Revenue Cycle Management Specialist with 14 years experience in hospital inpatient/outpatient billing, coding and insurance follow-up. Familiar with commercial and private insurance carriers. Desire a position in Revenue Cycle Management.
Thoroughly investigated past due invoices and minimized number of unpaid accounts.
Carefully reviewed medical records for accuracy and completion as required by insurance companies.
Examined diagnosis codes for accuracy, completeness, specificity and appropriateness according to services rendered.
Acted as a liaison between the business department, billers and third party payers in resolving billing and reimbursement accuracy.Appropriately and correctly identified errors and re-filed denied/rejected claims as they were received from the Patient Account Representative.Thoroughly reviewed remittance codes from EOBS/AR's.Confirmed patient information, collected copays and verified insurance.Completed appeals and filed and submitted claims.Posted charges, payments and adjustments.Applied payments, adjustments and denials into medical manager system.Submitted refund requests for claims paid in error.Ensured timely and accurate charge submission through electronic charge capture, including the billing and account receivables (BAR) system and clearing house.Meticulously tracked and resolved underpayments.Performed quality control of the data entry system to verify that claims and payments were posted correctly.Remained up-to-date with all insurance requirements, including the details of patient financial responsibilities, fee-for-service and managed care plans.Prepared and attached all required claims documentation including referrals, treatment plans or other required correspondence to reduce incidence of denials.Demonstrated analytical and problem-solving ability by addressing barriers to receiving and validating accurate HCC information.
Health Information Administration coursework
accounting, benefits, billing, billing system, closing, CMS, excellent communication, interpersonal skills, CPT, clients, customer satisfaction, diagnosis, documentation, forth, general office, ICD-9, Inpatient Coder, insurance, JD Edwards, logging, Medical Billing, medical coding, medical terminology, Office, organizational, personnel, policies, processes, coding, protocols, reconciling, sales, supervisor, Unique, Validation
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