Administration Specialist I Resume Example Asm America Inc.

ADMINISTRATION SPECIALIST I

Skill Highlights

Knowledge of HMOs, Medicare and Medi-Cal
Managed care contract knowledge
ICD-9 coding/ ICD-10 coding
Electronic Medical Record (EMR) software
Maintains strict confidentiality
CPT and HCPCS coding
Medical billing software

Professional Summary

Highly efficient Medical Biller with experience with Medicare and private insurance billing and verification, Excellent multi-tasker and demonstrated team player with a positive attitude. Seeking a position in Medical Billing and Insurance Verification.

Professional Experience

Administration Specialist I
August 2014 to October 2015Asm America Inc. - Boise , ID

Carefully review and analyze Contract Quick Reference Guides used by all departments for billing and collection.
Interpret payer rules and guidelines for Multiple Insurance Companies to appropriate setup in the Company'sContract and Item Master.
Research and analyze daily contract and item master request submitted by the billing center on issues.
Perform daily maintenance and administration of claims submission and set up.
Analyze request to ensure proper claims submission via electronic or paper (invoices or 1500's).
Review assigned Contract to Global Carrier linked to assure correct setup so the appropriate payer rules and pricing are extracted.
Review pricing maintenance and administration to Contract and Item Master as required.

Collection Specialist
November 2011 to August 2014Badger Daylighting - Boston , MA

Collection Specialist
November 2011 to August 2014Badger Daylighting - Buffalo , NY

Perform review of Medicare claims for denial of payment.
Resubmit claims missing documents required for Medicare approval.
Submit request for reimbursement to the Payments Department for overpaid Medicare accounts.
Review correspondence letters from Medicare and take appropriate action needed on individual claims.
Call Doctors' office to verify ICD-9 and CPT codes used on non-paying claims.
Call Medicare to get clarity on missing documents or request update on a claim Call patients when need for updated insurance information or any changes to resubmit claims Setup request for Medicare Appeals Court for final attempt of approval.
Process Financial Assistance applications to qualifying patients in financial crisis.
Update doctors' NPI and tax ID information when alerted by the system.
Work weekly AR (Aging Report) and Over/Under Report on assigned accounts.
Post payments for the Payments department on the end the month for closing.
Load CMN and SOP in the system for CMN department on the end of the month closing.
Assist the Private Pay Insurance Team on Authorization or special projections.

Project Specialist
April 2010 to November 2011Actua Corporation - Tampa , FL

Verify patients' insurance eligibility for payment.
Setup patients in IMBS system for billing of equipment.
Verify ICD-9 and HCSPCS codes to see if it qualifies for billing the equipment.
Request CMN from physicians' office to process for billing.
Research patients' account for nonpayment of a claim.

Quality Assurance Specialist
February 2006 to April 2010Res-Care, Inc. - Concord , NH

Sort and verify documents listed on Batch-Work Control Sheet before processing.
Audit incoming paperwork for new and existing patient for billing setup.
Carefully view and verify the accuracy of the information in IMBS system with the documents receive to assure claims are submit properly for billing.
Alert the store of any errors on face to face or doctor's order that conflict with the store's paperwork.
Enter cash sales from store location for payment posting.
Verify correct ICD-9 and HCSPCS codes for insurance billing.

File Clerk Team Leader
July 2004 to February 2006Iqvia Holdings Inc - Shreveport , LA

Pull and return patient charts upon request.
Train new file clerks on filing system used.
Convert patient files coming from purchased companies.
Pull and ship off all inactive patient charts to warehouse.
Process labels in the system for new patients.
Oversee file clerks time cards for payroll.

Laboratory Associate
December 1997 to November 2003Bay Medical Center - City , STATE

Process Doctor's lab request on tested specimens.
Give fax or verbal results to Doctors once results are received.
Pick up lab work from contracted sites.
Process lab orders for billing for the hospital's medical records department.
Log and deliver specimens to prepare lab department for testing.
Verify insurance and ICD-9 codes for outpatient billing.
Pick up and log specimens from Operating Room for the Pathology department.
Open Outpatient Centers and register patients for lab work.
Close Outpatient Center and restock lab with supplies.

Education and Training

B.S. Degree : Business Administration, July 2015Columbia College - City, StateBusiness Administration

A.S. Degree : Office Systems Technology (Medical Management), July 2002Gulf Coast Community College - City, StateOffice Systems Technology (Medical Management)

Skills

AR, Billing, charts, closing, client, database, Financial, forms, ICD-10, ICD-9, ICD - 9, Insurance, Team lead, letters, notes, Excel, Microsoft Office, office, Outlook, Power Point, Word, Pathology, Pick, pricing, progress, Quality Assurance, Quick, Research, sales, tax, phones

Resume Overview

School Attended

Columbia College
Gulf Coast Community College

Job Titles Held:

Administration Specialist I
Collection Specialist
Project Specialist
Quality Assurance Specialist
File Clerk Team Leader
Laboratory Associate

Degrees

B.S. Degree : Business Administration , July 2015
A.S. Degree : Office Systems Technology (Medical Management) , July 2002

Administration Specialist I Resume Example

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