Richa Sharma
Dublin,OH
Summary
20+ years of Medical billing and administrative experience, Bilingual and skilled Supervisor of billing seeking for a PART TIME Position in a company where the skills, knowledge and experience can be utilized. Preferring REMOTE opportunities.
Overview
15
15
years of professional experience
Work History
Pediatric Professional Billing Representative
Nationwide Children Hospital
Columbus, OH
09.2022 - Current
- Reviews patient account information for completeness and accuracy.
- • Makes necessary changes/updates to patient account information to ensure timely payment on accounts.
- • Retrieves status information from government and third party payers regarding outstanding professional claims.
- • Collects and documents ongoing payer source information.
- • Verifies prior authorization requirements based on payer specific reimbursement policies.
- • Obtains initial and retro-authorizations for professional services according to payer requirements.
- • Performs data entry of initial and ongoing patient information and authorizations within acceptable timeframe.
- • Reviews patient statements and professional claims for accuracy and completeness.
- • Identifies and obtains additional supporting information for claims submission, when necessary.
- • Processes all professional claims with any necessary supporting documentation for submission to government and third party payers in a timely manner.
- • Posts charges, payments, and adjustments to patient accounts as appropriate.
- • Provides follow-up on claim edits, rejections, denials, and outstanding professional claims in a timely manner.
- • Utilizes information and data relevant to the position to identify payer problems and initiates recommendations for solution to supervisor.
- • Coordinates professional claim and appeal information with governmental agencies and third party payers to ensure maximum reimbursement for professional services rendered.
- • Acts as a liaison between the hospital and third party payers in resolving billing and reimbursement issues.
- • Stays up-to-date with payer specific requirements and reimbursement policies for billing professional claims.
- • Identifies areas or processes for improvement and reports recommendations to their supervisor.
- • Maintains confidentiality of hospital and individual patient information.
- • Effectively utilizes supplies and resources within the department to deliver quality service and control costs.
- • Properly maintains assigned equipment.
- • Interacts in a professional, honest, fair, and respectful manner when presenting information and responding to questions.
- • Represents the organization in a professional manner and provides a positive example of performance for co-workers.
- • Performs other related duties as assigned.
Offshore Lead
Medi-Centrix
, New Jersey
04.2021 - 08.2022
- Organize and schedule all training activities off off shore AR team, as it relates to insurance follow up / revenue cycle management
- Provide training in MPower on all functions related to AR, including smart feeds when needed
- Monitors and analyze productivity along with performing Q/A
- Identify struggles with offshore AR team and provide guidance
- Documents and Records training sessions to be used for future reference
- Fields questions from AR staff.
Account Representative Specialist
Orthopedic ONE Upper
Columbus, OH
01.2018 - 04.2021
- Review outstanding claims and follow up with insurance carriers regarding denials for specified physicians reviewing aged report monthly
- Audit charges for optimal charges coding when needed complete data entry charges and payments as needed for department coverage and productivity
- Post insurance denials into practice management system within 5 days of denials
- Communicate with patients, insurance carriers and other outside entities in professional manners
- Identifies solutions and responds professionally to patient concerns
- Keeps up on changes in medical billing and coding procedures.
Receivable Supervisor
First source Solutions
Columbus, OH
06.2016 - 12.2017
- Monitored 10 billing coordinators, supervise staff of 15 responsible for weekly billing activities to ensure maximum efficiency, provided guidance and direction to staff covering all aspects of billing ensuring adherence to policies and procedures
- Trained, Delegated and assist staff in data entry, editing and maintained records of all incoming and outgoing work
- Responsible for maintaining all claims submitted to Medicare, Medicaid as well as private carriers and reviewed all information for accuracy to ensure immediate payment
- Report and document employee disciplinary problems to billing manager
- Adhere to prescribed policies and procedures as outlined in employee handbook and employee code of conduct
- Assist with hiring process, Coordinate and /or assume responsibility for employees during absenteeism, heavy workloads.
- Maintain time and coordinate with overtime with billing manager to accommodate workloads and assist with other projects as assigned by management
- Managed clerical and administrative staff, Organize, arrange and coordinate office meetings
- Responsible to post payment to meet month end deadline and responsible for Bonus check to office staff.
Patient Finance Service Specialist
The Ohio state Wexner medical Center
Columbus, OH
05.2007 - 05.2016
- Electronically submitted claims through use of software systems Epic
- Printed paper claims for insurance companies who did not accept them electronically
- Billing experience in Medicare, Medicaid and commercial insurance
- Billed, Follow up on rejected claims and followed up with posting dept if there was any discrepancy
- Processing patient's billing, statements, reimbursement claims, post transaction and data
- Dealing with queries and responding to them by telephone or by writing Responsible for reports distribution, telephone, and generation of bills
- Improved revenue for most recent provided over 85% with same patient load
- Offered options to clients when mistakes were found on invoices by billing clerk.
Education
Bachelor of Law -
Banaras Hindu University
Varanasi, INDIA08.1995
Bachelor of Arts -
Banaras Hindu University
Varanasi, INDIA07.1992
Skills
- Customer service
- Medical billing
- ICD-10
- CPT Coding
- ICD-9
- Medical Records
- Insurance Verification
- Medical Terminology
- Microsoft Excel
- Microsoft Word
- Microsoft Office
- Anatomy Knowledge
- Physiology Knowledge
- Medical Scheduling
- Time management
- Supervising experience
- Leadership
- Google Suite
- Analysis skills
- Accounts Receivable
- Medical Office Experience
- Hospital Experience
- Languages
- Hindi and English - Expert
- Additional Information
- Summary of Skills
- Experience of more than 20 years and in-depth knowledge of medical insurance claims procedure
- Documented success in executing all operational aspects of insurance claims, denials and account
- Receivables
- Known for establishing clearly defined department and individual goals and objectives and
- Communicate them to billing staff
- Demonstrated expertise in resolving billing issues to denials
- Adept at analyzing data for bill presentation, based on technical and compliance requirements
- Increased instances of insurance claims payment by 75% by effectively creating and maintaining
- Meaningful relationships with all insurance companies on board
- Core Qualifications
- ICD-9 and 10, Medical terminology, Physiology
- HMO's, Medicare and Medicaid billing
- Medical Insurance Records
- HIPAA compliance,
- Billing proficiency, Keyboarding 50 WPM
- Excellent oral and written communication and interpersonal skills
- Epic, Imagine, CAPI, E-Clinical, Medent, Cubs software
- Ability to hire, train and supervise
- Various practice management software efficient
- Fiscal budgeting knowledge
- Highly organized and Multi-tasking
- HCPCS coding
- Detail Oriented, Motivated, trustworthy and problem solver
- Portal Servers
Additional Information
- Willing to relocate: Anywhere
Timeline
Pediatric Professional Billing Representative
Nationwide Children Hospital
09.2022 - Current
Offshore Lead
Medi-Centrix
04.2021 - 08.2022
Account Representative Specialist
Orthopedic ONE Upper
01.2018 - 04.2021
Receivable Supervisor
First source Solutions
06.2016 - 12.2017
Patient Finance Service Specialist
The Ohio state Wexner medical Center
05.2007 - 05.2016
Bachelor of Law -
Banaras Hindu University
Bachelor of Arts -
Banaras Hindu University
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