Dedicated, result-driven and well-organized professional with the 7+ years of extensive experience developing and implementing initiatives to ensure that claims are accepted by health insurance companies and payments are being released. Highly skilled at processing claims to collect payments, answering billing inquiries from patients, verifying insurance coverage and reviewing denied claims. Outstanding communicator who can easily build influence and consensus with professionals of all levels and backgrounds. CORE COMPETENCES Extensive experience in patient relationship management, accounts maintenance and records management In-depth knowledge of electronic billing systems Outstanding ability to multitask in fast-paced environments and respond quickly and effectively to problems Strong working knowledge of Managed Care Companies' eligibility requirements and obtaining pre-authorizations Exceptional customer service skills with proven ability to plan, prioritize and organize work to meet deadlines Excellent organizational, people and time management abilities Strong communication, negotiation and interpersonal skills Demonstrated ability to follow-through and handle multiple tasks simultaneously Proficient in the use of computer applications like Microsoft Office Suite, Experian/MPV, IDX, Crown (EHR), IDEAS HER) KEY AREAS Multi-line Phone System Records Management Payment Administration Patient Scheduling Examination Preparation Medical Procedures Workers Comp & Motor Vehicle Medical Billing & Processing Referral Processing
Authorization Specialist / Medical Biller January 2014 to CurrentCenter for woman's Reproductive Care at Columbia University SEP
Develop systems to properly verify insurance eligibility and to ensure that all pre-certification, authorization and/or referral required by the managed care companies are obtained prior to the appointment.
Manage high call from both inbound and outbound call from call center.
Maintain constant positive communication with patients, faculty practice managers, clinicians, and office staff to obtain patient information and any clinical documentation required for authorization approval.
Monitor operations and activities of the center to ensure conformity to all applicable HIPAA, Billing Compliance and safety policies and guidelines.
Professionally handle all escalations pertaining to the authorization, eligibility and registration process to improve patients' satisfaction.
Coordinate all aspects of securing accounts to include pre-registration, eligibility, benefits, and authorization for scheduled and/or same day appointments.
Checking patients in/out with their appointment Increase revenue by securing payment via telephone, and financially clear accounts once payments have been finalized.
Streamline the process of identifying, correcting and selecting appropriate insurance Financial Status Clarification FSC) to improve productivity.
Utilize standard systems to document and update all registration, financial data and referral/authorization in IDX system and/or applicable system applications.
Identify and document all financial clearance issues through collection-specific coding and account notes for billing and follow-up communication Neurology Surgery P.C.
Island Professional Billing.
Medical Biller January 2013 to June 2014
Maintained and updated all files including insurance companies, diagnosis, procedure, fees/profiles.
Followed the guidelines to ensure compliance with local, state or federal laws and regulations.
Processed and audited workers compensation claims according to the various medical fee guidelines.
Minimized risks by identifying account discrepancies and issues that hindered claim payments.
Reviewed patient bills for accuracy and completeness, and provided insurance company with correct information.
Provided assistance to patients in understanding financial obligations and established payment arrangements for outstanding balances.
Supervisor February 2008 to January 2013Empire Medical Billing Solutions
Provided strategic leadership and direction to all billing paperwork and records management activities.
Monitored staff to ensure compliance with the organizations confidentiality policy in accordance to Health Insurance Portability and Accountability Act (HIPAA) regulations.
Leveraged expertise to direct patients and administered all medical history information.
Constantly interacted with physicians and staff members to increase office efficiency and minimize communication errors.
Ensured accurate records by preparing/executing payment batches and posting all payments into system with expediency.
Developed a strong orientation with CMS-1500, WC, Medisoft, Lytec, TCMS and Kareo.
Streamlined and optimized workflow processes by obtaining all pertinent patient information and ensured accuracy of all patient invoices and insurance claim forms.
Adjusted patient accounts to reflect insurance fee scheduling and submission procedures.
Drafted and prepared general correspondence including payment balance letters, insurance follow-ups, and office rejection letters.
Led efforts aimed at processing workers comp claims, motor vehicle billings as well as commercial insurance.
Education and Training
Certification in Medical Billing and Coding Specialist : 2010NY Medical Center
High School Diploma : 2005John Adams High School － NY