Latina Gamble-Pringle
Medical Biller
Yaphank,NY
Summary
Experienced Physician skilled in examining patient histories, assessing conditions and conducting physical examinations. Professionally develops individualized treatments to deal with symptoms and root causes. Works thoroughly, precisely and with balanced approach incorporating patient needs and optimal treatments. Talented medical professional with 18+ years of experience in related roles. Expertly oversees practice operations while helping patients manage chronic conditions or cure acute ones. Knowledgeable and detail-oriented caregiver with methodical mentality. Board-certified Physician offers team facilitation, patient care and medication administration expertise paired with outstanding recordkeeping and communication abilities. Patient-oriented and respectful professional with 18 years of comprehensive experience providing preventive treatment, evaluating clients and diagnosing illnesses. Committed to facilitating optimal care through highly individualized and dedicated patient contact. Knowledgeable MOA provides optimal support for patients. Respectful, knowledgeable and conscientious in addressing concerns. Brings 18 years of related experience and desire to positively impact patient health and wellbeing. Hardworking Physician dedicated to improving patient health and wellness with proactive strategies. Analytical in approaching individual concerns and talented in leveraging wealth of medical training and contemporary knowledge to formulate successful plans. Talented in handling high volume of diverse patients and leading support staff to maximize outcomes. Insightful Medical Office Assistant with 18 years of experience in patient care environments. Expert in long-term patient care with dedication to comprehensive health plans for success. Known for personable and compassionate demeanor with detail-oriented work ethic. Highly-motivated employee with desire to take on new challenges. Strong worth ethic, adaptability and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills. Hardworking employee with customer service, multitasking and time management abilities. Devoted to giving every customer a positive and memorable experience. Committed job seeker with a history of meeting company needs with consistent and organized practices. Skilled in working under pressure and adapting to new situations and challenges to best enhance the organizational brand.
Overview
19
19
years of professional experience
1991
1991
years of post-secondary education
Work History
Physician A/R Clerk
Northwell Health Hospital
11.2009 - Current
- Verified insurance coverage and eligibility for medical services rendered.
- Processed and submitted claims to insurance companies electronically or by paper.
- Resolved discrepancies between provider invoices, patient accounts, and insurance reimbursement.
- Investigated denials from insurance carriers and resubmitted claims as needed.
- Entered data into electronic billing system.
- Maintained accurate records of claims processing in compliance with HIPAA regulations.
- Utilized various software programs such as Microsoft Office Suite, Electronic Medical Records, and Practice Management Systems.
- Reviewed patient accounts for accuracy prior to submission of claims to payers.
- Performed follow-up on unpaid or rejected claims with insurance providers.
- Reconciled account balances when necessary due to incorrect payments or rejections from payers.
- Conducted audits on all medical bills for accuracy before submitting them for payment.
- Reviewed Explanation of Benefits statements from insurers for accuracy against charges submitted to ensure proper reimbursement was received.
- Prepared reports on billing activities for management review.
- Submitted appeals to insurance companies when necessary.
- Identified potential coding issues that could lead to denials or underpayments and addressed these issues promptly.
- Worked closely with other departments such as clinical staff, administrative staff, and finance department personnel to resolve any issues related to billing.
- Input details into accounts and tracked payments.
- Monitored reimbursement from managed care networks and insurance carriers to verify consistency with contract rates.
- Applied HIPAA privacy and security regulations while handling patient information.
- Completed and submitted appeals for denied claims.
- Reviewed claims for coding accuracy.
- Reviewed account information to confirm patient and insurance information is accurate and complete.
- Contacted insurance providers to verify insurance information and obtain billing authorization.
- Handled billing, waivers and claims for private and commercial clients.
- Distributed or posted financial data to appropriate accounts and prepare simple reconciliations.
- Organized information for past-due accounts and transferred to collection agency.
- Leveraged EMR software to post payments received for medical services.
- Interpreted medical terminology and pharmacological information to translate information into coding system.
- Maintained billing software by updating rate change, cash spreadsheets and current collection reports.
- Assessed billing statements for correct diagnostic codes and identified problems with coding.
- Monitored past due accounts and pursued collections on outstanding invoices.
- Reviewed engine assigned codes and modifiers to update and verify accuracy.
- Executed account updates and noted account information in company data systems.
- Enforced compliance with organizational policies and federal requirements regarding confidentiality.
- Gathered information to produce accounts payable reports for review.
- Verified accuracy and integrity of motor vehicle and workers' compensation claims through careful research and analysis.
- Verified accuracy of information and resolved discrepancies with vendors before entering invoices for payment.
- Managed all payments processing, invoicing and collections tasks.
- Collected, posted and managed patient account payments.
- Processed invoice payments and recorded information in account database.
- Entered procedure codes, diagnosis codes and patient information into billing software to facilitate invoicing and account management.
- Input statement information, reconciled accounts and resolved discrepancies.
Medical Billing Assistant
Woodbury Optical
01.2006 - 09.2009
- Verified insurance coverage and eligibility for medical services rendered.
- Processed and submitted claims to insurance companies electronically or by paper.
- Resolved discrepancies between provider invoices, patient accounts, and insurance reimbursement.
- Investigated denials from insurance carriers and resubmitted claims as needed.
- Entered data into electronic billing system.
- Maintained accurate records of claims processing in compliance with HIPAA regulations.
- Answered inquiries from patients regarding their bills and payment plans.
- Assisted patients in understanding the details of their billings and payments.
- Utilized various software programs such as Microsoft Office Suite, Electronic Medical Records, and Practice Management Systems.
- Reviewed patient accounts for accuracy prior to submission of claims to payers.
- Performed follow-up on unpaid or rejected claims with insurance providers.
- Reconciled account balances when necessary due to incorrect payments or rejections from payers.
- Conducted audits on all medical bills for accuracy before submitting them for payment.
- Reviewed Explanation of Benefits statements from insurers for accuracy against charges submitted to ensure proper reimbursement was received.
- Provided customer service support to patients over the phone related to billing questions or concerns.
- Prepared reports on billing activities for management review.
- Submitted appeals to insurance companies when necessary.
- Identified potential coding issues that could lead to denials or underpayments and addressed these issues promptly.
- Worked closely with other departments such as clinical staff, administrative staff, and finance department personnel to resolve any issues related to billing.
- Assisted with training new employees in billing procedures.
- Communicated with insurance representatives to complete claims processing or resolve problem claims.
- Input details into accounts and tracked payments.
- Coordinated communications between patients, billing personnel and insurance carriers.
- Monitored reimbursement from managed care networks and insurance carriers to verify consistency with contract rates.
- Applied HIPAA privacy and security regulations while handling patient information.
- Completed and submitted appeals for denied claims.
- Submitted appeals using provider portals and phone communication.
- Reviewed claims for coding accuracy.
- Reviewed account information to confirm patient and insurance information is accurate and complete.
- Contacted insurance providers to verify insurance information and obtain billing authorization.
- Handled billing, waivers and claims for private and commercial clients.
- Distributed or posted financial data to appropriate accounts and prepare simple reconciliations.
- Organized information for past-due accounts and transferred to collection agency.
- Leveraged EMR software to post payments received for medical services.
- Interpreted medical terminology and pharmacological information to translate information into coding system.
Education
High School Diploma -
Bushwick High School
Skills
Chart Updating
Timeline
Physician A/R Clerk
Northwell Health Hospital
11.2009 - Current
Medical Billing Assistant
Woodbury Optical
01.2006 - 09.2009
High School Diploma -
Bushwick High School
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