Zohaib Abbas
Boerne
Summary
Detail-oriented RCM Specialist with 8 years of experience across physician CMS1500, hospital UB04, and DME billing. Proficient in Epic, Athena, NextGen, Waystar, Tebra, TriZetto, AdvancedMd, Meditech, Cerner, HST pathway, OfficeAlly and payer portals, with expertise in ICD10, CPT, HCPCS coding, AR follow-up, denial management, appeals, eligibility verification, and payment posting. Proven record of reducing AR aging, improving first-pass claim acceptance, and optimizing revenue recovery while maintaining 98% compliance with Medicare, Medicaid, and commercial payer standards. Collaborative, detail-oriented, and skilled in streamlining billing operations in remote healthcare environments.
Overview
7
7
years of professional experience
Work History
Medical Billing Specialist
All Physicians Care
Minnesota
12.2023 - Current
- Utilized multiple healthcare software systems, including Athena Health, Epic, Cerner, eClinicalWorks, Health MedTech, and AllScripts, to perform daily billing and RCM tasks.
- Managed daily work queues in Epic, including obtaining medical records, authorizations, referrals, and verifying patient insurance and demographic information.
- Performed comprehensive AR follow-up on denied, unpaid, and underpaid claims, including handling rejections, collections, EOB reviews, claim edits, and secondary billing.
- Verified eligibility and benefits with all payers while ensuring strict compliance with HIPAA guidelines.
- Demonstrated strong proficiency in Microsoft Outlook, Excel, and Word for reporting and documentation.
- Identified and resolved coding issues related to modifiers, ICD-10, CPT, and HCPCS.
- Achieved a 90% payment recovery ratio on denied and rejected claims through effective follow-up and problem resolution.
- Conducted follow-up on inpatient, outpatient, hospital-based, and physician-based claims by contacting payers and using payer portals to expedite resolution.
- Prepared and submitted appeals via payer portals and mail, ensuring inclusion of all required supporting documentation.
- Performed diligent follow-up on all submitted appeals to ensure timely outcomes.
- Interpreted and analyzed insurance denial letters to determine corrective actions and prevent recurring issues.
- Maintained excellent attendance, consistently delivered high-quality work, and demonstrated strong productivity.
- Exceeded performance goals through effective task prioritization, time management, and strong work ethic.
- Provided exceptional customer service by actively listening, resolving concerns promptly, and escalating critical issues to supervisors when necessary.
- Processed and submitted medical claims to various insurance providers, ensuring compliance with regulations.
- Reviewed patient accounts for accuracy, identifying discrepancies and resolving issues promptly.
- Maintained up-to-date knowledge of billing codes and insurance policies, streamlining claims submissions.
- Collaborated with healthcare providers to gather necessary documentation for efficient claim processing.
- Trained junior staff on billing procedures and software utilization to enhance team performance.
- Developed workflows that improved the efficiency of claims handling and reduced billing errors.
Accounts Receivable Specialist
P3 Healthcare Solutions
California
01.2019 - 11.2023
- Gained hands-on experience across the full Revenue Cycle Management (RCM) process.
- Processed Medicare, Medicaid, Commercial, Veterans Affairs, and Workers' Compensation claims.
- Reduced charge capture errors by 25% through pre-submission verification and modifier validation.
- Followed up with payers via calls and portals to resolve underpayments, denials, and non-payments.
- Reviewed EOBs/ERAs to correct underpayments, denials, and shortfalls.
- Ensured compliance with CPT and ICD-10 coding standards, increasing first-pass acceptance rates.
- Collaborated with coding team to resolve CPT/ICD10 discrepancies and ensure CMS/payer compliance.
- Resolved unique billing issues proactively and efficiently, minimizing delays in reimbursement.
- Documented and tracked claim issues to support process improvements and audits.
- Maintained adherence to CMS and payer-specific billing requirements.
- Updated billing records to reflect insurance plan changes accurately.
- Posted and reconciled payments from ERAs/EOBs with 100% accuracy, reducing unapplied cash.
- Managed accounts receivable processes to ensure timely collections and accurate billing.
- Reconciled customer accounts, resolving discrepancies to maintain financial accuracy.
- Developed and implemented strategies to reduce outstanding invoices and improve cash flow.
- Led training sessions for new staff on internal systems and best practices in accounts receivable management.
- Analyzed aging reports to identify trends and recommend solutions for overdue accounts.
- Collaborated with cross-functional teams to streamline invoicing procedures and enhance operational efficiency.
- Utilized ERP software to track payments, generate reports, and support financial audits effectively.
- Mentored junior staff in effective communication techniques for client interactions regarding payment inquiries.
- Supported month-end closing activities by reconciling accounts, preparing reports, and analyzing trends in account performance.
- Reduced outstanding accounts receivable balances by diligently following up on overdue payments.
- Ensured the accuracy of customer records in internal systems by updating contact information, payment terms, and other relevant data as needed.
- Prepared and mailed invoices to customers, processed payments, and documented account updates.
- Monitored accounts to verify compliance with payment terms and schedules.
Education
High School Diploma -
Beaconhouse School
Lahore, Pakistan06-2020
Skills
- CPT Coding
- EOB/ERA Review
- Charge Entry
- AR Follow-up
- Appeals Creation and Follow-Up
- HIPAA Compliance
- Denial Management
- Payment Posting
- Commercial Insurance Billing
- Eligibility Verification
- Prior Authorizations
- Payer Trend Analysis
- Medical Terminology
- Claim submission
- Denial management
- Medicare and medicaid process
- Medical terminology
- CMS-1500/UB-04 billing forms
STRENGTHS
- UB04 & CMS-1500: Maintained a 99% clean-claim rate on UB-04 and CMS-1500 submissions by validating codes, modifiers, revenue codes, and payer rules reducing rejections and accelerating reimbursements.
- A/R Reduction Success: Recovered high-dollar insurance payments through proactive follow-ups and effective resolution of denied and underpaid claims.
- Claim Acceptance Improvement: Increased clean claim rate by optimizing coding accuracy, documentation review, and timely error resolution.
- Appeals Management: Consistently overturned high-value denials through strong, evidence-based appeals, boosting payer reversals by 30-40% and recovering major revenue.
- EOB/Payment Posting: Accurately posted EOBs and payments, ensuring correct allocation and reducing posting discrepancies.
Timeline
Medical Billing Specialist
All Physicians Care
12.2023 - Current
Accounts Receivable Specialist
P3 Healthcare Solutions
01.2019 - 11.2023
High School Diploma -
Beaconhouse School