Nichole Johnson
Merrillville,IN
Summary
Detail-oriented medical billing professional with proven skills in HIPAA compliance, insurance verification, and claim submission. Committed to enhancing patient experiences through effective denial management and accurate billing processes.
Overview
7
7
years of professional experience
Work History
Medical-billing-professional
Lakeshore Bone and Joint Institute
Portage, IN
01.2024 - Current
- Processed medical claims accurately and efficiently, ensuring timely reimbursement for services rendered.
- Coordinated with insurance providers to resolve billing discrepancies and facilitate payment resolution.
- Reviewed patient accounts for accuracy, identifying errors in coding and billing submissions.
- Maintained detailed records of transactions and communications with patients and insurers.
- Communicated with insurance providers to resolve denied claims and resubmitted.
- Posted and adjusted payments from insurance companies.
- Communicated effectively and extensively with other departments to resolve claims issues.
- Located errors and promptly refiled rejected claims.
- Assisted patients with understanding their medical bills and provided clarification on complex insurance issues, promoting a positive customer experience.
- Identified and resolved patient billing and payment issues.
- Examined patients' insurance coverage, deductibles, insurance carrier payments and remaining balances not covered under policies when applicable.
- Ensured timely submission of claims to various insurance carriers, resulting in prompt payment for services rendered.
- Maintained strong working relationships with healthcare providers, fostering clear communication regarding billing-related matters.
- Managed patient accounts effectively, resolving discrepancies and addressing outstanding balances in a timely manner.
- Enhanced revenue collection through diligent follow-up on unpaid claims and denials with insurance companies.
- Analyzed complex Explanation of Benefits forms to verify correct billing of insurance carriers.
- Collected payments and applied to patient accounts.
- Precisely completed appropriate claims paperwork, documentation and system entry.
- Precisely evaluated and verified benefits and eligibility.
- Provided exceptional customer service to both patients and insurance representatives, resolving inquiries quickly and professionally.
- Communicated with patients for unpaid claims for HMO, PPO and private accounts and delivered friendly follow-up calls for proper payments to contracts.
- Verified insurance of patients to determine eligibility.
- Accurately entered patient demographic and billing information in billing system to enable tracking history and maintain accurate records.
- Adhered to established standards to safeguard patients' health information.
- Delivered timely and accurate charge submissions.
- Skilled at working independently and collaboratively in a team environment.
- Excellent communication skills, both verbal and written.
- Learned and adapted quickly to new technology and software applications.
Precertification Specialist-Financial Counselor
Centers for Pain Control and Vein Care
Valparaiso, IN
06.2021 - 12.2023
- Facilitated precertification processes for various pain management and vein care procedures.
- Reviewed and ensured accuracy of patient insurance information for timely authorizations.
- Trained new staff on precertification protocols and software systems to enhance team performance.
- Monitored changes in insurance policies to maintain compliance and improve approval rates.
- Resolved complex authorization issues by liaising with insurance representatives effectively.
- Maintained strict adherence to HIPAA regulations by safeguarding confidential patient information during all aspects of the precertification process.
- Contributed extensively to departmental goals through consistent achievement of individual performance benchmarks related to precertification accuracy and timeliness.
- Ensured smooth communication between healthcare providers, patients, and insurance companies, resulting in timely approvals and positive experiences.
- Reduced patient wait times for approval by diligently reviewing medical records and obtaining necessary documentation.
- Conducted thorough follow-ups with insurance companies, ensuring timely receipt of authorization numbers for approved services.
- Analyzed trends in denials or authorization delays to identify opportunities for improvement within the precertification department.
- Facilitated successful appeals for denied services by providing detailed documentation supporting medical necessity as required by insurers.
- Increased accuracy of submitted claims through meticulous attention to detail in verifying insurance eligibility and benefits.
- Resolved discrepancies with client applications to verify eligibility.
- Greeted and interacted with patients to provide information, answer questions and assist with appointment scheduling.
- Obtained payments from patients and scanned identification and insurance cards.
- Scheduled patient appointments in respective doctors' calendars and followed up with reminder phone calls.
- Processed medical insurance claims and payments.
- Assisted in verifying insurance benefits, ensuring accurate coverage information for services rendered.
Patient Service Representative
NorthShore Health Centers
Hammond, IN
06.2019 - 06.2021
- Managed patient scheduling and appointment confirmations, ensuring optimal clinic workflow.
- Facilitated patient check-in and intake processes, enhancing overall patient experience.
- Coordinated insurance verification and eligibility checks for patients prior to appointments.
- Resolved patient inquiries and concerns promptly, improving satisfaction rates.
- Verified insurance eligibility and coverage for patients.
- Handled sensitive patient concerns with professionalism and empathy, fostering an atmosphere of trust within the clinic.
- Filed and maintained patient records in accordance with HIPAA regulations.
- Provided exceptional customer service to patients, answering questions and addressing concerns.
- Managed patient registration process, confirming data accuracy and completeness.
- Assisted patients in filling out check-in and payment paperwork.
- Facilitated patient registration by accurately entering demographic and insurance information into electronic health record systems.
- Entered patient demographic and insurance data into electronic medical record system.
- Processed medical records requests efficiently, safeguarding patient privacy while ensuring timely information access for healthcare providers.
- Assisted with insurance verification tasks, ensuring accurate billing and timely reimbursement for services rendered.
- Took copayments and compiled daily financial records.
- Balanced deposits and credit card payments each day.
- Built and maintained positive working relationships with patients and staff.
- Actively participated in team meetings focused on improving workflows and enhancing overall practice performance.
- Handled complex insurance pre-authorization processes accurately, enabling timely delivery of necessary medical services.
- Increased overall practice revenue by diligently collecting copayments and outstanding balances at the time of service.
- Enhanced office efficiency by managing multi-line phone systems and promptly directing calls to appropriate personnel.
Education
Associate of Science - Medical Office Management
University of Phoenix
Tempe, AZ05-2027
Skills
- HIPAA compliance
- Payment posting
- Claim submission
- Insurance verification
- Patient billing
- CPT knowledge
- Denial management
- Medicare and medicaid process
- Bill payment
- Files and records management
- Quality-oriented team player
- AllScripts, Epic, ModMed, Practice Fusion
- Insurance billing
- Insurance claims
- Claims review
Timeline
Medical-billing-professional
Lakeshore Bone and Joint Institute
01.2024 - Current
Precertification Specialist-Financial Counselor
Centers for Pain Control and Vein Care
06.2021 - 12.2023
Patient Service Representative
NorthShore Health Centers
06.2019 - 06.2021
Associate of Science - Medical Office Management
University of Phoenix