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Hospital Revenue Cycle Specialist Resume Example

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HOSPITAL REVENUE CYCLE SPECIALIST
Professional Summary

Continue to utilize my knowledge and experience in the healthcare revenue Cycle field, while helping to create a positive image in the workplace. Provide high standards of professionalism to clients and to help grow and be successful with an organization

Skills
  • Proficient in MS Word 2000 XP, Excel, PeopleSoft, Vision, Lawson, Hyland
  • Emdeon, Visnetic, 3M Coding system, Meditech, Host, Artiva, OnBase
  • EMR and Electronic Health Records
  • Synergy, Passport, HPF, Relay Billing System, CMS 1500/UB04, HIPAA, ICD 9/10, CPT, Medicare DDE, Ability, HCS, eSolutions, WellSky
  • Medicaid, Medicare and private insurance claims, Insurance billing and collections
  • EDI, payer rejections, Clear housing
  • Accounts receivable
  • CMS
  • CPT
  • Customer service
  • Flexibility
  • ICD 10
  • Insurance verification
  • Medical Coding
  • Word processing
  • Time Management
  • Professional telephone Etiquette
  • Ability to multi task in a fast paced environment
  • Result driven
  • Detail orientated
Work History
Hospital Revenue Cycle Specialist, 07/2019 to Current
Engie – Maine , ME
  • Evaluated patients' financial status and established appropriate payment plans
  • Post and adjust payments from insurance companies
  • Review monthly patient aging report for unpaid payments
  • Locate errors and promptly refile rejected claims
  • Communicate with patients for unpaid claims for HMO, PPO and private accounts and delivered friendly follow-up calls to ensure proper payments are made according to contracts
  • Perform targeted collections on past due accounts aged over 30 days
  • Track pending authorizations to ensure timely resolution and avoid revenue loss
  • Appropriately respond to payor denials through written, verbal appeals processes, corrected/voided claims and /or any other payor specific denial process
  • Submission of 837 files, resolve CCI edits for CMS 1500 claims and UB04
  • Communication with clearinghouse, Medicare, Medicaid, secondary UB04 and 1500 form from the electronic billing system
Billing Specialist-Remote , 09/2013 to 07/2019
Maximus, Inc. – Falls Church , VA
  • Process hospital claims electronically to insurance carriers; Work all billing errors including Medicare and Medicaid Government payers
  • Submit electronic insurance rejects to resubmit with corrected insurance information
  • Attach I-bills, ER records, implant invoices to paper billing when required
  • Submit adjustment requests to Medicaid through online automated system
  • Utilize monthly aged accounts receivable reports to follow up on claims
  • Ensure all claims are submitted with a goal of zero errors and decrease bad debt write offs
  • Follow up to correspondence from insurance carriers
  • Credit or debit late charges through adjustment/voids or write off
  • Research medical billing discrepancies for claims, appeals and denials
  • Review insurance eligibility and prior authorization for commercial, Medicaid and Medicare insurance
  • Maintain effective communication with all staff and management team
  • Examine patients' insurance coverage, deductibles, co-pay, insurance carrier payment and remaining non covered balance
  • Resolve accounts for underpayment/over payments to reconcile figures and review Remits/ EOB
  • Maintain and resolve all issues and concern with staff and client
Outpatient Medical Coder, 06/2011 to 09/2013
Capital Vacations – Jensen Beach , FL

Proficiency in assigning accurate medical codes for diagnoses, procedures and services performed in the outpatient setting (emergency department visits, occupational therapy and speech therapy.
Correctly complete CMS 1500 for ASC services and UB04 for outpatient services, including modifiers.
Able to accurately abstract information from the medical records into the abstract system according to established guidelines.
Ensures codes are assigned in compliance with Federal, State and other coding guidelines.
Maintain 95% accuracy and productivity standards defined by department policy.
Keep abreast of coding guidelines and reimbursement reporting requirements.

Collections Specialist, 01/2008 to 06/2011
Parallon Business Solutions – City , STATE
  • Perform day to day overall management of patient accounts and collection receivables
  • Document all telephone and correspondent communications with third-party payors and guarantors Maintain weekly communication with Manager, staff and comply with department workflows and guidelines
  • Prioritizes and work proactively on accounts in assigned work queue to ensure all accounts are submitted in a timely manner
  • Maintain update knowledge of third party payor regulations of both state and federal guidelines
  • Perform insurance follow up on unpaid accounts for payment and resolution
  • Establish and maintain a high level of customer service approach working with all patients
Education
Property and Casualty Insurance, 2018
R.S. Thomas Training Associates - City, State
Medical Coding Certificate / Atlanta, GA may
Bachelor of Business Administration: Accounting, 2004
City, State
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How this resume score could be improved?

Many factors go into creating a strong resume. Here are a few tweaks that could improve the score of this resume:

67Fair
Resume Strength
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  • Length
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Resume Overview

School Attended

  • R.S. Thomas Training Associates

Job Titles Held:

  • Hospital Revenue Cycle Specialist
  • Billing Specialist-Remote
  • Outpatient Medical Coder
  • Collections Specialist

Degrees

  • Property and Casualty Insurance , 2018
    Medical Coding Certificate / Atlanta, GA may
    Bachelor of Business Administration : Accounting , 2004

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