Competent Third Party Specialist with 10 years of experience in handling wide variety of medical billing tasks. Sophisticated and hardworking individual with excellent analytical and multitasking abilities. Coordinates with insurance companies and expedites claims processes.
Overview
9
9
years of professional experience
Work History
Third Party Specialist
Beth Israel Deaconess Medical Center
Boston, MA
2019.08 - Current
Communicated with insurance providers to resolve denied claims and resubmitted.
Precisely evaluated and verified benefits and eligibility.
Precisely completed appropriate claims paperwork, documentation and system entry.
Determined prior authorizations for medication and outpatient procedures.
Communicated effectively and extensively with other departments to resolve claims issues.
Located errors and promptly refiled rejected claims.
Prepared billing correspondence and maintained database to organize billing information.
Filed and updated patient information and medical records.
Delivered timely and accurate charge submissions.
Prevented financial delinquencies by working closely with managers to resolve billing issues before becoming unmanageable.
Gathered information from multiple sources to simplify billing and organize accounts.
Examined patients' insurance coverage, deductibles, insurance carrier payments and remaining balances not covered under policies when applicable.
Researched CPT and ICD-9 coding discrepancies for compliance and reimbursement accuracy.
Assistant Client Manager
Plexus Management Group
Westwood , Ma
2016.02 - 2019.04
Request and process medical records from hospital contacts
Follow up on concurrency irregularities.
Oversee client service representatives, assisting with and resolving any escalated issues.
Responsible for providing weekly reports on team metrics.
Review accounts with collection agencies.
Coordinate patient requests and status updates.
Resolve issues with third party groups, Expecteds, Dictionary, and Ajuba assist clients and patients.
Client Service Associate
Plexus Management Group
Westwood, MA
2012.Aug - 2016.Feb
Manage the anesthesia claim submission process to Medicare, Medicaid, and commercial payers.
Responsible for sending Electronic Data Interchange (EDI) transactions to GE Centricity, including corrections and re-spooling as necessary.
Balanced billing to secondary and tertiary insurance with correct primary insurance.
Processed and posted credit card payments taken by phone.
Answered patient calls and assisted with overall concerns.
Managed delinquent accounts including collections.