10_2015Resume_Desiree Rice
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Desiree Rice has over 20 years of experience in healthcare billing and claims processing. She has held various roles such as a performance supervisor at Health Net Inc., a reimbursement advocate at the California Medical Association, and a claims examiner at Health Net. Her experience includes adjudicating medical claims, overseeing associates, and facilitating daily inventory calls. She has strong skills in insurance billing, collections, verifying insurance coverage, and obtaining prior authorizations.
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10_2015Resume_Desiree Rice
- 1. Desiree Rice 1451 Rocky Ridge Drive #1807 Roseville,Ca 95661 H (916) 742.4741 C (916) 410.6824 desireerice@hotmail.com Experience Select Staffing Assignment: Adventist Health May 2015 – August 2015 Adjudicate50 Medical and Vision claims a day or more Closeout open calls in Call Tracker Assigned projects and other assistanceas needed Health Net Inc. Performance Supervisor Claims April 2011 – November 2014 Adhere to CMS, DOI, DMHC, timely claims processingand forwarding guidelines Oversee claims inventory accordingto company policy an in accordancewith financial goals Hire, train,mentor and disciplineassociates Act as liaison for Health Net’s Bariatric network, and Stanford University healthcareplan Oversee Cap/Deduct database Oversee Foreign Claims processing Create and deliver Mid-Year and Year-end reviews Conduct monthly 1:1 with my direct reports Facilitatemonthly team meetings Review and approvetime cards as wells as PTO and make-up time Facilitatedaily inventory call with our partner CTS, based in India California Medical Association Reimbursement Advocate September 2007 – July 2010 Staffed the toll free Help Line designed to assistPhysician members and their staff with reimbursement issues related to payor denials Participated in annual liaison meeting with the heads of United Healthcareand Anthem Blue Cross Health Net, Inc. Claims Examiner III April 2006 – July 2007 Adjudicated 200 claims a day with a minimum of 98% accuracy Stanford Ranch Chiropractic InsuranceBillingCoordinator October 2004 – April 2006 Charge entry and claims billing Payor and patient collections Payment posting, rebilling,and appeals Bank deposits Obtain prior authorization,verify insuranceeligibility Audit Workmen’s Compensation cases prior to trial
- 2. EMSource Charge Entry Coordinator March 2000 –October 2004 Supervised monthly chartentry and billingfor Emergency Room Physicians Daily coordinated with Coding, Operations supportand Charge/Chart entry Interviewed, hired, and mentored associates A/R Representative Worked off an agingcollectingon unpaid, underpaid,and denied accounts both Payor and patients Rebilled underpaid and claims denied in error Submitted firstand second level appeals Served as Projectpoint Served as Lead Core Competencies: 10+ years SupervisingAssociates between 10 – 40 individuals 20+ years A/R collections utilizingpayor’s Customer Service Representatives 20+ years coordinatinginsuranceand billingsecondary and tertiary payers 20+ years patient collections for co-pays/deductibles,shareof costand patient responsibility 20+ years verifyinginsurancecoverage 20+ years obtainingprior/retro Authorization 20+ years postingcharges,payments and bank deposits CPT, ICD-9, HCPCS ABS, CSI, DOFR, Milecalc Excellent organizational and administrativeskills –Detail oriented with high degree of accuracy Experienced in handlinghighly confidential matters with discretion Written and verbal communication skills Demonstrated expertise in MS PowerPoint, Excel, Word and the Internet Team working oriented – Ability to prioritizeand work under minimum supervision Technical Proficiencies: MS Word,Excel, Outlook, Lotus Notes MS PowerPoint, Publisher MS Word,Excel Type 45 WPM Education: Accounting and Economics coursework Orange CoastCollege Costa Mesa, California