Advanced Medical Biller resume example with 20+ years of experience
JessicaClaire
, , 609 Johnson Ave., 49204, Tulsa, OK100 Montgomery St. 10th Floor
Home: (555) 432-1000
Cell:
resumesample@example.com
Summary
Organized Advanced Medical Biller with 20+ year career performing difficult multitasking and claims-processing tasks. Hands on experience in account management and medical billing and coding from start of the billing cycle to finish. Familiar with processing online appeals, refund requests and billing audit information. Brings can-do attitude to collaborating with medical professionals, insurance providers, clerical staff and clients to handle billing and coding related charges and inquiries. Accustomed to answering questions, providing information and resolving concerns.
Advanced Medical Biller, 09/2010 to Current Wsp – Manchester, NH,
Examine diagnosis and procedure codes for accuracy, completeness, specificity and appropriateness according to services rendered.
Verify proper coding, sequencing of diagnoses, and accuracy of procedures. Return coding errors found on claims back to HRG (our outsourced coding agency) for correction or further review.
File and submit insurance claims after thorough review of coding and billing rules for each insurance type.
Maintain current working knowledge of CPT and ICD-10 coding principles, government regulation, protocols and billing requirements, which includes continuing education and certification renewal.
Research, and maintain coding and billing reimbursement periodicals, LCD's, NCD's, insurance policies, and updates and collaborate with coding and billing team to confirm no additional diagnosis codes available for LCD and NCD coverage.
Communicate with insurance companies to Investigate rejected and denied claims, correcting applicable coding and rebilling as needed.
Quickly respond to front desk and call center staff inquiries pertaining to the proper set up of insurance and/or to verify eligibility and provider network status.
Respond to patient requests for billing statement clarification and correction of billing/coding errors.
Research and verify workers comp and Auto Injury claims to confirm patient and insurance information is accurate and complete.
Review requests for refunds and recoupment of payments from insurance companies and determine if the request is appropriate. Proceed with either disputing the request or refunding the overpayment.
Work with physicians, clinic staff and leadership to identify and develop process improvements with billing and collections.
Maintain spreadsheet to track Maternity Care services for proper capture of RVU's for accurate physician reimbursement and billing to insurances.
Maintain spreadsheet to track provider writeoffs related to procedures that do not meet medical necessity requirements of Medicare LCD's, NDC's and MCD guidelines.
Conduct extensive research into RHC specific guidelines for appropriate billing. Communicate the information with other team members and departments.
Medical Coder/Biller/Collector, 12/2004 to 12/2009 UCI Medical Center – City, STATE,
Independently performed professional fee ICD-9 and CPT coding for multiple billing specialties (Ophthalmology, Dermatology, Gastroenterology, Oncology)
Exercised professional coding judgment consistent with government and private payer requirements to ensure codes/modifiers are appropriate and assure maximum reimbursement
Maintained accurate and up-to-date logs of error or problematic coding trends that negatively impact collections
Provided assistance to other staff and physicians with coding issues that extended from dictated reports, chart notes, procedures, encounter forms, and error billing reports (scrubber)
Provided collections functions on outstanding insurance claims and noted accounts of appropriate actions.
Senior Office Administrator, 12/1998 to 12/2004 Associated Therapists, Inc – City, STATE,
Collected new patient information and ensured completion of all required forms
Verified patient eligibility and benefits and obtained medical authorizations as needed
Prepared and filed medical insurance claims and patient statements
Ensured full payment of amount due had been collected from both patient and insurance company
Initiated follow-up procedures when full payment was not received
Managed the completion and maintenance of client accounts
Performed general administrative duties, managing multiple projects and priorities as required.
Education and Training
Certified Professional Coder (CPC): Medical Coding, Expected in 04/2009 American Academy of Professional Coders - , GPA:
Master of Science (MS): Counseling, Expected in 01/2004 California State University - Fullerton - Fullerton, CA GPA:
Bachelor of Arts (BA): Psychology, Expected in 06/2001 California State University, Fullerton - Fullerton, CA, GPA:
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