To obtain a challenging position within a growing company where my knowledge and skill will be utilized and enhanced to provide an opportunity for advancement with increasing levels of responsibility.
Overview
1
1
Certification
14
14
years of professional experience
Work History
Billing Specialist/Trainer
Nextcare Urgent Care
2025.11 - Current
Managed insurance verifications and coordinated benefits to optimize reimbursement rates.
Implemented streamlined billing procedures that improved efficiency in claims processing.
Trained new staff on billing systems and coding practices to enhance team performance.
Processed patient billing inquiries and resolved discrepancies to ensure accurate account information.
Collaborated with healthcare providers to clarify services rendered and improve documentation accuracy.
Researched and resolved billing discrepancies to enable accurate billing.
Responded to customer concerns and questions.
Assisted colleagues in resolving complex billing issues, promoting teamwork and knowledge sharing within the department.
Negotiated with insurance companies to resolve disputed claims, securing rightful payments.
Contributed to a positive work environment by offering support and guidance to junior billing staff.
Streamlined onboarding process, reducing new hire ramp-up time.
Review, prepare, and submit medical records to commercial, Medicare, Medicaid and other payers.
Audit claims for accurate CPT, ICD-10, HCPCS, and modifier coding.
Investigate and resolve claim denials, rejections, underpayments, and payment discrepancies.
Post insurance payments, denials, and adjustments correctly.
Team Lead
Allergy Partners
2025.02 - 2025.11
Coordinates special projects for assigned team. Ensures projects are completed within deadline constraints.
Supported the team by addressing and filtering Accounts Receivable Rep inquiries, enhancing response efficiency.
Reviews the team monthly reports to track issues and identify potential training issues.
Reviewed the monthly team reports to identify issues and recommend targeted training initiatives.
Ensures all team members have a clear understanding of CBO policies and procedures.
Clarified CBO policies and procedures for team members, ensuring compliance and operational consistency.
Collaborated with Accounts Receivable Manager and trainer to ensure team members received additional training.
Maintains detailed knowledge of practice management and other computer software as it relates to job functions.
Attends OSHA, HIPAA, and OIG training programs as required.
Attends all meetings as requested including regular staff meetings.
Participated in all scheduled meetings to stay informed about team updates and initiatives.
Attends Medicare and other continuing education courses as requested. Pursues and participates in education to remain current with changes in the Healthcare industry.
Completes all assigned AP training (such as CPR, OSHA, HIPAA, Compliance, Information Security, others) within designated timeframes.
Complies with Allergy Partners and respective hub/department policies and reports incidents of policy violations to a Supervisor/Manager/Director, Department of Compliance & Privacy or via the AP EthicsPoint hotline.
Forwards to appropriate contact when unable to answer question or resolve issue.
Billing Specialist
Allergy Partners
2018.03 - 2025.11
Processed all paper and electronic claims for assigned carriers, verifying completeness of claim information prior to mailing
Follows up on rejected claims the day that the rejected EOB is received
Called carriers to appeal payments that did not match contractual agreements; notified Manager of payers with consistent issues
Responds to written and telephone inquiries from insurance companies
Responds to written and telephone inquiries from patients regarding their insurance questions
Makes necessary arrangements for medical records requests, completion of additional paperwork, etc., if payers request this information prior to payment of claims
Maintained detailed knowledge of practice management and relevant software to enhance job performance
Maintains detailed knowledge of practice management and other computer software as it relates to job functions
Manages relationships with personnel from assigned carriers
Billing Specialist/Cash poster/Trainer
Genova Diagnostics
2013.11 - 2018.03
Manual and EFT posting for all insurance carriers as well as patient payments.
Depositing patient checks into Remote Deposit Capture
Checking claim status for aged insurance as well as working denials from the insurance companies for further processing.
Corrected patient demographics and insurance information.
Prepared and submitted medical records to insurance companies to support efficient claims processing.
Worked refund requests due to the patients and to the insurance companies
Corresponded with doctor offices to obtain additional information for claim processing.
Ran necessary reports to ensure that all claims were worked in a timely manner.
Researched accounts for recoupments for insurance companies.
Submitted appeal letters to insurance companies to dispute claim denials.
Printing and processing all secondary claims and attaching EOBs from the primary in order to get claims paid in a timely manner.
Diagnosis coding for CPT codes for claims processing.
Proficient with using the clearinghouse Zirmed (Waystar)
Conducted training sessions for new employees on denial management and cash posting.
Invoice billing and further tracking.
Billing Specialist
Doctors Management
2012.04 - 2013.08
Posted payments from insurance and patients to appropriate accounts. Research and resolve incorrect payments or insurance recoups.
Manual, EFT and ERA posting for all insurance companies as well as patient payments.
Compiled medical records for insurance companies and attorneys to facilitate claims processing.
Putting collections together, issuing collection letters, and printing patient charts to send to a collection agency.
Organized collections, issued collection letters, and prepared patient charts for submission to collection agency.
Reviewed claim status for aged insurance at office and women's surgery center, addressing denials for timely resolution.
Posted manual, EFT, and ERA payments for all insurance companies and patients.
Experienced with billing for OBGYN specialty office and surgery center.
Prepared medical records for insurance companies and attorneys
Checked ICD-9 codes and CPT codes for various procedures to ensure accuracy.
Education
Associates - Medical Assisting
Haywood Community College
Clyde, NC
Diploma - medical billing/coding & insurance
Haywood Community College
Clyde, NC
High School Diploma - undefined
Enka High School
Candler, NC
Skills
Medical billing expertise
Claims processing
Insurance verification
Denial management
Payment posting
Attention to detail
Claim appeals
Conflict resolution
Coaching and mentoring
Leadership
Multitasking
Medical billing
Accomplishments
Haywood Community College Dean's List 2011-2012 school year.
Graduated Cum Laude (with honors) 2012
Certification
Certified in HIPPA, Certified in OSHA, Certified in CPR/First Aid, Active member in AAMA (American Association of Medical Assistants)
Administrative & Billing Specialist at HCA (Overseeing both Los Gatos Surgical Center & Endoscopy Center of Silicon Valley – Los Gatos & San Jose, CA)Administrative & Billing Specialist at HCA (Overseeing both Los Gatos Surgical Center & Endoscopy Center of Silicon Valley – Los Gatos & San Jose, CA)