A R Reimbursement Specialist resume example

Engaged students and boosted understanding of material using focused instructional strategies and hands-on activities. Helped students build learning and study skills to achieve educational goals. Enforced classroom routines to keep students on schedule and operating at consistent level. Engaged students in discussions to promote interest and drive learning. Built and strengthened positive relationships with students, parents and teaching staff. Assisted fellow teachers with assignment development, special projects, tests, administrative updates and grading. Graded student papers and assignments to track student progression.

Ensures that claims are processed accurately through review and audit functions to ensure timely payment. Responds to inquiries regarding claims with under payment or non-payment. Responds to inquiries, questions, and concerns from patients regarding the status of claims in a clear, concise, and courteous manner. Interfaces with external and internal customers to ensure optimal efficiency of service. Monitors aging of claims to ensure timely follow-up and payment. Coordinates, monitors, and manages the follow-up on unpaid claims. Ensures follow-up and reimbursement appeals of unpaid and inappropriately paid claims. Ensures appropriate documentation of billing, follow-up, collection, and appeal efforts are recorded on accounts. Maintained confidentiality and integrity of patient data. Researched rejections, investigating problems to appeal claims. Advised supervisors and clinicians of billing deficiencies to support charge capture. Identified opportunities for coverage access to address reimbursement Claireiers. Enforced adherence to several states and federal reporting regulations by performing regular compliance audits. Reviewed uninsured accounts, verifying medical assistance application process, charity care application and drug replacement program availability. Worked with billing department to reduce contract implementation errors. Verified clients' Medical insurance claims coverage by coordinating with providers. Determined medical necessity, using individual insurance carrier regulations. Coded patient care records to provide accurate information for billing. Verified technical reimbursement questions for providers, billing and coding staff. Checked claims coding for accuracy with ICD-10 standards. Enforced compliance with organizational policies and federal requirements regarding confidentiality. Provided prompt and accurate services through knowledge of government regulations, health benefits and healthcare terminology. Trained new team members on company policies and accounting systems to keep team operations productive and efficient. Was named TOP collector over 9 months in a row.

Overseen morning huddles. Quickly responded to staff and client inquiries. Thoroughly investigated past due invoices and minimized number of unpaid accounts. Recorded and filed patient data and medical records. Carefully reviewed medical records for accuracy and completion as required by insurance companies. Acquired insurance authorizations for procedures and tests ordered by the attending physician. Prepared prescription refill requests on behalf of the physician. Quickly responded to staff and client inquiries regarding CPT codes. Demonstrated knowledge of HIPAA Privacy and Security Regulations by appropriately handling patient information. Appropriately and correctly identified errors and re-filed denied/rejected claims as they were received from the Patient Account Representative. Confirmed patient information, collected copays and verified insurance. Completed appeals and filed and submitted claims. Posted charges, payments and adjustments. Applied payments, adjustments and denials into medical manager system. Submitted refund requests for claims paid in error. Carefully prepared, reviewed and submitted patient statements. Tracked and resolved underpayments. Consistently informed patients of their financial responsibilities prior to services being rendered. Remained up-to-date with all insurance requirements, including the details of patient financial responsibilities, fee-for-service and managed care plans. Performed quality control of the data entry system to verify that claims and payments were posted correctly. Prepared and attached all required claims documentation including referrals, treatment plans or other required correspondence to reduce incidence of denials. Efficiently performed insurance verification and pre-certification and pre-authorization functions. Performed daily, weekly, and monthly reports. Balanced daily deposits. Performed other administrative tasks, including filing, answering phones and marketing.

Audited each insurance claim and researched for underpayments. Negotiated with insurance companies for settlement of payments. Collect insurance claim data for review to ensure timely resolution on existing and outstanding issues. Evaluated each insurance claims to determine which claim requires an appeal. Consistent follow-up with insurance companies to discover the determination and the appeal progress level. Send out letters to patients requesting Authorization to appeal their claim on their behalf. Write appeal letters to insurance companies to resolves denials. Obtained Retro-Auth for claims to be processed correctly and paid. Resolve patient and facility complaints in NetSuite. Served as a mentor/trainer for the collection team. Supplied team support to other collectors. Assisted in Auditing collector’s productivity. Conducted Direct Pay project. Worked with Advanced MD software.

Business Administrator -Managed team of 12 professionals. Quickly responded to staff and client inquiries. Thoroughly investigated past due invoices and minimized number of unpaid accounts. Recorded and filed patient data and medical records. Appropriately and correctly identified errors and re-filed denied/rejected claims as they were received from the Patient Account Representative. Confirmed patient information, collected copays and verified insurance. Completed appeals and filed and submitted claims. Posted charges, payments and adjustments.