Knowledgeable Billing Representative familiar with Billing processes practices and compliance requirements. Excellent customer service and problem solving abilities. Offering 14+ years of experience and the drive to excel in all areas. Confident Biller with great knowledge of multi specialty skills and more than 10+ years of experience. Effective team player known for reliability and quick work. Dedicated to accuracy and efficiency. Detail-oriented and methodical Medical Claims Professional offering 10+ years of experience in related roles. Exceptional abilities in prioritizing simultaneous tasks. Leverages resourcefulness, critical thinking skills and superior work ethic for top job performance.
Overview
3
3
years of professional experience
Work History
Biller, Billing Rep
Optum-West Med Medical Group
Charlotte, NC
01.2022 - Current
Internal Medicine, Family Medicine, Pediatrics, Orthopedics, Endocrinology, Nephrology, Anesthesiology Allergy, Immunology and Pediatric Endocrinology, General Surgery, Gastro, Physical Therapy, Laboratory
Researching errors by comparing billing error reports against system information along with CMS (Center for Medicare and Medicaid Services) records
Sending correspondence to members or CMS (Center for Medicare and Medicaid Services) to gather information or provide updates for corrections
Reconciling reports
Performing basic clerical functions with proficient PC skills
Analytical and Researching techniques to trend or quantify projects
Initiate and assist with developments/changes to increase or change quality and productivity
Responding to member premium billing questions & verify enrollment status
Working with various types of member correspondence
Inventory control of member transactions dashboard and package development to team members and management as needed
Access all portals to obtain EOBs/ERA
Check hospital charges for providers
Ensure/Verify source date us valid for billing and that it will be submitted to correct payer
Reconcile 5+ discrepancies identified within customer invoice/billing
Review/resolve claim edits prior to submission
Keying claims into insurance portals for payment
Uploading medical records to insurance companies.
Reviewed and solved account and billing discrepancies
Executed billing tasks and recorded information in company databases
Assessed accounts for payment status and reached out to customers
Followed up with appropriate parties to obtain prompt payments
Received incoming information and entered into database system
Checked insurance eligibility by making appropriate phone calls and conducting research on services rendered
Coordinated with intermediate parties to obtain payments and resolve issues
Kept all patient information secure and confidential
Completed and processed purchase orders and customer invoices each quarter
Worked effectively with medical payers such as Medicare, Medicaid, commercial insurances to obtain timely and accurate payments
Billing Office Coordinator
Hill Country Primary Care Physicians
Fredericksburg, Texas
06.2019 - Current
Multi Specialty Group
Lockbox payment posting JP Morgan
Assist patients with hospital billing/Medical Group questions
Bank reconciliation for all payment sources throughout entire medical group
Employee deductions for payroll set up
Responsible in playing pivotal role in ensuring patient have great experience from moment walk through door to when leaving office
Coordinate and help oversee operations of clinical and front office functions to provide patients with high quality, patient-centered care
Serve as team leader with all front office functions including patient relations check-in/check-out, scheduling, insurance verification, and answering phones
Assist nurse/medical assistant with obtaining authorizations for in office and out of office procedures and surgeries from insurance companies
Ensure any patient complaints are handled appropriately for maximum patient benefit and organizational success
Develops guidelines for prioritizing work activities, evaluating effectiveness and modifying activities as necessary to ensure appropriate staffing levels are maintained
Conducts daily huddles to organize work tasks with team
Watching for trends and educating physicians on accurate coding and billing guidelines
Manage filing and retrieving medical records and patient information
Performs and ensures timeliness and accuracy of patient charge entry into practice management system and clearing house, and assists with collecting and recording co-pays
Coordinate receipt of all applicable deductible, co-insurance, and co-pay amounts from patients for their procedures and surgeries
Prepares all physician expense reports, obtains appropriate leadership signatures, and submits to accounting for processing
Assist medical group leadership with completing facility credentialing paperwork, for all assigned providers
Assist with Revenue Cycle and work back-office operations directly through eClinicalWorks application, securely and accurately
Ensure all documentation meets billing guidelines for CPT codes selected
Work all follow ups AR for multi-specialty groups, Scrub, and clean claims for accurate claims submission
Work AR and denial reports in timely manner
Work collections console and collections portal
Assure that all incomplete encounters are cleaned and fixed for providers
Assure providers meet ACO requirements with Annual Wellness exams
Completes billing process
Billing/Revenue Cycle
Verify that daily reconciliation has been completed for all assigned receptionists
Input day sheet numbers on accounting spreadsheet
Review all claims denials/RCM requests, Review LCDs/Payer policies with provider education as needed
Review and processing payer refund requests, Verify/update patient information as requested by RCM, Review and submit claims for adjustment/voids, Work eligibility edits, process claim edits in encounter review status, notify providers of unlocked and incomplete encounters, Run reports weekly for trends
Post payments in system
Add old A/R payments to spreadsheet to transfer to old system
Review tasks daily for completion or action needed
Review patient inquiries and amount owed by patient
Process/posting patient payments Process patient refunds as appropriate
Set up payment plans/move patient payment plan to status as appropriate
Utilize patient estimate form
Pull appropriate charges per facility from fee schedule
Inform patient of estimated charges
Collect patient estimate and set up payment plan prior to procedure
Review patients in payment plan status
Move patients in default status to collections
Review provider specific incomplete encounters weekly
Review encounters for accuracy
Notify providers of incomplete encounters as appropriate
Educate providers and staff of new company protocols.
Education
Associate of Science Degree - Medical Billing And Coding Associate of Science De
Ultimate Medical Academy
Florida City, FL
08.2017
Skills
Financial Transactions-Start to Finish
Claim Processing-Start to Finish
Account Posting
Excellent Communication
Accounts Payable and Accounts Receivable
Verbal, Written, Via Telephone and Front Desk patient services
Referrals & Medical Records
Billing and Collection
Data Entry & Processing of Payroll
Computer Skills
Strong understanding of EOBs
Daily Reconciliation of collections collected daily
Excellent leadership abilities to react with appropriate levels of urgency to situations, and events that require quick response to exercise good judgment and discretion with demonstrated ability to think creatively and strategically
SOFTWARE-PROFICIENT
E Clinical Works, Athena, Centricity, Connex, EPACES, CT Medicaid, EPAY, Chase, IQ,CDS Desk top fax, Intelligent medical software with Aims, Implementation of Athena Health EMR, Meditech, Availity, Allscripts, Transact RX, PECOS & NPPES Registry, CAQH and Death Certificates (TER), One drive, Fax age electronic faxing, Greenway, Fax age, one drive CTMS-Real time System, E-Clinical Works. Various insurance portals. Appeal claims, Insurance Verification, CPT, ICD-9/10 coding/HCPC, Medical Terminology, Collections, Medicare/Medicaid, HIPAA/OSHA, AR/Collections, Medical Billing, Pre-Certification/authorizations, post patient payments, H.H. Certifications, HMO & PPO insurance, Deposits.
EARLIER CAREER PROFESSIONAL EXPERIENCE
Santé Clinical Research- Clinical Research Coordinator- Kerrville, TX 03/06/2016-04/12/2019
Caisson Superstructure Construction Works Manager at Nador West Med Port Project, STFA Construction GroupCaisson Superstructure Construction Works Manager at Nador West Med Port Project, STFA Construction Group