Darlene Maltese
Weedsport,NY
Summary
Professional billing expert prepared for intricacies of physician billing. Proven track record in managing billing cycles, enhancing revenue recovery, and ensuring compliance with healthcare regulations. Strong focus on teamwork and adaptability, providing reliable support and achieving consistent results through effective communication and collaboration.
Overview
9
9
years of professional experience
Work History
Physician Billing Specialist
Compassionate Family Medicine
12.2024 - Current
- Collaborated with physicians to ensure accurate documentation of diagnoses and procedures for proper billing purposes.
- Maintained strict confidentiality of patient information in accordance with HIPAA regulations while handling sensitive documents.
- Assisted patients in understanding their insurance coverage and payment options, promoting a positive customer experience.
- Utilized advanced analytical skills to identify patterns in unpaid claims, leading to innovative solutions for prompt resolution.
- Reduced denied claims by maintaining up-to-date knowledge of insurance guidelines, coding practices, and compliance requirements.
- Resolved complex billing issues through thorough research, analysis, and effective communication with relevant parties.
- Communicated with insurance providers to resolve denied claims and resubmitted.
- Verified insurance of patients to determine eligibility.
- Posted payments and collections on regular basis.
- Collected payments and applied to patient accounts.
- Accurately entered patient demographic and billing information in billing system to enable tracking history and maintain accurate records.
- Delivered timely and accurate charge submissions.
- Generated monthly billing and posting reports for management review.
- Processed payment via telephone and in person with focus on accuracy and efficiency.
Medical Billing Specialist
MMRI
05.2023 - 07.2023
- Worked with coworkers to complete tasks.
- Demonstrated ability to manage multiple tasks while remaining adaptable and flexible.
- Responded quickly to meet customer needs and resolve problems.
- Utilized electronic billing systems to submit claims to insurance providers in a timely manner. (Cintrix)
- Researched denied or rejected claims for accuracy and took appropriate action to resolve discrepancies.
- Adhered to HIPAA regulations when handling confidential patient information.
- Assisted with accounts receivable by following up on unpaid claims within designated time frames.
Medical Billing Specialist/Physician Billing Specialist
Medbest Medical Management
02.2016 - 05.2023
- Posted and adjusted payments from insurance companies
- Filed and updated patient information and medical records
- Liaised between patients, insurance companies, and billing office
- Analyzed complex Explanation of Benefits forms to verify correct billing of insurance carriers
- Identified and resolved patient billing and payment issues
- Communicated with insurance providers to resolve denied claims and resubmitted
- Examined patients’ insurance coverage, deductibles, insurance carrier payments and remaining balances not covered under policies when applicable
- Precisely evaluated and verified benefits and eligibility
- Precisely completed appropriate claims paperwork, documentation and system entry
- Printed and reviewed monthly patient aging report and solicited overdue payments
- Collected payments and applied to patient accounts
- Located errors and promptly refiled rejected claims
- Researched CPT and ICD-9 coding discrepancies for compliance and reimbursement accuracy.
Education
High School Diploma -
Auburn High School
01.2006
Skills
- Information Updates
- Medical Billing
- Statement Billings
- Billing Codes
- Microsoft Office
- Work Prioritization
- Data Security Procedures
- CMS-1500 Billing Forms
- Customer Service
- Insurance Collections
- Payments Posting
- Training and Development
- Adding, Calculating and Billing Machines
- Insurance Authorizations
- System Updates
- Database Systems
- Claims Review
- Healthcare Terminology
- Process Payments
- Emergency Room Services
- Medicare and Medicaid Processes
- CPT Code Modifiers
- Verbal and Written Communication
- Insurance Claim Requirements
- Data Entry
- ICD-9
- Reviewing Patient Information
- HIPAA Compliance
- Active Listening
- A/P and A/R Expertise
- Medical Claims Submission
- Discrepancy Reconciliation
- Reimbursements
- Bill Payment
- ICD-10
- Insurance verification
- Claims processing
- HIPAA compliance
- ICD-10 proficiency
- Denial management
- Analytical problem solving
- Accounts receivable management
- Medical billing
- Payment posting
- Patient account resolution
- Teamwork and collaboration
- Customer service
- Electronic claims
- Billing and collection procedures
- Multitasking and organization
- Claims review
- Insurance claims processing
- CMS-1500 billing forms
- Critical thinking
- Medical terminology
- Medicare and medicaid process
- Commercial and private insurance
- Proficiency in [software]
Timeline
Physician Billing Specialist
Compassionate Family Medicine
12.2024 - Current
Medical Billing Specialist
MMRI
05.2023 - 07.2023
Medical Billing Specialist/Physician Billing Specialist
Medbest Medical Management
02.2016 - 05.2023
High School Diploma -
Auburn High School
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