Janine Nutche
Summary
Certified Medical Billing Specialist/RCM Manager, with over 16 years of experience in fast-paced, multiple-client medical clinics serving large private practice conglomerates and outpatient clinics. Researched denied claims and submitted appeals. Familiar with health billing and collections. Detail-oriented professional with focus on deadlines and skilled in handling medical billing without errors.
Confident Medical Biller knowledgeable in data confidentiality and privacy practices when reviewing patient information.
Organized Medical Biller skilled at accurately auditing patient charts and billing corresponding parties.
Professional with strong expertise in medical billing, bringing reliable and adaptable approach to navigating evolving needs. Proven track record in team collaboration and achieving results through effective communication and problem-solving. Skilled in coding, claims processing, and patient account management, with keen eye for accuracy and compliance. Known for dependability and focus on efficiency, ready to contribute to streamlined billing operations.
Overview
12
12
years of professional experience
Work History
Medical Biller Specialist/RCM Manager
Rev Rehab
05.2014 - Current
- Examined patients' insurance coverage, deductibles, insurance carrier payments and remaining balances not covered under policies when applicable.
- Posted and adjusted payments from insurance companies.
- Located errors and promptly refiled rejected claims.
- Precisely evaluated and verified benefits and eligibility.
- Identified and resolved patient billing and payment issues.
- Researched CPT and ICD-9 and ICD 10 coding discrepancies for compliance and reimbursement accuracy.
- Communicated effectively and extensively with other departments to resolve claims issues.
- Precisely completed appropriate claims paperwork, documentation and system entry.
- Streamlined billing processes by implementing effective tracking systems for improved claims submission accuracy.
- Coordinated with insurance providers to resolve discrepancies, enhancing claim approval rates and processing times.
- Analyzed patient accounts to identify trends in billing issues, driving proactive solutions for common challenges.
- Led training sessions for staff on coding updates, ensuring compliance and accuracy in claim submissions.
- Resolved complex patient inquiries regarding billing statements, fostering trust and satisfaction through clear communication.
- Monitored regulatory changes in healthcare billing practices to maintain compliance and minimize risk exposure.
- Evaluated system workflows to optimize claim review processes, significantly reducing turnaround time for reimbursements.
- Prepared detailed reports on billing trends and performance metrics to support departmental decision-making initiatives.
- Collaborated with clinical teams to verify service documentation, ensuring accurate coding and reimbursement alignment.
- Developed comprehensive guides on insurance policies for staff reference, improving overall operational clarity and efficiency.
- Managed appeals process for denied claims, resulting in successful reimbursements from insurance companies.
- Ensured timely payments from insurance providers through submission of accurate and complete claims.
- Collected payments and applied to patient accounts.
- Posted payments and collections on regular basis.
- Communicated with insurance providers to resolve denied claims and resubmitted.
- Reduced claim denials by meticulously reviewing patient insurance information and coding practices.
- Enhanced revenue collections for the medical practice with diligent follow-ups on unpaid claims.
- Implemented quality control measures to identify potential errors before submitting claims, reducing rejections significantly.
- Maintained compliance with industry regulations by staying updated on changes to medical billing codes and requirements.
- Delivered timely and accurate charge submissions.
- Collaborated with healthcare providers, ensuring accurate documentation for seamless billing operations.
- Trained new team members in medical billing software, increasing efficiency within the department.
- Prepared billing statements for patients and verified correct diagnostic coding.
- Conducted regular audits of billing records to ensure accuracy and completeness, enhancing overall financial performance for the practice.
Education
Medical Billing - Medical Billing And Coding
Allied Medical & Health Services, Inc.
Glendale, CA03-2014
Skills
- System Updates
- HIPAA Compliance Certification
- Time Management
- Check Inspection and Validation
- Customer Contact
- Teamwork and Collaboration
- Active Listening
- Billing and Collections Procedures
- Financial Documentation
- Bill Payment
- Client Inquiries
- Itemized Statement Preparation
- Discrepancy Resolution
- Medical Terminology
- Multitasking and Organization
- Account Posting
- Statement Billings
- Claim Processing
- Patient Collections
- Workers' Compensation Knowledge
- Motor Vehicle Knowledge
- Electronic Claims
- CMS-1500 Billing Forms
- Electronic Health Record Software
- Insurance Claim Requirements
- Insurance claims
- Medical billing
- Patient billing
- CPT knowledge
- Billing and collection procedures
- Accounts receivable
- Insurance claims processing
- Medicare and medicaid process
- Commerical plans
- Out of Network plans
- Electronic health record software
- ICD-10 proficiency
- Medical terminology expert
- 15 different EMR systems
Timeline
Medical Biller Specialist/RCM Manager
Rev Rehab
05.2014 - Current
Medical Billing - Medical Billing And Coding
Allied Medical & Health Services, Inc.