MALISSA STEPHENS
GLASGOW,KY
Summary
Dedicated Medical Billing Specialist with over 14 years of experience in healthcare billing and claims processing. Expertise in insurance verification and compliance ensures accurate and timely billing, enhancing patient satisfaction and operational efficiency.
Overview
14
14
years of professional experience
Work History
Medical Billing Specialist
GLASGOW PRESCRIPTION CENTER
Glasgow, KY
08.2012 - Current
- Processed medical claims to ensure accuracy and compliance with insurance guidelines.
- Verified patient information and insurance coverage to facilitate timely billing.
- Collaborated with healthcare providers and insurers to resolve billing discrepancies, enhancing reimbursement processes.
- Maintained detailed records of billing transactions and patient accounts to ensure accuracy and support timely collections.
- Addressed patient inquiries regarding billing issues and payment options.
- Utilized electronic health record systems to manage patient data efficiently.
- Trained new staff on billing procedures and software applications.
- Reviewed changes in regulations to ensure compliance in billing practices.
- Contacted insurance providers to verify insurance information and obtain billing authorization.
- Adhered to HIPAA regulations when handling confidential patient information.
- Recorded financial transactions related to charges, payments, and adjustments in the billing system.
- Completed appeals and filed and submitted claims.
- Maintained current working knowledge of CPT and ICD-10 coding principles, government regulation, protocols and third-party billing requirements.
- Applied payments, adjustments, and denials into medical manager system.
- Analyzed rejected claims and corrected errors as necessary before resubmitting them for payment.
- Submitted appeals for denied claims when appropriate according to the insurance company's criteria.
- Identified errors and re-filed denied or rejected claims quickly to prevent payment delays.
- Provided customer service support to patients who had questions about their bills or payments due.
- Submitted refund requests for claims paid in error.
- Reviewed patients' insurance coverage, deductibles, possible insurance carrier payments and remaining balances not covered under policies.
- Ensured HIPAA compliance by maintaining confidentiality of all patient information.
- Collaborated closely with other departments to resolve claims issues.
- Resolved discrepancies between insurance companies and patients regarding payment of bills.
- Monitored aging accounts receivable balances to facilitate timely resolution of outstanding balances and improve cash flow.
- Initiated collection efforts on unpaid accounts by contacting insurance companies or patients directly via phone or mail.
- Verified the accuracy of claim data prior to submission to insurance carriers.
- Precisely completed appropriate paperwork and system entry regarding claims.
- Updated patient accounts with information obtained from internal departments or external sources.
- Reviewed and verified benefits and eligibility with speed and precision.
- Accurately coded diagnostics and prepared billing statements for patients.
- Reviewed patient records for accuracy and completeness of information in the medical billing system.
- Generated monthly invoices for patients based on services provided according to established fee schedules.
- Prepared and attached referrals, treatment plans or other required correspondence to reduce incidence of denials.
- Created and processed claims to third-party payers using specific coding guidelines.
- Analyzed and interpreted patient medical and surgical records to determine billable services.
- Prepared billing statements for patients, ensuring correct diagnostic coding.
- Contacted patients for unpaid claims for HMO, PPO and private accounts and performed friendly follow-ups to ensure proper payments were made according to contracts.
- Determined prior authorizations for medication and outpatient procedures.
- Conducted research on insurance policies, procedures, and regulations to ensure compliance with all applicable laws.
- Performed quality assurance audits on submitted claims ensuring that they met industry standards.
- Applied HIPAA privacy and security regulations while handling patient information.
- Communicated with insurance representatives to complete claims processing or resolve problem claims.
- Submitted appeals using provider portals and phone communication.
- Evaluated claims to verify accuracy of coding to ensure compliance with industry standards.
- Reviewed account information to confirm patient and insurance information is accurate and complete.
- Monitored reimbursement from managed care networks and insurance carriers to verify consistency with contract rates.
- Managed billing processes, waivers, and claims for both private and commercial clients to ensure timely payments.
- Organized information for past-due accounts and transferred to the collection agency.
- Submitted claims to insurance companies.
- Entered procedure codes, diagnosis codes and patient information into billing software to facilitate invoicing and account management.
- Collected, posted and managed patient account payments.
- Checked claims coding for accuracy with ICD-10 standards.
- Provided prompt and accurate services through knowledge of government regulations, health benefits and healthcare terminology.
- Accurately input procedure codes, diagnosis codes and patient information into billing software to generate up-to-date invoices.
- Managed invoice payment processing and ensured proper documentation in the account database.
- Monitored past due accounts and pursued collections on outstanding invoices.
- Participated in workshops, seminars, and training classes to gain stronger education in industry updates and federal regulations.
Education
High School Diploma -
BARREN COUNTY HIGH SCHOOL
Glasgow, KY05-1988
Skills
- Medical coding expertise
- ICD-10 coding
- Billing software
- Healthcare billing software
- Claim submission
- Claims processing
- Claims reviews
- Regulation compliance
- Regulatory compliance
- HIPAA compliance
- Insurance verification
- Patient billing
- Accounts receivable
- Revenue cycle management
- Accounts management
- Record management
- Payment recording
- Billing codes
- CMS-1500 billing forms
- Medicare processes
- Insurance types
- Account follow-up
- EHR software
- Account follow-up
- ICD-10 coding
Timeline
Medical Billing Specialist
GLASGOW PRESCRIPTION CENTER
08.2012 - Current
High School Diploma -
BARREN COUNTY HIGH SCHOOL