Committed and results-oriented Business Account Representative willing to go above and beyond to contribute to team objectives. Highly skilled in collections with aptitude for addressing past-due accounts and cultivating satisfaction. Good Communication, organizational and multitasking abilities.
Overview
14
14
years of professional experience
Work History
Medical Billing Specialist
CPI Collects
Ft.Collins
09.2024 - Current
Handled billing, waivers and claims for private and commercial clients.
Reviewed patient records for accuracy and completeness of information in medical billing system.
Reviewed patients' insurance coverage, deductibles, possible insurance carrier payments and remaining balances not covered under policies.
Collaborated closely with other departments to resolve claims issues.
Applied HIPAA privacy and security regulations while handling patient information.
Precisely completed appropriate paperwork and system entry regarding claims.
Completed appeals and filed and submitted claims.
Maintained detailed records of all billing activities including denials, adjustments, and payments received.
Monitored reimbursement from managed care networks and insurance carriers to verify consistency with contract rates.
Submitted appeals for denied claims when appropriate according to the insurance company's criteria.
Performed insurance verification, pre-certification and pre-authorization.
Contacted patients for unpaid claims for HMO, PPO and private accounts and performed friendly follow-ups to ensure proper payments were made according to contracts.
Posted charges, payments and adjustments.
Submitted claims to insurance companies.
Accurately input procedure codes, diagnosis codes and patient information into billing software to generate up-to-date invoices.
Maintained current working knowledge of CPT and ICD-10 coding principles, government regulation, protocols and third-party billing requirements.
Refund Specialist
Quincy Medical Group
Quincy
12.2022 - 07.2024
Reviewed account activity to ensure accuracy of refunds issued
Processed refunds accurately according to established guidelines
Adhered strictly to departmental policies and procedures pertaining to issuing refunds
Processed refunds for clients, insurance companies and patients
Called insurance companies and disputed reimbursement if necessary
Monitored progress of pending refund requests
Verified customer information and eligibility for refunds in accordance with company policies and procedures
Researched discrepancies related to refund requests
Compiled and submitted precertification requests for review by payers in accordance with established timelines
Developed and maintained relationships with payer contacts to resolve complex issues quickly
Schedule patients for appointments through all entities
Called insurance companies to get approval for patients to have tests, surgeries, scans, and labs completed
Provided follow-up on pending precertification requests to ensure timely processing
Verified insurance eligibility, coverage levels, and benefit parameters prior to submission of precertification requests
Processed appeals when necessary following denial or rejection of claims due to lack of proper authorization