Karen Candido
Fishers,IN
Summary
Competent Medical Billing Manager with 10+ years of experience in handling wide variety of medical coding and billing tasks. Sophisticated and hardworking individual with excellent analytical and multitasking abilities. Coordinates with insurance companies and expedites claims processes. Expertise in accurately inputting procedure and diagnosis codes into billing software to generate invoices.
Overview
6
6
years of professional experience
Work History
Medical Billing Consultant
ERCC
04.2023 - Current
- Analyzed complex Explanation of Benefits forms to verify correct billing of insurance carriers.
- Adhered to established standards to safeguard patients' health information.
- Prevented financial delinquencies by working closely with managers to resolve billing issues before becoming unmanageable.
- Generated reports and analyzed trends to maximize reimbursement and reduce claim denials.
- Generated accounts payable reports for management review to aid in financial and business decision making.
- Verified accuracy of accounts payable payments, resulting in 85% reduction in payment errors and check reissues.
- Audited and corrected billing and posting documents for accuracy.
Client Manager
Rpm Billing
01.2021 - Current
- Resolve issues and remove barriers in claims management process in order to maximize collections
- Coordinate with other operational staff or departments to ensure client Key Performance Indicators are met
- Compile accurate month end reporting package and provide to RCM Director and client based on required monthly data points
- Identify and report when escalations need to occur from operational staff or departments; determine patterns and manage for resolution
- Promote positive relationships by consistent, professional communication with clients
- Organized daily workflow and assessed appropriate staffing to provide optimal service.
- Handled complaints, provided appropriate solutions, and alternatives within appropriate timeframes and followed up to achieve resolution.
- Developed new employees and on-going performance assessment of current employees.
- Established performance and service goals and held associates accountable for individual performance.
- Partnered with business leaders to deliver services that support company objectives and consistent with corporate values.
- Resolved problems with high-profile customers to maintain relationships and increase return customer base.
- Achieved established KPI for company, regional team and individual performance through teamwork and focus on customers.
- Built relationships with customers and community to establish long-term business growth.
- Managed accounts to retain existing relationships and grow share of business.
- Managed revenue models, process flows, operations support and customer engagement strategies.
- Collaborated with upper management to implement continuous improvements and exceed team goals.
- Delegated tasks to existing support team members and used cloud-based tools to help solve complex business issues.
- Built client relationships by responding to inquiries, identifying and assessing clients' needs, resolving problems, and following up with potential and existing clients.
Medical Billing Representative
Pharmscript
01.2019 - 01.2021
- Diligently filed and followed up on third party claims.
- Confidently and adeptly handled claim denials and/or appeals.
- Precisely completed appropriate claims paperwork, documentation and system entry.
- Precisely evaluated and verified benefits and eligibility.
- Delivered timely and accurate charge submissions.
- Reviewed patient diagnosis codes to verify accuracy and completeness.
- Communicated with insurance providers to resolve denied claims and resubmitted.
- Reviewed patient records, identified medical codes, and created invoices for billing purposes.
- Generated reports and analyzed trends to maximize reimbursement and reduce claim denials.
- Prevented financial delinquencies by working closely with managers to resolve billing issues before becoming unmanageable.
- Accurately entered patient demographic and billing information in billing system to enable tracking history and maintain accurate records.
Medical Biller
Franciscan Physician Network
01.2018 - 01.2019
- Review daily edit reports from billing system and makes necessary corrections to allow electronic submission
- Ensure follow-up of claims on timely basis and adheres to contractually binding conditions
- Daily review of denials and payment discrepancies identified on EOB, RA, or Payer Correspondence
- Take necessary action to address denial, determine true payment source and take steps to secure payment
- Verify additional information received, update account in billing systems and generate rebills as needed
- Research and update patient's registrations as needed
- Analyzed complex Explanation of Benefits forms to verify correct billing of insurance carriers.
- Prepared billing statements for patients and verified correct diagnostic coding.
- Communicated with insurance providers to resolve denied claims and resubmitted.
- Filed and updated patient information and medical records.
- Delivered timely and accurate charge submissions.
- Reviewed patient diagnosis codes to verify accuracy and completeness.
- Prevented financial delinquencies by working closely with managers to resolve billing issues before becoming unmanageable.
- Generated reports and analyzed trends to maximize reimbursement and reduce claim denials.
- Audited and corrected billing and posting documents for accuracy.
- Monitored outstanding invoices and performed collections duties.
Education
Associate in Science -
HVCC
Troy, NYSkills
- Collections Management
- HIPAA Compliance
- Payment posting
- Claims Processing
- Revenue Cycle Management
- Patient Billing
- Insurance Verification
- Commercial and Private Insurance
- Claims review
- HIPAA Compliance Certification
- Insurance Claims
- Medicaid and Medicare Knowledge
- Medical Terminology
Medical Billing Systems
- EPIC
- Evolution
- eCW
- Meditech
- Cerner
- ICANotes
- NextGen
- Centricity
- Medisoft
Timeline
Medical Billing Consultant
ERCC
04.2023 - Current
Client Manager
Rpm Billing
01.2021 - Current
Medical Billing Representative
Pharmscript
01.2019 - 01.2021
Medical Biller
Franciscan Physician Network
01.2018 - 01.2019
Associate in Science -
HVCC
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