Emily Shields
Murray,KY
Summary
Proven Medical Billing Specialist with a track record of enhancing revenue cycle management and ensuring billing compliance at Alliance Health Care. Excelled in insurance verification and patient billing, leveraging multitasking abilities to streamline claims processes. Skilled in both Medicare and Medicaid, significantly improved reimbursement accuracy through meticulous claims review and coding error resolution.
Overview
27
27
years of professional experience
Work History
Medical Billing Specialist
Alliance Health Care
02.2008 - Current
- Researched CPT and ICD-9 coding discrepancies for compliance and reimbursement accuracy.
- Collected payments and applied to patient accounts.
- Filed and updated patient information and medical records.
- Communicated with insurance providers to resolve denied claims and resubmitted.
- Printed and reviewed monthly patient aging report and solicited overdue payments.
- Examined patients' insurance coverage, deductibles, insurance carrier payments and remaining balances not covered under policies when applicable.
- Posted and adjusted payments from insurance companies.
- Precisely evaluated and verified benefits and eligibility.
- Located errors and promptly refiled rejected claims.
- Analyzed complex Explanation of Benefits forms to verify correct billing of insurance carriers.
- Communicated with patients for unpaid claims for HMO, PPO and private accounts and delivered friendly follow-up calls for proper payments to contracts.
- Reviewed patient records, identified medical codes, and created invoices for billing purposes.
- Adhered to established standards to safeguard patients' health information.
- Liaised between patients and insurance companies
- Communicated effectively and extensively with other departments to resolve claims issues.
- Precisely completed appropriate claims paperwork, documentation and system entry.
- Prepared billing correspondence and maintained database to organize billing information.
- Identified and resolved patient billing and payment issues.
- Evaluated patients' financial status and established appropriate payment plans.
- Prepared billing statements for patients and verified correct diagnostic coding.
- Posted payments and collections on regular basis.
- Delivered timely and accurate charge submissions.
- Reviewed patient diagnosis codes to verify accuracy and completeness.
Office Clerk
Kroger
05.1997 - 02.2008
- Responded to inquiries from callers seeking information.
- Provided clerical support to company employees by copying, faxing, and filing documents.
- Maintained organized files and stocked supplies to support team needs and maximize performance.
- Greeted incoming visitors and customers professionally and provided friendly, knowledgeable assistance.
- Managed and processed payroll for over 80 employees
- Maintained accounting records utilizing in-house and client systems.
- Processed credit card payments and reconciled credit card statements for accuracy in accounting process.
- Inspected account books and recorded transactions.
- Streamlined daily reporting information entry for efficient record keeping purposes.
- Tracked financial progress by creating quarterly and yearly balance sheets.
Education
High School Diploma -
Murray High School
Murray, KYNo Degree - Associate in Arts
West Kentucky Community And Technical College
Paducah, KYSkills
- Medicare and Medicaid process
- Revenue Cycle Management
- Collections Management
- HIPAA Compliance
- Claim submission
- Patient Billing
- Multitasking and Organization
- Claims review
- Billing and Collection Procedures
- Records Management
- Teamwork and Collaboration
- Commercial and Private Insurance
- Collection calls
- ICD-10
- Electronic Claims
- CMS-1500 Billing Forms
- Insurance Billing
- Organizational abilities
- Coding Error Resolution
- Payment posting
- Insurance Verification
Timeline
Medical Billing Specialist
Alliance Health Care
02.2008 - Current
Office Clerk
Kroger
05.1997 - 02.2008
High School Diploma -
Murray High School
No Degree - Associate in Arts
West Kentucky Community And Technical College
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