8/11 Temps Unlimited/Victor Valley Hospital Victorville CA
INSURANCE VERIFIER
• Responsible for reviewing patient’s case, and insurance coverage information
• Take and verify all patients demographic information when registering for
services
• Request pre certification and benefits on all patients, both inpatient and
outpatient for surgery
• Using DDE, perform verification of Medicare coverage and limits on all Medicare
accounts of inpatients
• Verification of all Insurances HMO, PPO, Medicare to determine copay,
coinsurance, deductible, and max out of pocket
03/09 - 4/10 Kforce Temp Agency/Kaiser Permanente Rancho Cucamonga CA
DEDUCTIBLE PRODUCT SERIVCE TEAM COLLECTOR
• Handled in bound calls
• Customer complaint cases
• Responsible for resolving outstanding receivables by conducting direct payment
• Settlement negations, Appeals, Bad Debit, Write off, revenue skip tracing and
agency assignments for commercial accounts
11/5/ -10/08 San Antonio Community Hospital Upland CA
BILLING COORDINATOR
• Supervision of staff involved in department billing clerical tasks
• Delegate duties monitor policies and procedures within the department
• Responsible for Commercial, HMO, Medicare, Workers Compensation, and Self
pay billing
• Posting and follow up with EOB’s reviewing correspondence
• Work aged report 30-120 days
• Assist in preparation of monthly and weekly AR reports
• Liaison to finance department with billing and payments
• Provide training of new employees and ensure continued education through
cross training
SKILLS
• Typing (70wpm)
• 10 Key (touch)
• Microsoft Excel and Word
• Medical Terminology
• MHC, QNXT, Meditech, MDX Billing, Diamond, Advanced MD, Allegra, Health
Connect, AS400, Medisoft, Cerner and Emedeon
