EPIC
Tiera Seats
Summary
Organized and dependable candidate successful at managing multiple priorities with a high degree of accuracy and a positive attitude. Detail-oriented team player with strong organizational skills.
Overview
6
6
years of professional experience
Work History
Clinical Billing Specialist
Domain Laboratory
02.2023 - Current
- Analyzed complex Explanation of Benefits forms to verify correct billing of insurance carriers.
- Posted payments and collections on regular basis.
- Filed and updated patient information and medical records.
- Adhered to established standards to safeguard patients' health information.
- Delivered timely and accurate charge submissions.
- Reviewed patient records, identified medical codes, and created invoices for billing purposes.
- Prepared billing statements for patients and verified correct diagnostic coding.
- Reviewed patient diagnosis codes to verify accuracy and completeness.
- Communicated with insurance providers to resolve denied claims and resubmitted.
- Assist patients with billing, service, and insurance questions
- Update systems with insurance or patient demographic corrections
- Document encounters and actions in appropriate systems
Appeals and Grievances Coordinator
Spectrum Health
06.2021 - 12.2022
- Reviewing and resolving member and provider complaints, and communicating resolutions to members and providers (or authorized representatives) in accordance with standards and requirements established by the Centers for Medicare and Medicaid Services (CMS)
- Request and review medical records, notes, and/or detailed bills as appropriate
- Compose all correspondence and appeal/dispute and/or grievances information concisely and accurately, in accordance with regulatory requirements
- Research claims processing guidelines, provider contracts, fee schedules, and system configurations to determine the root cause of payment errors
- Resolve and prepare written responses to incoming provider reconsideration requests relating to claims payment and requests for claim adjustments
- Identified issues, analyzed information and provided solutions to problems.
- Applied effective time management techniques to meet tight deadlines.
- Update systems with insurance or patient demographic corrections
- Document encounters and actions in appropriate systems
Appeals COordinator
BCBS of IL
09.2018 - 12.2020
- Reviewing and resolving member and provider complaints, and communicating resolutions to members and providers (or authorized representatives) in accordance with standards and requirements established by the Centers for Medicare and Medicaid Services (CMS)
- Request and review medical records, notes, and/or detailed bills as appropriate
- Compose all correspondence and appeal/dispute and/or grievances information concisely and accurately, in accordance with regulatory requirements
- Research claims processing guidelines, provider contracts, fee schedules, and system configurations to determine the root cause of payment errors
- Resolve and prepare written responses to incoming provider reconsideration requests relating to claims payment and requests for claim adjustments
- Identified issues, analyzed information and provided solutions to problems.
- Applied effective time management techniques to meet tight deadlines.
- Update systems with insurance or patient demographic corrections
- Document encounters and actions in appropriate systems
Education
Medical Billing And Coding
Stark State College
Canton, OHBusiness
Cuyahoga Community College
Cleveland, OHAssociate of Arts - Nutrition
Maricopa Community Colleges - Scottsdale Community College
Scottsdale, AZ05.2017
Skills
- Claim submission
- Collections Management
- Performance metrics analysis
- Payment posting
- HIPAA Compliance
- Analytical Problem Solving
- Revenue Cycle Management
- Claims review
- Insurance Claims
- Medical Terminology
- Data Entry
- Knowledgeable in EPIC
- Medicaid and Medicare Knowledge
- Medicare and Medicaid process
- ICD-10
- Electronic Claims
- Records Maintenance
- Claims Processing
Software
Facets
MedHok
LENS
PeopleSafe
Timeline
Clinical Billing Specialist
Domain Laboratory
02.2023 - Current
Appeals and Grievances Coordinator
Spectrum Health
06.2021 - 12.2022
Appeals COordinator
BCBS of IL
09.2018 - 12.2020
Medical Billing And Coding
Stark State College
Business
Cuyahoga Community College
Associate of Arts - Nutrition
Maricopa Community Colleges - Scottsdale Community College
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