Rosemary Smith
medical biller
Rochelle Park,nj
Summary
Results-driven Medical Biller with extensive experience at Physician Management, Inc, excelling in claims processing and payment reconciliation. Demonstrated strong problem-solving abilities while ensuring compliance with HIPAA regulations. Proficient in ICD-10 coding and adept at enhancing team collaboration to improve billing accuracy and expedite reimbursements. Competent revenue cycle management with 30 years of experience in handling wide variety of medical coding and billing tasks. Sophisticated and hardworking individual with excellent analytical and multitasking abilities. Coordinates with insurance companies and expedites claims processes. Expertise in accurately inputting procedure and diagnosis codes into billing software to generate invoices.
Overview
40
40
years of professional experience
Work History
Medical Biller
Rheumatology Associates of North Jersey
Teaneck
11.2021 - Current
- Managed all payments processing, invoicing and collections tasks.
- Accurately input procedure codes, diagnosis codes and patient information into billing software to generate up-to-date invoices.
- Expedited payments by verifying accuracy and currency of vendor information.
- Performed follow up activities on unpaid claims with insurance companies or other third party payers by phone or written correspondence.
- Completed and submitted appeals for denied claims.
- Entered procedure codes, diagnosis codes and patient information into billing software to facilitate invoicing and account management.
- Generated reports in order to track payments due from insurance companies or other third party payers.
- Communicated with insurance representatives to complete claims processing or resolve problem claims.
- Weighed envelopes containing statements to determine correct postage and affix postage.
- Reviewed patient insurance information to ensure accuracy and completeness of claims submission.
- Created monthly aging reports to identify delinquent accounts for review by management team.
- Submitted electronic claims to various insurance carriers.
- Checked claims coding for accuracy with ICD-10 standards.
- Reconciled codes against services rendered.
- Submitted claims to insurance companies.
- Performed daily reconciliation of accounts receivable with payment postings on the computer system.
- Applied HIPAA privacy and security regulations while handling patient information.
- Submitted appeals using provider portals and phone communication.
- Coordinated communications between patients, billing personnel and insurance carriers.
- Performed insurance verification, pre-certification and pre-authorization.
- Processed refunds requests timely and accurately according to established protocols.
- Organized information for past-due accounts and transferred to collection agency.
- Compiled and processed data for billing purposes utilizing billing software programs.
- Collected, posted and managed patient account payments.
- Contacted insurance providers to verify insurance information and obtain billing authorization.
- Ensured compliance with HIPAA guidelines when handling confidential patient information.
- Assisted with collection efforts as needed including contacting patients via phone, mail or email for collection of past due balances due to insurance denials or patient responsibility amounts owed.
- Assessed billing statements for correct diagnostic codes and identified problems with coding.
- Researched discrepancies between billed charges and payments received from insurance companies or other third party payers.
- Monitored reimbursement from managed care networks and insurance carriers to verify consistency with contract rates.
- Reviewed account information to confirm patient and insurance information is accurate and complete.
- Assisted in auditing process by verifying accuracy of submitted claim forms against documentation provided by physicians' offices.
- Reviewed claims for coding accuracy.
- Maintained up-to-date knowledge of government regulations related to healthcare reimbursement policies and procedures.
- Monitored customer account details for non-payments, delayed payments, and other irregularities.
- Answered incoming calls regarding billing inquiries from patients and and or providers in a professional manner.
- Verified medical codes for diagnosis, treatments, procedures and supplies using ICD-10 coding system.
Medical Follow-up
QSS Management
Fairfield
10.2019 - 10.2021
- Conducted comprehensive research and data analysis to support strategic planning and informed decision-making.
- Worked effectively in team environments to make the workplace more productive.
- Demonstrated strong problem-solving skills, resolving issues efficiently and effectively.
- Contributed innovative ideas and solutions to enhance team performance and outcomes.
- Prioritized and organized tasks to efficiently accomplish service goals.
- Collaborated closely with team members to achieve project objectives and meet deadlines.
- Completed day-to-day duties accurately and efficiently.
- Managed time effectively to ensure tasks were completed on schedule and deadlines were met.
Revenue Cycle Specialist
Physicians Management, Inc
Rochelle Park
04.1985 - 09.2018
- Processed appeals related to denied or rejected claims in a timely manner.
- Reconciled monthly accounts receivable reports against system transactions.
- Conducted audits of medical records to ensure compliance with payer requirements.
- Monitored accounts receivables daily to determine appropriate follow-up action needed.
- Maintained current knowledge of insurance policies, procedures, regulations, and guidelines.
- Audited payments from third-party payers to ensure accuracy of reimbursement amounts.
- Evaluated existing workflows for efficiency and effectiveness in order to recommend changes as needed.
- Provided training sessions on billing software applications and procedures to staff members.
- Analyzed claims data to identify trends in denials and rejections.
- Developed reports detailing billing activities, including payment trends and denial rates.
- Identified and corrected payment problems involving patients or third-party payers.
- Assisted with the development of new processes for billing, coding, collections, and reimbursements.
- Contacted insurance providers to check patient coverage.
- Reviewed patient accounts to ensure accuracy and completeness of information.
- Reviewed patient charts for accuracy prior to submitting claims for reimbursement.
- Reached out to responsible companies and individuals to collect on outstanding debts.
- Advised healthcare providers on best practices for submitting accurate claims for reimbursement.
- Ensured all regulatory requirements were met when submitting claims for payment.
- Managed time effectively to ensure tasks were completed on schedule and deadlines were met.
- Worked effectively in team environments to make the workplace more productive.
- Contributed innovative ideas and solutions to enhance team performance and outcomes.
Education
High School Diploma -
Hackensack High School
Hackensack, NJ06-1980
Skills
- Insurance verification
- Claims processing
- Payment reconciliation
- Billing software
- Regulatory compliance
- Customer service
- Patient communication
- Medical coding
- Data analysis
- Attention to detail
- Time management
- Problem solving
- Report generation
- Account management
- Team collaboration
- Knowledgeable in numerous software packages Practice Management, Allscripts, ADS software, SequelMed, Centrix/Imagine & Eclinical
- ICD-10 coding
- Collection calls
- Teamwork and collaboration
- Payment posting
- Submission of medical claims
- Commercial and private insurance
- CMS-1500 billing forms
- Billing and collection procedures
- Medical billing
- Insurance billing
- Multitasking and organization
- Patient collections
- Denial management
- Insurance collections
- Insurance claims
- Collections management
- CPT knowledge
- Work prioritization
- Verbal and written communication
- HIPAA compliance certification
- Insurance claims processing
- Claim submission
- Electronic claims
- Reimbursements
- Procedure coding
- ICD-10
- Medical billing technology
- Medical coding expertise
- Account follow-up
- CPT code modifiers
- Claims review
References
References available upon request.
Timeline
Medical Biller
Rheumatology Associates of North Jersey
11.2021 - Current
Medical Follow-up
QSS Management
10.2019 - 10.2021
Revenue Cycle Specialist
Physicians Management, Inc
04.1985 - 09.2018
High School Diploma -
Hackensack High School
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