Maryam Ahmed
RCM Specialist | Medical Billing | AR & Denial Management | Claims Follow-Up & Appeals
Kennesaw,GA
Summary
RCM & Claims Follow-Up III Specialist with 7+ years of experience in U.S. healthcare billing, AR follow-up, claims processing, denial management, and insurance appeals. Skilled in resolving complex denials, reducing AR aging, and maximizing reimbursements across commercial, Medicare, and Medicaid payers. Proven 90%+ recovery rate through effective appeals, payer follow-up, and root-cause analysis.
Overview
2
2
Languages
8
8
years of professional experience
Work History
RCM Specialist
Exponere Billing LLC
01.2023 - Current
- Managed end-to-end Revenue Cycle Management (RCM) for hospital and physician billing across Commercial, Medicare, Medicaid, Managed Care, PPO, and HMO payers.
- Performed AR and insurance follow-up via payer portals and phone to resolve unpaid, denied, and underpaid claims and accelerate reimbursement.
- Analyzed denial codes, claim history, payer responses, and account documentation to identify root causes and resolve complex billing issues.
- Resolved CO, PR, and OA adjustments, including patient responsibility, contractual adjustments, and payer processing discrepancies.
- Reviewed and corrected claims for CPT, ICD-10-CM, HCPCS, modifiers, bundling, and medical necessity issues to improve clean claim rates and reduce denials.
- Managed appeals, reconsiderations, and claim disputes, achieving a 90%+ recovery rate on eligible denied and underpaid claims.
- Resolved Coordination of Benefits (COB) and payer-order discrepancies to ensure accurate primary and secondary billing.
- Monitored 30/60/90+ day AR aging, prioritizing high-value and high-risk accounts to reduce outstanding balances and improve collections.
- Utilized EHR/EMR and medical billing systems to research accounts, document claim activity, track follow-ups, and maintain accurate billing records.
- Researched payer-specific policies and reimbursement requirements to support denial resolution and maximize claim recovery.
- Collaborated with coding, eligibility, front-end, and clinical teams to resolve billing issues and reduce recurring claim denials.
- Maintained HIPAA, payer, and billing compliance while consistently meeting productivity, accuracy, and quality standards in a high-volume environment.
Insurance Claims Follow up III
CureMD, New York
02.2019 - 12.2022
- Managed high-volume AR follow-up for unpaid, denied, and underpaid claims across commercial and government payers.
- Reduced AR aging by prioritizing high-balance, high-risk, and timely-filing accounts for proactive resolution.
- Resolved complex denials involving coding, eligibility, authorization, medical necessity, and timely filing requirements.
- Submitted 40+ appeals daily, supporting improved claim overturns and reimbursement recovery.
- Analyzed payer-specific denial trends and implemented root-cause strategies to reduce recurring denials.
- Utilized Availity, Waystar, Change Healthcare, and TriZetto for claim status, payer research, follow-up, and resolution.
- Verified insurance eligibility, benefits, and coverage to improve front-end billing accuracy and prevent claim rejections.
- Researched claim history, payer policies, and account documentation to resolve reimbursement discrepancies and outstanding balances.
- Maintained accurate patient financial records and claim documentation while ensuring HIPAA and payer compliance.
- Communicated effectively with insurance payers, patients, and internal teams to resolve complex billing and reimbursement issues.
Education
Associate of Science - Business Administration
Georgia State University
01-2018
Skills
- Revenue Cycle Optimization
- Workflow Improvement & Productivity
- HIPAA Compliance & Audit Readiness
- Denial Prevention & Root-Cause Analysis
- Clean Claim Rate Improvement
- RCM Data Tracking & Reporting
- AR Recovery Strategy
- Coordination of Benefits
- RCM Systems & Tools Epic, Athenahealth, eClinicalWorks (ECW), NextGen, Kareo, AdvancedMD, HealthFusion
- RCM Analytics & Reporting
- Denial Trend Analysis
- AR Aging Reports
- Productivity Tracking
- Workflow Optimization
- Billing & Revenue Cycle Functions
- AR Follow-up & Recovery
- Denial Management & Appeals
- Eligibility & Authorizations
- Coordination of Benefits (COB)
- Payment Posting & Reconciliation
- Productivity Tools Microsoft Excel, Microsoft Office Suite, Outlook, Microsoft Teams
Timeline
RCM Specialist
Exponere Billing LLC
01.2023 - Current
Insurance Claims Follow up III
CureMD, New York
02.2019 - 12.2022
Associate of Science - Business Administration
Georgia State University