Detail-oriented AR Specialist with 15 years of experience in Medical Billing. Strong understanding of Medical billing requirements and Claims collection processes. Ability to organize and Managing high caseloads with accuracy. Considered focused and organized team player.
Overview
18
18
years of professional experience
Work History
Account Receivables Collections Specialist
East West Eye Institute
01.2020 - Current
Maintained Strong knowledge of commercial / private PPO, HMO and government payors policies, billing requirements and clinical criteria to ensure accurate and prompt payment .
Identified root causes of Claim denials, sends appeals to payors to minimize lost revenue
Managed large volume of medical claims on daily while maintains ageing to 90 days
Reviewed provider coding information to report services and verify correctness
Examined patients' insurance coverage, deductibles, insurance carrier payments and remaining balances not covered under policies when applicable.
Researched CPT and ICD-10 coding discrepancies for compliance and reimbursement accuracy.
Communicated effectively and extensively with other departments to resolve claims issues.
Analyzed complex Explanation of Benefits forms to verify correct billing of insurance carriers.
Orchestrated medical coding, payment posting, accounts receivables and collections.
Billing Specialist
Surprise Valley Community Hospital
09.2005 - 12.2016
Identified, researched and resolved billing variances to maintain system accuracy and currency.
Generated and submitted invoices based upon established accounts receivable schedules and terms.
Contacted clients with past due accounts to formulate payment plans and discuss restructuring options.
Worked effectively with medical payers such as Medicare, Medicaid, commercial insurances to obtain timely and accurate payments.
Handled high volume of in-bound calls pertaining to reconciliation of delinquent accounts.
Responded to customer concerns and questions on daily basis.
Produced and mailed monthly statements to customers and assisted with related requests for information and clarification.
Education
MA License - Medical Assisting
Institute of Technology - Redding
Redding, CA
04.2018
Skills
Medicare and Medicaid Processes
Commercial / Private HMO PPO processes and requirements
Time Management
Healthcare Terminology
Work Prioritization
CMS-1500 Billing Forms
Medical Billing Technology
Obtaining Authorizations
Insurance Claim Requirements
ICD-10 Coding
Medical Billing
Insurance Authorizations
Medical Coding Knowledge
Timeline
Account Receivables Collections Specialist
East West Eye Institute
01.2020 - Current
Billing Specialist
Surprise Valley Community Hospital
09.2005 - 12.2016
MA License - Medical Assisting
Institute of Technology - Redding
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