Billing Representative PPO/Worker Resume Example Comp Sutter Hospital

BILLING REPRESENTATIVE PPO/WORKER

Professional Summary

To obtain a position in a Billing Process and Patient Access Representative where my skills, education, and training will be utilized to gain experience as well as professional growth opportunities

Professional Experience

11/2013 to 02/2016

Billing Representative PPO/WorkerComp Sutter Hospital

Responsible for verifying all PPO insurances including BlueCross, BlueCross out of State, BlueShield, BlueShield out of State, Aetna, Cigna, Heath Net, United Health Care, and decide which carrier code and upload in DI, then update in MS4 system.
Responsible to fix all the rejecting claims including CPT, Units, Modifiers.
Follow up and update the carrier codes, check eligibilities and resend the claims in Cirius system.
Responsible to fix all the errors on the claim in Cirius system including missing physician names, NPI, Taxonomy, payor address, payor electronic ID, patient information, unit, or modifier, ect...
Release the claim for primary insurance.
Responsible to release the secondary insurance claims attached EOBs and send to insurance.
Responsible to open OTR for missing charges, CPTs, or medical records.
Follow up and check email from customer service or account representatives for updated information and send claims to the insurances.

11/2012 to 11/2013

Pre-billing Representative/PPO/Workers CompensationSutter Hospital

01/2000 to 07/2011

Medical Biller Phillip Tse and Daniel － MD

Responsible to verify eligibility for inpatient, outpatient, and emergency room for all PPO insurance (BlueCross, BlueShield, Aetna, Cigna, Health Net, United Health Care, and Human) and decide which carrier code to use.
Validate Worker Compensation billable informations.
Follow up authorization of inpatient and outpatient by website or call insurance and request clinical for review to certify the authorization.
Request medical record if insurance denied the authorization for appeal.
Strong ability to analyze with a deep knowledge of billing, medical terminology, Medi-Cal, Medicare, HMO (PMG, SCIPPA), PPO (BlueCross, BlueShield, Aetna, Cigna), etc.
Performed billing with Encounter Manager software and Fox Meadows Software.
Entered super bills for outpatient, inpatient, & nursing home patients in system, transmit claims to the clearing house, handled all insurance records.
Responsible for the analyzing, researching and resolving the customer issues.
Registered patient record in the system, scheduled patients appointments.

Education and Training

10/2012

Medical Billing and Coding TechSkills of California

Skills

billing, CPT, customer service, email, insurance, Medical Billing, medical terminology, nursing home, Coding, researching, website

Resume Overview

Companies Worked For:

Comp Sutter Hospital
Sutter Hospital
Medical Biller Phillip Tse and Daniel

Job Titles Held:

Billing Representative PPO/Worker
Pre-billing Representative/PPO/Workers Compensation

Degrees

Medical Billing and Coding TechSkills of California

Billing Representative PPO/Worker Resume Example

Resume Score: 90%

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