HEROIKE AHMEDI

Dedicated healthcare professional with strong problem-solving, communication, and leadership skills, as well as office management experience. Recent Healthcare Administration graduate with 12+ years of clinical and administrative experience in the medical field. Demonstrated expertise in managing medical office operations, including payroll, benefits, scheduling, budgeting, and staff education. Highly organized and detail-oriented professional with extensive experience in medical billing and administrative clerical support. Proven ability to accurately process and submit claims to maximize reimbursement and ensure compliance with regulations. Proactive and reliable multitasker with excellent organization skills, capable of prioritizing patient needs and coordinating daily basic care requirements. Seeking a Management position to utilize and enhance industry knowledge and coding experience. Responsible for resolving claims with third-party payers within defined time frames, diligently working to correct errors on claims and submit them promptly. Possesses strong problem-solving skills and can quickly locate information to follow up on claims for resolution. Collaborates effectively with other departments in the Revenue Cycle to obtain necessary information for claim adjudication. Keeps up-to-date on regulatory requirements through informal and formal updates, including self-study of payer bulletins and guidelines. Willing to perform additional duties as assigned.

• Patient Care Coordinator, County Care, Remote, 10/22, 02/23, Addressed patient concerns and identified effective resolutions for up to 80 patients daily., Developed patient care plans and evaluated patient progress., Verified state benefit eligibility and informed patients on which physicians are in network based on health insurance coverage., Coordinated with primary care offices to ensure patients received the necessary medical care., Collected payments for medical services., Reviewed claim adjustment reason codes or explanations of benefits received by the payer to determine what reasons for denials records are indicating for appropriate follow-up.
• Patient Access Services Representative, Medical Biller, NYU Langone Health, Winthrop, Mineola, NY, 08/19, 01/21, Coordinated daily registrations, patient arrivals, admissions, and observations for the Emergency Department., Captured accurate personal demographic information as well as insurance cards and legal consent forms., Completed quality assurance audits of all Emergency Department encounters to verify accuracy prior to processing claims., Verified Inpatient and Outpatient insurance claims., Processed financial transactions upon services being rendered and provided Financial Assistance information as needed., Verified claims are received by the payer and follows up to obtain payment via phone calls, portal or website use., Reviewed claim adjustment reason codes or explanations of benefits received by the payer to determine what reasons for denials records are indicating for appropriate follow-up., Ability to review billing forms for both paper submissions and electronic submissions for accuracy., Identified trends with payer rejections or denials and escalated these trends to leads/supervisors., Used computer systems/technology to locate claims information to resolve account balances., Maintained compliance with patient financial services policies and procedures., Used fax machine and other office equipment during the course of normal daily operations., Reviewed accounts based on patient or departmental inquiries. Also, worked and followed up with other departments in a timely fashion if outstanding questions are not resolved and a claim is in jeopardy of not being paid.
• Certified Medical Assistant, Medical Coder, Medical Biller, Advantage Care Physicians of New York, Emblem Health, Hicksville, NY, 10/17, 01/21, Assisted patients with scheduling appointments, checking in/out, obtaining and making referrals and verifying insurance coverage., Collaborated with physicians specializing in Internal Medicine, Cardiology, Pediatrics, Endocrinology, Gastroenterology and Optometry by assisting with procedures, patient vitals, EKG results, and blood pressure readings., Conducted blood draws and sent blood specimens to the correct lab to be processed according to patients’ Health Insurance plan., Verified claims are received by the payer and followed up to obtain payment via phone calls, portal or website use., Used computer systems/technology to locate claims information to resolve account balances., Maintained compliance with patient financial services policies and procedures., Used fax machine and other office equipment during the course of normal daily operations., Reviewed accounts based on patient or departmental inquiries. Also, worked and followed up with other departments in a timely fashion if outstanding questions are not resolved and a claim is in jeopardy of not being paid.
• Phlebotomist, Nassau University Medical Center, East Meadow, NY, 06/15, 10/17, Demonstrated skills/expertise by ensuring patients are properly identified prior to receiving services., Received/Sent specimens from patient care floors to lab for processing.
• Reception Office Manager & Medical Assistant, Medical Coder/Biller, MZF Medical Office, Hicksville, NY, 01/14, 09/15, Oversaw staff coverage by creating and distributing staff schedules., Trained new hires and assisted clinical staff with procedures., Managed a high volume of patient calls by answering questions, scheduling appointments, and updating notes for physicians., Completed weekly inventory of office supplies and initiated purchase orders as needed., Verified patient insurance and processed deductibles and co-pays from patients according to the patient’s financial responsibility., Reviewed claim adjustment reason codes or explanations of benefits received by the payer to determine what reasons for denials records are indicating for appropriate follow-up., Drafted an appeal or completed reconsideration forms when applicable based on payer requirements in a format that is logical and relates to the open denial of payment.
• Receptionist & Medical Assistant, Medical Coder/Biller, STAT Care, Hicksville, NY, 01/12, 12/14, Interviewed patients and recorded medical history, vital statistics, and test results in Electronic Health Records (EHR)., Explained treatment procedures and physicians' instructions to patients to set expectations and verify understanding., Prepared treatment rooms for patient examinations, ensuring rooms were kept neat and clear for patient visual excellence., Assisted physicians with examining and treating patients by providing proper instruments or materials needed for the procedure., After denial review, evaluated next steps and took action to call payer, followed up with a resubmission or dispute/appeal/reconsideration as required by payer, or worked internally to receive payment on account.
• Manager, Receptionist, & Make Up Artist, New Look Hair Salon, Hicksville, NY, 08/08, 09/14, Created the weekly schedule for employees., Ensured employees were properly paid for their services., Scheduled client appointments and answered a high volume of incoming phone calls., Updated customer information cards to maintain current customer records.

Honor Society

Deans list

National Society of Leadership and Success

Certified Medical Assistant