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insurance and claims manager resume example with 13+ years of experience

Jessica Claire
  • Montgomery Street, San Francisco, CA 94105 609 Johnson Ave., 49204, Tulsa, OK
  • Home: (555) 432-1000
  • Cell:
  • resumesample@example.com
  • :
Summary

Billing Specialist with over 10 years of experience, committed to assisting others and able to work well in a high pressure environment. Skilled to work well in teams or independently. Skilled to direct and lead others to produce desired results. Knowledge of accounts receivable. Knowledge of office administrators and procedures. Proficient in relevant computer applications. Detail-oriented, observant and knowledgeable with excellent interpersonal and documentation skills. Skilled to efficiently handle high case volumes with accuracy and care.

Skills
  • Communications
  • Organization
  • Team building
  • Team management
  • Customer service
  • Supervision
  • Substance Abuse billing and coding
  • Provider billing and coding
  • Telemedicine modifiers
  • ICD 10 coding
  • CPT coding
  • Microsoft Office, including Word and Excel
  • Insurance billing, proficient with Maryland Medicaid and Multiple Commerical Insurance's.
  • Proficient in Incedo, Medical Mastermind, and Office Ally
Experience
Insurance and Claims Manager, 03/2019 to Current
Goodwill SeattleAlderwood, WA,
  • Submitted clean claims to reduce denial rates, following payer reimbursement policies and procedures.
  • Determined insurance coverage levels and restrictions by thoroughly examining claims forms and associated records.
  • Checked into questionable claims, interviewing agents and claimants to resolve errors and omissions.
  • Maintained current working knowledge of CPT and ICD-10 coding principles, government regulation, protocols and third-party billing requirements.
  • Determined prior authorizations for outpatient procedures.
  • Contacted insurance providers to verify correct insurance information and obtain authorization for proper billing codes.
  • Reviewed and verified benefits and eligibility with speed and precision.
  • Remained up-to-date with all insurance requirements, including details of patient financial responsibilities, fee-for-service and managed care plans by participating in training programs.
  • Prepared billing statements for patients, ensuring correct diagnostic coding.
  • Reviewed patients' insurance coverage, deductibles, possible insurance carrier payments and remaining balances not covered under policies.
  • Consistently informed patients of financial responsibilities prior to services being rendered.
  • Entered procedure codes, diagnosis codes and patient information into Office Ally.
  • Posted charges, payments and adjustments.
  • Obtained state of Maryland grants for those in need of funding.
  • Reconciled clinical notes, patient forms and health information for compliance with HIPAA rules.
Key Holder Supervisor- Part Time Position, 12/2017 to 02/2019
Docgo Inc.Gadsden, SC,
  • Stocked, replenished and organized inventory.
  • Provided customer service
  • Processed payments and maintained accurate drawers.
  • Made sure each register balanced out at the close of business.
  • Prepared bank deposit.
  • Greeted customers with a positive attitude and helped with locating items.
  • Processed returns and exchanges.
  • Operated cash register, collected payments and provided accurate change.
Medical Secretary/Billing Specialist, 09/2009 to 02/2019
Dr Ernesto TorresCity, STATE,
  • Addressed, documented, and responded to incoming correspondences to address client queries.
  • Updated patient financial information to promote accurate record keeping.
  • Managed medical practice administrative needs to provide patient satisfaction.
  • Managed front office customer service, appointment management, billing and administration tasks to streamline workflow.
  • Managed physician calendar, including scheduling patient appointments and procedures.
  • Maintained office supplies inventory by checking stock and ordering new supplies as needed.
  • Processed invoice payments and recorded information in account database.
  • Medical billing and coding.
  • Collected co-payment and deductible balances.
  • Contacted insurance providers to verify correct insurance information and obtain authorization for proper billing codes.
  • Proficient and familiar with ICD 10 coding and the use of modifiers when necessary.
  • Filed and submitted insurance claims.
  • Maintained knowledge of new or revised codes and industry regulations to complete accurate coding services, including local coverage determinations.
  • Reviewed all claims for accuracy and appropriateness.
  • Submitted claims to insurance companies.
Administrative Assistant, 09/2007 to 09/2009
Amber Hill Physical TherapyCity, STATE,
  • Scheduled and confirmed appointments.
  • Maintained several therapists schedules to be accurate and efficient.
  • Insurance verification
  • Collect co payments and deductible balances
  • Daily bank deposits from insurance payments
  • Enter charges to be billed
Education and Training
High School Diploma: , Expected in 06/1999 to Frederick High School - Frederick, MD
GPA:

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Resume Overview

School Attended

  • Frederick High School

Job Titles Held:

  • Insurance and Claims Manager
  • Key Holder Supervisor- Part Time Position
  • Medical Secretary/Billing Specialist
  • Administrative Assistant

Degrees

  • High School Diploma

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