Armela Husnic

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• Managed accounts receivable and payables processes, including invoicing, payments, and collections.
• Submitted electronic claims through various clearinghouses when necessary.
• Maintained up-to-date knowledge of health care industry trends and changes in regulations affecting medical billing processes.
• Prepared documents for submission to insurance companies for review and approval for payment of claims.
• Assisted in the development of annual budgets by providing input on expected expenses related to accounts payable and receivable activities.
• Provided support for Accounts Payable and Receivable staff when needed.
• Ensured compliance with insurance company policies and procedures related to the processing of claims.
• Reviewed medical claims for accuracy and completeness, verifying patient eligibility and coding.
• Investigated discrepancies in medical billing information such as incorrect codes or amounts due.
• Processed a high volume of claims on a daily basis using established time frames.
• Analyzed physician's reports, hospital records, laboratory results, operative reports, diagnostic tests. to assess medical necessity of services rendered.
• Researched claim denials and appeals to determine appropriate resolution.
• Responded promptly to customer inquiries regarding claim status or other issues.
• Updated system records with payment information received from insurance companies or patients directly.
• Calculated payments due based on allowed charges compared to billed charges according to contract terms with payers, insurers, third parties.
• Verified accuracy of provider data entered into the system including tax ID numbers, NPI numbers, address changes .
• Worked collaboratively with providers' offices to ensure timely reimbursement on submitted claims by providing missing documentation or correcting errors that caused delays in payment processing.
• Performed Quality Assurance checks on processed claims ensuring all edits were resolved prior to submitting them for adjudication and payment.
• Identified potential fraud cases based on analysis of submitted claims data and escalated accordingly.
• Provided assistance in training new staff members as needed.
• Inputted data into the system, maintaining accuracy of provider coding information and reported services.
• Stayed current on HIPAA regulations, benefits claims processing, medical terminology and other procedures.
• Assisted in developing strategies aimed at improving efficiency in the process flow of Claims Processing.
• Accurately processed large volume of medical claims every shift.
• Based payment or denials of medical claims upon well-established criteria for claims processing.
• Evaluated pending claims to identify and resolve problems blocking auto-adjudication.
• Sent clinical request and missing information letters to obtain incomplete information.
• Reviewed claims for accuracy before submitting for billing.
• Tracked differences between plans to correctly determine eligibility and assess claims against benefits and data entry requirements.
• Used contract notes and processing manual to correctly apply group-specific classifications to claims.
• Reviewed administrative guidelines whenever questions arose during processing of claims.
• Administered standard contract benefits to process pending claims for dental benefits.
• Examined claims, records and procedures to grant approval of coverage.
• Corresponded with insured or agent to obtain information or inform of account status or changes.
• Handled modification and updating of policies.
• Signed payment approvals accepted claims.
• Retained strong medical terminology understanding in effort to better comprehend procedures.
• Checked documentation for appropriate coding, catching errors and making revisions.
• Processed claims for payment or forwarded to appropriate personnel for further investigation

• Update and change payer per denials and rejections
• Process high volume of requests per day (through email, WQ and calls)
• Research insurance make sure all addresses and payers are up to date
• Call insurance and obtain correct info, follow state guidelines and provider enrollment standards.
• Evaluated insurance claims to ensure accuracy and completeness of documents.
• Verified insurance coverage and eligibility for services provided.
• Researched policy provisions to determine coverage levels, limitations, and exclusions.
• Applied knowledge of coding systems such as ICD-10, CPT, and HCPCS to accurately process claims.
• Interpreted medical records to identify diagnosis codes for claim submissions.
• Conducted reviews of medical records for compliance with payer requirements.
• Reviewed provider reimbursement requests for accuracy and adherence to contractual agreements.
• Investigated complex cases involving multiple providers, services, or diagnoses.
• Assessed denials based on established criteria and procedures.
• Responded to inquiries from members regarding their health care benefits.
• Maintained accurate documentation of all activities related to claim adjudication.
• Performed audits on provider billing practices to ensure compliance with regulations.
• Analyzed data from previous payments made by the insurer in order to set appropriate payment rates.
• Communicated decisions about claims via phone or written correspondence with providers.
• Reviewed claims for accuracy before submitting for billing.
• Accurately processed large volume of medical claims every shift.
• Coordinated emergency repair, cleaning companies and contractors to optimize customer claim handling.
• Verified liability extent with reviews of police reports, medical treatment histories and other records.
• Gathered and documented evidence to support court proceedings.

• Entered patient insurance, demographic and health information into software and confirmed records.
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• Pulled patient records and transferred information to appropriate parties.
• Safeguarded medical records to maintain patient confidentiality.
• Transmitted information or documents to customers through email, mailings or facsimile machine.
• Processed patient admission and discharge documents.
• Based payment or denials of medical claims upon well-established criteria for claims processing.
• Developed reports summarizing audit findings and recommendations to management.

• Responsible for handling incoming and outgoing calls
• Respond to high volume of calls, answer questions regarding insurance and billing issues
• Preparing, correcting and submitting (medical claims, corrected claims, appeals) to insurance
• Ensuring each patient's information is correct and accurate
• Providing patients with regarding billing statements and insurance claims
• Work in several WQ and rejections (appeals, medical records, update primary insurance, EOB from primary, patient bills)
• Bilingual patient's assistant (Bosnian, Serbian and Croatian language).
• Developed customer service policies and procedures for the Senior Representative team.
• Generated reports on sales performance, customer satisfaction, and other related metrics.
• Conducted customer service training for new hires.
• Developed and implemented customer service policies and procedures.
• Provided technical support to customers via phone, email, and chat.
• Resolved escalated customer complaints in a timely manner.