Nicholas Chiarella
Chicago,IL
Summary
Reliable Medical Biller with coding and medical terminology knowledge. Polished and hardworking performer with background overseeing accounts and handling records management tasks. Team-oriented person with great decision-making skills.
Overview
9
9
years of professional experience
Work History
Senior Business Support Services Representative
MEPCO
09.2021 - Current
- Maintaining relationships by investigating and resolving billing errors, payment application errors, disputes, documentation errors, following up to ensure resolution and by maintaining confidentiality
- Maintaining and processing customer and counter-party records
- Support dealer agreements and confidential documents) and compliance by updating account information and processing adjustments
- Maintaining financial account integrity by reviewing contract financial information and recommending modifications to the manager, waiving late charges within policy/procedural guidelines, entering or connecting payment applications; processing reinstatements, cancellations and account holds
- Processing customer in-coming correspondence by reviewing, sorting; investigating content, distributing; generating written or verbal responses; updating database
- Assisting agents, dealers, and administrators with customer issues by clarifying service questions and explaining how certain elements of the contract work and by investigating new and/or returned contract issues
- Processing payments as requested by customer or counter-party on loan system
- Preparing production reports by collecting, analyzing and reporting customer information
- Enhancing company service reputation by communicating a customer friendly service attitude, orientation and demeanor; portraying a "can do" attitude with both customers and counter-parties.
Customer Service Representative
ADVACARE SYSTEMS
07.2019 - 08.2020
- Responsible for creating DME orders for hospice/nursing facilities and private homes
- Assisting both nursing staff and patient families on how to operate, maintain and troubleshoot medial equipment
- Prioritizing hospital discharge orders to help assure DME delivery times were met
- Collecting demographic/financial information from private pay families
- Coordinatiing Autofill deliveries for patients receiving oxygen tanks on a weekly basis
- Maintaining knowledge on all DME offered by AdvaCare such as hospital beds, PAP machines, hoyer lifts, AP mattresses and more
- Generating orders through patient portal systems such as DMEtrack, Stateserv, HospiceLink, Synapse and Qualis
- Coordinating between hospice facilities and AdvaCare warehouses on timeframes regarding santizing equipment to avoid cross contamination of COVID-19 during deliveries.
Billing Specialist
PRESBYTERIAN HOMES
02.2019 - 05.2019
- Responsible for entering claims from patient MD visits that occur within the assisted living facility
- Proofreading claims for accuracy on diagnosis codes and procedure codes within the date of service
- Updating the ICD/CPT lookup within Medisoft when new codes are not accessible
- Entering new patient/MD information within Medisoft to keep the database current
- Maintaining logbook of total claims entered daily and the expected amount from each claim.
Billing Specialist
OPTION CARE
06.2018 - 10.2018
- Solely responsible for managing and billing claims for enteral patients in Illinois, Michigan and Wisconsin
- Identifying proper coding procedures required among each payor
- Identifying fee errors and omissions, making necessary corrections to claims based on negotiated rates
- Providing insurance companies with additional documentation (if requested) to help expedite payments and resolve denials
- Understanding EOB's, payor contracts and fee schedules in order to bill a clean claim
- Submitting electronic and paper claims within 30 days of delivery or before month close
- Running insurance verification on Illinois public aid claims to confirm patients' status under IDPA
- Examining authorizations to see CPT codes approved for what DOS and how many units
- Pushing back claims to intake department if missing information (ie
- Auth not on file, incorrect insurance ID, insurance termed) Maintaining daily spreadsheets of claims billed and the expected payment amount for each claim
- Maintaining knowledge of systems Pharma Point (CPR+), Onesource and Zirmed
- Maintaining Knowledge of current CPT codes and ICD-10 codes.
Insurance Verification Specialist/ Referral Coordinator
SWEDISH COVENANT HOSPITAL
05.2017 - 06.2018
- Running insurances for outpatient tests to check benefits and eligibility
- Contacting commercial insurances to verify authorization start/end dates and CPT codes approved
- Following up with MD's offices to inform which outpatient tests require authorization
- Notifying MD's offices when authorizations need to be extended and when CPT codes need to be changed
- Informing relevant departments when authorizations have been obtained
- Maintaining knowledge of what procedures require authorization through different insurance types
- Coordinating with other departments when overbooks or stat appointments need to be added on
- Managing incoming orders/referrals through outlook
- Checking for orders/referrals through eClinicals/Outlook in order to attach relevant documents into patient accounts
- Referring patients to different specialists that are offered by SCH
- Maintaining knowledge of ICD-10 codes, CPT codes, insurance mnemonics, OP procedures, and public events that are offered by SCH
- Taking incoming calls from patients/MD offices who want to book for outpatient procedures
- Verifying patient demographics and insurance information to ensure accounts are up to date
- Informing patients on what instructions they must follow in order for tests to be performed such as food and medication restrictions.
DME Representative/ Intake
PATIENT'S CHOICE MEDICAL
07.2016 - 05.2017
- Checking insurance for Medicare referrals in order to obtain eligibility, SOS, deductibles met, SNF d/c dates and Medicare start dates
- Answering patients' questions regarding the coverage of medical equipment through Medicare/Private Insurance
- Assist with trouble shooting equipment for patients prior to creating service calls Generating delivery paperwork, pick up tickets, service calls, CMN's and DWO's
- Educating MD's offices on how to complete DWO's and how to explain the medical necessity for DME in accordance to insurance guidelines
- Assist in face to face demonstrations on how to operate medical equipment within the home
- Following up with patients/MD's offices on C-PAP compliance and oxygen recertification
- Entering new patients into BrightTree System and Smartsheets
- Following up with patients on pending invoices/co-pays
- Obtaining payment information from patients in regards to their out of pocket expenses
- Updating billing department on any changes in patients' insurance
- Proof reading DME intake forms for correct billing codes
- Submitting completed order forms and clinical to insurance for PAR
- Maintaining knowledge of ICD-10 and HCPCS codes.
Outsourcing Coordinator
HEALTH TEAM CORPORATION
12.2014 - 07.2016
- Refer patients in need of medical equipment/supplies to appropriate suppliers
- Assist in obtaining necessary documentation in order to bill Medicare for medical equipment/supplies
- Scheduling patients with visiting physicians for assessment
- Refer patients to other public resources/services such as homemaker services, podiatry, social workers and medical transport
- Assist patients with insurance applications such as public aid and Medicare part D
- Contacting patients to complete annual customer satisfaction surveys
- Following up with MD offices/hospitals to obtain signed medical documents needed for billing
- Completing clerical tasks such as filing signed paperwork, creating new patient charts, faxing/mailing physician orders, assembling admission packets, logging orders into AXXESS system and transferring incoming calls.
Education
Associates in Arts -
COLLEGE OF DUPAGE
05.2012
High School Diploma -
DOWNERS GROVE SOUTH HIGH SCHOOL
05.2009
Skills
- Claims Processing
- Payment posting
- Contract Preparation
- Invoice Processing
- Data entry proficiency
- Medical coding knowledge
- Collections
- HIPAA Compliance
- Insurance Verification
- Claim submission
- Records Research
- Payment Collection
Timeline
Senior Business Support Services Representative
MEPCO
09.2021 - Current
Customer Service Representative
ADVACARE SYSTEMS
07.2019 - 08.2020
Billing Specialist
PRESBYTERIAN HOMES
02.2019 - 05.2019
Billing Specialist
OPTION CARE
06.2018 - 10.2018
Insurance Verification Specialist/ Referral Coordinator
SWEDISH COVENANT HOSPITAL
05.2017 - 06.2018
DME Representative/ Intake
PATIENT'S CHOICE MEDICAL
07.2016 - 05.2017
Outsourcing Coordinator
HEALTH TEAM CORPORATION
12.2014 - 07.2016
Associates in Arts -
COLLEGE OF DUPAGE
High School Diploma -
DOWNERS GROVE SOUTH HIGH SCHOOL
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