Open To Work
Rachel Ramirez
Billing Specialist
Clarksville,TN
Work Preference
Summary
Medical Billing Specialist experienced in full-cycle revenue cycle management across various healthcare settings. Demonstrates a strong track record in resolving denied claims, ensuring accurate submissions, and maintaining compliance with healthcare regulations. Proficient in multiple billing systems, contributing to improved claims accuracy and optimized revenue capture.
Overview
18
18
years of professional experience
Work History
Billing Specialist
Covenant Care Practices
Clarksville
01.2025 - 03.2026
- Calculated billing charges, prepared and submitted claims to insurance companies.
- Submitted claims to insurance companies.
- Reviewed claims for errors to ensure accurate submission to insurance providers.
- Verified insurance coverage and identified third-party payers for billing purposes.
- Coordinated with healthcare providers to efficiently resolve billing issues.
- Maintained accurate records of collections, adjustments and denials in the system.
- Processed patient billing and insurance claims efficiently.
- Processed payment adjustments and appeals per payer guidelines.
- Utilized billing software for tracking payments and adjustments.
- Utilized multiple systems including Athena, Availity, Passport, and all insurance portals.
- Answered customer inquiries regarding billings, payments, account status.
- Communicated with patients to clarify billing inquiries and resolve discrepancies.
- Worked closely with patients to discuss payment arrangements when needed.
- Assisted in training new staff on billing procedures and policies.
- Enforced compliance with organizational policies and federal requirements regarding confidentiality.
- Managed revenue cycle and accounts receivable efficiently.
- Reviewed and verified billing data for accuracy.
- Worked closely with patients to discuss payment arrangements when needed.
Billing Specialist
Hughes Alan
Clarksville
06.2023 - 01.2025
- Resolved denied and rejected claims through thorough research, corrections, and appeals, ensuring maximum reimbursement for services rendered.
- Reviewed and verified billing data for accuracy, contributing to reduced claim denials and improved revenue capture.
- Communicated with patients and insurance providers to resolve billing discrepancies
- Processed patient billing and insurance claims efficiently.
- Posted payments and adjustments while maintaining accurate account records
- Review all claims for errors corrected and submit to insurance
- Utilized billing software for tracking payments and adjustments.
- Coordinated with healthcare providers to resolve billing issues.
- Communicated with patients regarding billing inquiries and discrepancies.
- Maintained accurate records of collections, adjustments and denials in the system.
- Collected, posted and managed patient account payments.
- Submitted claims to insurance companies.
- Verified insurance coverage and identified third-party payers for billing purposes.
- Calculated billing charges, prepared and submitted claims to insurance companies.
- Monitored accounts receivable activity, ensuring timely payment of invoices and maintaining healthy cash flow for the organization.
- Monitored past due accounts and pursued collections on outstanding invoices.
- Investigated incorrect billings and processed refunds as necessary.
- Worked closely with patients to discuss payment arrangements when needed.
- Tracked changes in legislation that could affect billing procedures.
- Implemented new policies related to billing processes when required.
- Assisted in training new staff on billing procedures and policies.
- Trained new team members on company policies and accounting systems to keep team operations productive and efficient.
- Worked with team members to identify and develop process improvements.
- Answered customer inquiries regarding billings, payments, account status.
- Provided prompt and accurate services through knowledge of government regulations, health benefits and healthcare terminology.
- Enforced compliance with organizational policies and federal requirements regarding confidentiality.
- Performed data entry into accounting software programs such as QuickBooks.
- Reviewed medical records to ensure accuracy of billing information and patient data.
- Performed additional duties as assigned by management team.
- Supported other departments within the organization.
- Resolved discrepancies between customers' remittances and invoices received.
- Charged expenses to accounts and cost centers by analyzing invoice and expense reports.
- Reviewed engine assigned codes and modifiers to update and verify accuracy.
- Performed additional duties as assigned by management team.
- Tracked changes in legislation that could affect billing procedures.
- Enforced compliance with organizational policies and federal requirements regarding confidentiality.
- Identified professional development opportunities and delivered comprehensive, standardized and hands-on training to new staff.
- Reviewed engine assigned codes and modifiers to update and verify accuracy.
Medical Biller
California Business Bureau
Monrovia
08.2022 - 06.2023
- Submitted claims using UB-04 forms
- Investigated and corrected denied claims, facilitating secure reimbursement from insurance providers
- Coordinated with insurance companies to resolve claim issues and payment delays
- Communicated with insurance companies to resolve claim discrepancies.
- Maintained compliance with healthcare regulations and billing standards.
- Collaborated with healthcare providers to gather necessary documentation.
- Conducted follow-ups on unpaid claims to expedite payments.
- Submitted electronic claims to various insurance carriers.
- Applied HIPAA privacy and security regulations while handling patient information.
- Reviewed patient insurance information to ensure accuracy and completeness of claims submission.
- Followed up on unpaid claims with insurance companies and third-party payers via phone and written correspondence.
- Communicated with insurance representatives to complete claims processing or resolve problem claims.
- Compiled and processed data for billing purposes utilizing billing software programs.
- Maintained up-to-date knowledge of government regulations related to healthcare reimbursement policies and procedures.
- Organized information for past-due accounts and transferred to collection agency.
- Monitored past due accounts and pursued collections on outstanding invoices.
- Eliminated inaccuracies in accounts payable payments by verifying information prior to generating checks and electronic payment transfers.
- Investigated past due invoices and delinquent accounts to generate revenues and reduce number of unpaid and outstanding accounts.
- Reviewed legal claims for accuracy and issues.
- Managed accounts receivable, ensuring timely follow-up to reduce outstanding balances
Education
Diploma - Medical Billing
Everest College
Gardena, CA01-2007
Skills
- Revenue cycle management
- Claims processing
- Claims submission
- Claim management
- Claim handling
- Denial resolution
- Denial handling
- Claim disputes
- Billing and collections
- Payment posting
- Accounts receivable management
- Accounts receivable reporting
- A/R proficiency
- Billing proficiency
- Billing software proficiency
- Billing systems and software
- Insurance verification
- Insurance confirmation
- Regulatory adherence
- HIPAA regulations
- HIPAA compliance
- Billing standards
- Dispute resolution
- Dispute mediation
- Collections
- Collection practices
- Collections oversight
- Process optimization
- Invoicing proficiency
- Record preparation
- Patient account management
- Attention to detail
- Multitasking and organization
- Data research
- Critical thinking
- Problem-solving
- Decision-making
- Teamwork
- Relationship building
- Client service
- Verbal and written communication
- Deductible management
- Accounts receivable management
- Billing software proficiency
- Billing systems and software
- Collections
- Billing management
- Reconciliation skills
- Decision-making
- Claims submission
- Dispute resolution
- Regulatory adherence
Timeline
Billing Specialist
Covenant Care Practices
01.2025 - 03.2026
Billing Specialist
Hughes Alan
06.2023 - 01.2025
Medical Biller
California Business Bureau
08.2022 - 06.2023
Diploma - Medical Billing
Everest College