Seasoned healthcare professional with 15 years' diverse experience. Thrives in high-pressure settings, excels in teams and solo work. Specializes in Health Information Management, skilled in data analysis, billing, and revenue management. Effective communicator with strong management and problem-solving skills, dedicated to organizational success.
• Managed and resolved all stopped orders requiring additional documentation for multiple pricing options to ensure uninterrupted billing processes.
• Accurately maintained medical records in the database, ensuring clarity and proper placement within the appropriate sections of the patient's account.
•Ensure DME clients remain compliant with equipment usage requirements to meet insurance guidelines and support accurate billing."
•Process patient billing when insurance coverage was denied due to insufficient documentation or non-compliance by the patient.
· Confirm patients' insurance coverage and benefits before treatment for billing accuracy.
· Prepare and send claims to insurance firms for reimbursement, electronically or via paper.
· Monitor claim status and liaise with insurance companies to address payment delays or issues.
· Handle requests for medical records release adhering to established protocols.
· Processed medical claims for auto accident injuries with insurers and legal teams.
· Submitted insurance claims to various payers, including private insurers and government programs.
Communicated empathetically with patients dealing with pain or distress from auto injuries.
· Maintained documentation for claims, legal matters, and audits in compliance with privacy laws.
· Managed payroll, calculating wages, overtime, and deductions in compliance with laws.
· Submitted claims to insurance companies, Medicare, Medicaid, and third-party payers.
· Resolved billing discrepancies, denied claims, and outstanding balances.
· Managed referrals for home health care services from various providers.
· Verified patient insurance coverage including Medicare, Medicaid, and private plans.
· Provided customer service to patients and families during intake.
· Maintained accurate electronic records in EHR systems.
Skills
Proficient in schedule management
Expertise in Microsoft Office suite, including Excel & Access
Competent in insurance verification and handling claims/auto processes
Exceptional customer service skills
Proficient in medical billing and accounts receivable procedures
Strong data entry abilities
Skilled in ADP for human resources tasks
Competent in QuickBooks for financial management
Knowledgeable in human resources procedures
Effective leadership and supervision capabilities
Proficient in payroll management
Proficient in Brightree (DME/HME software)
Experienced with Epic electronic health records (EHR) system
Skilled in using ResMed platforms and solutions
In-depth knowledge of Durable Medical Equipment (DME) operations and workflows