Nicole Misa

• Conduct insurance verifications, pre-authorizations, coded medical procedures and managed patient charts.
• Managed pre-certifications and appeals of specialty medications for high volume Rheumatology practice with 2 office locations.
• Reviewed patient records, identified medical codes, and created invoices for billing purposes.
• Utilizing Tebra billing software and Practice Fusion EMR, while accurately assigning procedure and diagnosis codes for insurance billing of high volume Rheumatology on all claims.
• Maintained current working knowledge of CPT and ICD-10 coding principles, government regulation, protocols and third-party billing requirements.
• Assisted patients and providers with applying for copay assistance programs through the drug manufacturers company for specialty medications.
• Successfully negotiated insurance contracts and fee schedule updates with insurance companies to create increased revenue.

Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.

• Provide assistance to all parties, including practitioners, patients, and insurance company representatives.
• Developed improved standard operating procedures to increase billing accuracy and cash flow.
• Rectifying all medical claim denials received from insurance providers.
• Collected payments and applied to patient accounts.
• Delivered timely and accurate charge submissions.
• Prepared billing statements for patients and verified correct diagnostic coding.
• Posted payments and collections on regular basis.
• Adhered to established standards to safeguard patients' health information.
• Analyzed complex Explanation of Benefits forms to verify correct billing of insurance carriers.
• Used strong analytical and problem-solving skills to develop effective solutions for challenging situations.
• Goal-oriented professional with proven success in applying analytical skills to solve complex problems and overcome challenges. Dedicated to enhancing team performance and driving business success.
• Coordinated with other healthcare providers concerning treatment plans for patients.
• Managed pre-certifications and appeals for specialty medications.
• Developed and updated policies and procedures, maintaining compliance with guidelines relating to HIPAA, benefits administration and general liability
• Provided outstanding support to entire staff which helped improve process flow, office morale and boosted efficiency.
• Updated patient financial information to guarantee accuracy.
• Applied official coding conventions and rules from American Medical Association and Centers for Medicare and Medicaid Services to assign diagnostic codes.
• Reviewed, analyzed, and managed coding of diagnostic and treatment procedures contained in outpatient medical records.
• Processed insurance company denials by auditing patient files, researching procedures, and diagnostic codes to determine proper reimbursement.
• Monitored changes in coding regulations to provide recommendations for compliance.
• Coordinated services with other agencies and healthcare professionals to provide useful benefits to clients.
• Explained benefits to plan participants in easy to understand terms in order to educate each on available options.

• Post and reconcile insurance and patient payments as well as researching and resolving incorrect payments, EOB rejections, and other issues with outstanding accounts.
• Follow up on insurance and patient aging A/R and re-submitting insurance claims as necessary (Knowledgeable in timely filing guidelines per payer).
• Monthly processing of patient statements as well as answer and resolve patient billing inquiries.
• Verify patients' accurate insurance information for all insurance carriers.
• Learned and followed all organizational policies and procedures to maintain safe and professional working environments.
• Optimized customer experience by delivering superior services and effectively troubleshooting issues.
• Maintained confidential patient, employee and company information in compliance with company policies and regulatory requirements.
• Gathered information, assessed and fulfilled callers' needs and educated on important policies and procedures.
• Stayed calm under pressure to and successfully dealt with difficult situations.
• Identified and resolved discrepancies and errors in customer accounts.

• Worked hand in hand with front office staff, technicians, and physicians to ensure that the proper patient information was received for clean claims processing.
• Researched CPT and ICD-9 coding discrepancies for compliance and reimbursement accuracy.
• Communicated with insurance providers to resolve denied claims and resubmitted.
• Ran, processed and ensured accuracy of patient statements on a bi-monthly basis.
• Examined patients' insurance coverage, deductibles, insurance carrier payments and remaining balances not covered under policies when applicable.
• Worked collections which included mailing of correspondence, working with patients to establish payment arrangements and if necessary forwarded accounts to collection agency.
• Participate in development of organizational procedures and management projects.
• Set-up practice management software for submission of electronic claims to clearinghouse.
• Retrieved Electronic Remittance Advice (ERA's).
• Examined patients' insurance coverage, deductibles, insurance carrier payments and remaining balances not covered under policies when applicable.