Summary
Overview
Work History
Education
Skills
Timeline
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Susannah Naglee

Medical Billing Specialist
Raleigh,NC

Summary

Medical Billing Specialist of nine years providing administrative and patient support for medical office settings. Advanced knowledge of Medicare and private insurance processes and codes. Hardworking professional applies official coding conventions and rules established by American Medical Association and Centers for Medicare and Medicaid Services. Confident Medical Coder adheres to data confidentiality and privacy rules in all workflows and promotes dynamic interpersonal skills. Detail-oriented and diligent in the entire revenue cycle. Holds a solid foundation in billing and coding procedures. My position as a conscientious medical biller is integral to business, helps keep organizations financially solvent, and gives resources to expand business as needs change. Highly effective in getting reimbursement for aged claims through investigation and correction of the issue. Positive that ability to bill and code accurately would be an asset to any facility.

Overview

9
9
years of professional experience
5
5
years of post-secondary education

Work History

Medical Billing Specialist

Taylor Retina Center
Raleigh, NC
03.2023 - Current
  • Hired initially to work on A/R of major insurance payers via Nextech Practice Plus practice management software.
  • This position utilizes 9 years of knowledge of Revenue Cycle Management
  • Current position has expanded to include:
  • Accounts Receivable for several large and small insurance payers
  • Enter patient payments into Practice Plus daily.
  • Remote deposits into practice’s bank account of patient payments via check.
  • Bank visits weekly with cash collected from patients.
  • Responding to patient phone calls in regard to their patient balance due.
  • Obtaining pre-authorizations from insurance payers for treatments.
  • Processing requests for funds from co-insurance assistance program.
  • Building spreadsheets to ensure tasks are organized, completed, and tracked.
  • Edit coding and refiling corrected claims.
  • Filing appeals and submitting medical records to payers
  • Navigating many payer websites as well as SamaCare Preauthorization site.
  • Collected payments and applied to patient accounts.
  • Researched CPT and ICD-10 coding discrepancies for compliance and reimbursement accuracy.
  • Examined patients' insurance coverage, deductibles, insurance carrier payments and remaining balances not covered under policies when applicable.
  • Liaised between patients, insurance companies, and billing office.
  • Communicated with insurance providers to resolve denied claims and resubmitted.
  • Precisely evaluated and verified benefits and eligibility.
  • Located errors and promptly refiled rejected claims.
  • Analyzed complex Explanation of Benefits forms to verify correct billing of insurance carriers.
  • Maintained and updated collections tracking spreadsheet to help organize payment information.
  • Prepared billing correspondence and maintained database to organize billing information.

Medical Billing Specialist

AMS Software Inc
Wake Forest, NC
08.2014 - 03.2023
  • File clean claims to insurance companies for several separate physician's offices: Chiropractic, Gerontology, Opioid Addiction Specialist, Anesthesiology, Pulmonology, General Medicine.
  • Review claim charges for accuracy and coding relative to ICD-10 and CPT codes.
  • Verify patients' insurance coverage eligibility and enter patients' demographics into AMS system.
  • Recognize importance of entering all patient, subscriber, and insurance company data correctly on initial entry as well as verifying coverage before initial visit.
  • Enter charges and post payments into AMS billing system from EOBs and ERAs.
  • Follow up on denials of claims, file appeals, investigate errors and correct them in various clearinghouses.
  • Review A/R & denied claims weekly followed by calling insurance companies or using the Medicare website to determine reason for denials so that claims can be corrected and resubmitted in a timely manner.
  • Build Excel spreadsheets for CFO, develop and maintain client relations, and deliver customer support.
  • Educate physicians' support staff and train interns about AMS software.
  • Familiar with, and current user of: NCTracks, Availity, Gateway/Trizetto, HNS, ClaimRemedi, Amazing Charts, Apex, and Medicare.gov.
  • Researched CPT and ICD-10 coding discrepancies for compliance and reimbursement accuracy.
  • Examined patients' insurance coverage, deductibles, insurance carrier payments and remaining balances not covered under policies when applicable.
  • Communicated with insurance providers to resolve denied claims and resubmitted.
  • Precisely evaluated and verified benefits and eligibility.
  • Located errors and promptly refiled rejected claims.
  • Analyzed complex Explanation of Benefits forms to verify correct billing of insurance carriers.
  • Maintained and updated collections tracking spreadsheet to help organize payment information.
  • Precisely completed appropriate claims paperwork, documentation and system entry.
  • Posted and adjusted payments from insurance companies.
  • Communicated effectively and extensively with other departments to resolve claims issues.

Education

Medical Billing and Coding Certification -

Wake Technical Community College, Wake Tech Community College
Raleigh, NC
05.2013 - 05.2014

Bachelor of Science - Child Development and Family Relations

East Carolina University
Greenville, NC
09.1988 - 05.1992

Skills

    Medicare and Medicaid process

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Timeline

Medical Billing Specialist

Taylor Retina Center
03.2023 - Current

Medical Billing Specialist

AMS Software Inc
08.2014 - 03.2023

Medical Billing and Coding Certification -

Wake Technical Community College, Wake Tech Community College
05.2013 - 05.2014

Bachelor of Science - Child Development and Family Relations

East Carolina University
09.1988 - 05.1992
Susannah NagleeMedical Billing Specialist