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Administration Specialist I Resume Example

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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 2015
    Asm 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 2014
    Badger Daylighting - Boston , MA
    Collection Specialist
    November 2011 to August 2014
    Badger 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 2011
    Actua 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 2010
    Res-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 2006
    Iqvia 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 2003
    Bay 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

    Build Your Own Now

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    Resumes, and other information uploaded or provided by the user, are considered User Content governed by our Terms & Conditions. As such, it is not owned by us, and it is the user who retains ownership over such content.

    How this resume score could be improved?

    Many factors go into creating a strong resume. Here are a few tweaks that could improve the score of this resume:

    75Average
    Resume Strength
    • Completeness
    • Formatting
    • Word choice
    • Measurable results
    • Strong summary
    • Clear contact info
    • Typos

    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

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