*Front Office Manager, Medical Billing Specialist, AR Insurance Follow-Up Rep Resume Example
Working knowledge of CPT, HCPCS, ICD-9, ICD-10 coding products. Familiar with commercial and private insurance carriers. Expertise in researching, correcting and follow up on claim errors/rejections in a timely manner. Seeks a position of increased responsibility and authority.
HIPAA Certified
Training on new ICD-10 coding changes
Skilled in preparation of written material; proficient in wide variety of hardware and software application; evaluation of documentation; scientific data collection and quality control; ability to learn complex paradigms in proficient and timely manner; skilled in the use and maintenance of general office equipment and computer literate in Microsoft Works including, but not limited to, Office Word, Excel, Access, PowerPoint, and Publisher; keen ability to understanding and focusing on clients' needs; ability to communicate effectively both verbally and in writing; Maintains strict confidentiality; Knowledge of HMOs, Commercial, Medicare, Medicare Replacement and Medicaid insurance; OB-GYN, surgery, gastro, ENT, ortho, and transplant experience; Extensive anatomy/physiology knowledge; Electronic Medical Record (EMR) software and ICD-9 coding expertise; Quality assessment of coded data; HIPAA compliant; Patient-focused care with strong work ethic; Good written communication skills and exercises good judgment |
December 2014 to July 2015The Cliffs Resort - Pismo Beach , CA
Thoroughly investigated past due invoices and minimized number of unpaid accounts.Demonstrated analytical and problem-solving ability by addressing barriers to receiving and validating accurate HCC information.Carefully reviewed medical records for accuracy and completion as required by insurance companies.Strictly followed all federal and state guidelines for release of information.Wrote clear and detailed clinical phone messages for physicians.Examined diagnosis codes for accuracy, completeness, specificity and appropriateness according to services rendered.Provided administrative support for twenty-five; Resolved and clarified billing issues with patients; Consistently ensured proper coding, sequencing of diagnoses and procedures.Acted as a liaison between the business department, billers and third party payers in resolving billing and reimbursement accuracy.Demonstrated knowledge of HIPAA Privacy and Security Regulations by appropriately handling patient information.Appropriately and correctly identified errors and re-filed denied/rejected claims as they were received from the Patient Account Representative.Appropriately and correctly identified errors and re-filed denied/rejected claims as they were received from the Patient Account Representative.Added modifiers as appropriate, coded narrative diagnoses and verified diagnoses.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.Prepared and attached all required claims documentation including referrals, treatment plans or other required correspondence to reduce incidence of denials.Efficiently performed insurance verification and pre-certification and pre-authorization functions.Performed full-cycle medical billing in a fast-paced medical billing company.
August 2014 to December 2014Department Of The Interior - Fort Washakie , WY
Efficiently performed insurance verification and pre-certification and pre-authorization functions.
May 2011 to July 2014PRACTICE PLUS - BAPTIST HEALTH - City , STATE
Prepared and attached all required claims documentation including referrals, treatment plans or other required correspondence to reduce incidence of denials.Performed full-cycle medical billing in a fast-paced medical billing company.Performed quality control of the data entry system to verify that claims and payments were posted correctly.Ensured timely and accurate charge submission through electronic charge capture, including the billing and account receivables (BAR) system and clearing house.Submitted refund requests for claims paid in error.Applied payments, adjustments and denials into NextGen system. Completed appeals and filed and submitted claims. Appropriately and correctly identified errors and re-filed denied/rejected claims as they were received. Strictly followed all federal and state guidelines for release of information.Carefully reviewed medical records for accuracy and completion as required by insurance companies.
July 2010 to May 2011THOMAS NEUROLOGY CLINIC - City , STATE
- Accounts Receivable (AR) - Pt Accounts and Insurance Follow-Up team Review, research & correct billing issues, file appeals and communicate directly with insurance companies on behalf of provider & patient/client in order to get claims paid correctly and in timely manner.
- Successfully met all monthly qualitative & quantitative productivity requirements set by employer.
- Daily use of software programs, which include CPU Medical Management System, Laserfiche Client 8.3, NaviCare EDI Gateway, AHIN, Avality, UAMS/BH/RadCon Intranet Outlook, NextGen (EHR, EPM), EDI Gateway, AHIN, EPIC, IMF and MS Office programs.
- Monus - electronic payment processing program Working knowledge of: CPT/ICD9 billing & coding, EOBs, Medicaid EOB, ABN, corrected claim and appeal procedure/guidelines required by individual payers Clinical front office manager including: patient check-in & check-out, data entry , charge & payment posting, scheduling, collections, billing, filing and front office purchasing.
October 2008 to July 2010EnviroTech Pollution Solutions - City , STATE
- Owner of environmentally conscious technology; outside sales and consulting specialist.
August 2005 to July 2008Arkansas Children's Hospital - City , STATE
- Performed Electroencephalograms (EEGs) in accordance with hospital supervised training & protocol, in both an outpatient and inpatient clinical hospital setting Managed lab MSDS records; verified equipment, chemical, supplies etc.
- met regulatory guidelines Primary computer lab operator/research assistant in Neurophysiology Dept.
- Brain Function Laboratory for Beginnings Study.
- Operated specialized EEG equipment, performed client/subject orientation and set-up/clean-up of subject and data collection sites Assisted in the development of SOP, inter-rater reliability testing, data collection & evaluation, data management, literature searches, etc.
- related to the 2D4D research project Responsible for Neurophysiology Departmental purchasing and lab supply inventory/stocking Office Automation Assistant Delta Nutrition Intervention Research Initiative.
August 1999 to August 2005Agricultural Research Service ARS - City , STATE
- Coordinated display of graphics and production of documents; assisted with design &.
- development of numerous posters, Power Point presentations for national and international conferences, public advertisements, flyers, brochures, briefing books, conference programs, etc.
- Writer & editor for federal publication "Focus on the Delta".
- Designed, developed and managed Access database used to track and monitor manuscript submissions.
Accounts Receivable, advertisements, AR, billing, brochures, hardware, computer literate, conferences, consulting, CPT, CPU, Client 8.3, client, clients, data collection, data entry, data management, documentation, editor, EDI, filing, writer and editor of Focus on the Delta newsletter, front office manager, Gateway software, general office, graphics, Insurance, Medical Management, Access, Access database, Excel, MS Office, Office, Outlook, PowerPoint, Power Point, Publisher, Word, Microsoft Works, Office Automation, outside sales, payment processing, posters, presentations, coding, publication, purchasing, quality control, Research, scheduling, scientific, SOP, supply inventory,
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Resume Overview
School Attended
- School for Field Studies (Northeastern University)
- Bethany College
Job Titles Held:
- *Front Office Manager, Medical Billing Specialist, AR Insurance Follow-Up Rep
- medical billing specialist - insurance follow-up rep
- AR Insurance Follow-Up rep - BlueCross BlueShield team
- Front Office Manager
- Business Owner and Independent Contractor
- Research Assistant and Neurophysiology Technician
- Office Automation Assistant
Degrees
- Select One : Adv. Wildlife Management Course - Kenya Africa , Summer 1990
Bachelor of Arts : Biology , May 1990
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