Eric Blake
Leominster,MA
Summary
Experienced medical biller within the Healthcare, Insurance and Medical Billing fields. Eager to take on new role with long-term growth and advancement potential. First-rate skills in communicating, building relationships and resolving problems.
Overview
15
15
years of professional experience
Work History
Billing and Collections Specialist
Thrive Skilled Pediatric Care
Wakefield, MA
06.2020 - 05.2022
- Researched and resolved credit balances in software systems
- Researched and submitted appeals & audits in a timely manner
- Researched, prepared and completed any Write Offs
- Followed up on collections and appeals in an efficient and timely manner
- Demonstrated an ability to prioritize, multitask and utilize time efficiently
- Demonstrated proficiency with software applications used by the company
- Demonstrated the ability to clearly, accurately and concisely document notes in system per company guidelines
- Other duties as assigned
Medical Billing Manager
Groton Medical Associates
Groton, MA
08.2017 - 03.2020
- Worked for a Primary Care and Rheumatologist practice.
- Used Athena Health's A/R aging wizard to review the 30 day- over 120 days due reports
- Noted patients accounts with balances, the name of Health Insurance last billed, date of service, deductible, co-insurance, copay or denial, the amount due and date of the note's creation
- Made note of any contact such as, phone call or email
- Looked for cancelled insurance, incorrect insurance, or outdated copay amounts by checking details in quick view screen
- Followed up with patients regarding payment plans
- Watched for claims that became stuck in the system with a payer or Athena
- Used the Pay Span website to review BCBS, Harvard Pilgrim, Tufts and Fallon remits or explanations of payments
- Used the Optum website to review remits or explanations of payments for all United Healthcare corporate family of insurances including UMR, AARP, Medicare Replacement Plans and Medicare Supplement plans
- Used Cigna website to review remits or explanations of payments
- Used Athena Health as a resource to research claims
- Corresponded with Health insurance companies, Worker's Compensation or Motor Vehicle Insurances to resolve claim issues
- Appealed denials to Insurance companies
- Requested Insurance recoupment or refund insurance regarding over-payments
- Monitored infusion claims status
- Faxed explanations of benefits to Medication Copay Assistance programs
- Used Athena Health Billing Admin Function to review Enrollment Work list
- Checked for tasks that need attention, such as, Set Up Accounts & Numbers, Update Credentialing, Submit Claims, Receive
- Reconciled the previous workday's electronic deposits using Athena and Clover
- Reviewed of the previous day's receipts and checks are required
- Corresponded with our providers through Centricity
Billing Specialist
Logix Health
Bedford, MA
05.2016 - 08.2017
- Processed all denied and unpaid claims submitted to insurance carriers to ensure payment is received
- Reviewed denials on an explanation of benefits (EOB) statement and work on issues until resolved
- Analyzed A/R (Accounts Receivable) reports to follow up on unpaid claims
- Sent out appeals on claims as required
- Submitted any required documentation to insurance companies as requested
- Researched the claims for information in order to process bills in a timely manner
- Communicated with insurance companies, adjustors and patients on a regular basis
- Corrected any errors and resubmit all unprocessed or returned claims to insurance companies
- Created UB92 and HCFA bills by performing data entry into the billing software
Insurance Billing, Benefits and Authorization Specialist, COB Specialist
Surgi-Care Inc, TUFTS Health Plan
Waltham, Watertown, MA
12.2006 - 01.2010
- Researched and obtained health, workers compensation and automobile insurance information from doctor's offices, hospitals, employers and patients
- Obtained authorization from commercial health insurance companies as well as workers compensation and automobile insurance carriers for Surgi-Care bracing and DME products
- Worked with case managers from health insurance companies as well as utilization review departments and adjusters for workers compensation carriers and automobile insurance companies
- Entered orders and billed insurance companies
- Answered incoming calls to Surgi-Care
- Maintained and organized all relevant paperwork
- Worked together with sales and brace fitters in the field as well as patients regarding bracing orders
- Met team goals and standards such as working with fellow team members on tasks and keeping orders under 30 days
- Assisted with the implementation of quality improvement program to meet Company, State, Federal and CHAP standards
- Provider and
01.2001 - 11.2006
- Started working for Tufts Health Plan as a Tufts Provider, where I solved problems encountered by providers
- Dealt with provider problem resolution calls which included investigating, adjusting claims and explaining claim denials
- Ensured provider issues were accurately and completely resolved by using available resources, including on-line systems and a network of contacts in other departments
- Contributed to the Tufts Health Plan Subjugation team by resolving issues regarding motor vehicle claims
- Educated providers on the subjugation process and authorizations
- Contributed to the Tufts Health Plan PPO provider services department by resolving claims & benefit issues with PHCS affiliated providers
- Promoted to a COB Specialist where I answered department calls and solved internal and external customer issues
- Initiated required investigation calls and correspondence to answer and resolve customer questions for all Tufts Health Plan products
- Initiated and documented customer calls for COB and worker compensation cases in the appropriate computer systems
- Adjusted claims on a daily basis and determined if claims adjustments could be made by analyzing fund availability and generating refund request letters, if applicable
- Complied with all department and company guidelines and policies, as well as all applicable laws and regulations
- Maintained ownership of unresolved issues until completely resolved
- Reviewed and analyzed member claims history by accessing applicable computer systems
- Reviewed and analyzed applicable documentation to calculate Tufts Health Plan liability by determining either the appropriate claim period for post payment recovery or the appropriate claim for current recovery processing
- Completed special claims, customer service or investigative projects, which included review and analysis of several different product types as assigned by supervisor
- Participated in initiatives or requests for help to contribute to team and department success
Education
No Degree - Medical Coding Classes
Fisher College
Boston, MA06.2020
Associate of Science - Broadcasting And Electronic Media Production
Mount Wachusett Community College
Gardner, MA05.2012
Skills
- MS Word
- MAC OS, Medical Billing, Medical Insurance, DME
- Medical Billing
- Medical Insurance
- DME
- Athena Health
- Medical Office Experience
- CPT Coding
- ICD-10
- Workers' Compensation
- Insurance Verification
- Account Analysis
- MS Excel
- MS Power Point
- Microsoft Outlook
- Microsoft Excel
- HCPCS
- Indeed Medical Billing Assessments
Timeline
Billing and Collections Specialist
Thrive Skilled Pediatric Care
06.2020 - 05.2022
Medical Billing Manager
Groton Medical Associates
08.2017 - 03.2020
Billing Specialist
Logix Health
05.2016 - 08.2017
Insurance Billing, Benefits and Authorization Specialist, COB Specialist
Surgi-Care Inc, TUFTS Health Plan
12.2006 - 01.2010
01.2001 - 11.2006
No Degree - Medical Coding Classes
Fisher College
Associate of Science - Broadcasting And Electronic Media Production
Mount Wachusett Community College
Similar Profiles
FEKADE DIFUFEKADE DIFU
RN at THRIVE SKILLED PEDIATRIC CARERN at THRIVE SKILLED PEDIATRIC CARE
Doranda HedrickDoranda Hedrick
Nursing at Thrive Skilled Pediatric CareNursing at Thrive Skilled Pediatric Care
Kimberly JenkinsKimberly Jenkins
Prior Authorization Specialist/ DME at Thrive Skilled Pediatric CarePrior Authorization Specialist/ DME at Thrive Skilled Pediatric Care