Organized Healthcare Administration professional with foundation in revenue cycle solutions management with strong project development, implementation and management skills. Over ten years experience in a healthcare administration business office setting. Advanced medical terminology knowledge. Health insurance professional with background in preregistration, insurance verification, prior authorization, billing, insurance follow up, plan contracts, disputes/appeals and collections, records management and maintenance. Desires a role in a professional business setting or environment.
Acted as a liaison between the business department, billers and third party payers in resolving billing and reimbursement accuracy. Handled high level and detailed projects from implementation to completion. Provided mentoring to all levels of Specialists. Actively maintained current working knowledge of CPT and ICD-9 coding principles, government regulation, protocols and third party requirements regarding billing. Interacted with providers and other medical professionals regarding billing and documentation policies, procedures and regulations. Proficiently identified, calculated, and pursued the reimbursement for all contract terms including stop loss, cost pass through items and fee schedules. Confidently and adeptly handled claim denials and/or appeals. Examined patients' insurance coverage, deductibles, possible insurance carrier payments and remaining balances not covered under their policies when applicable.
Handled all Physical, Occupational, and Speech Therapy claims billing follow up with commercial, managed care, and government insurance. Obtained physician referrals for Therapy. Assisted in the maintenance of medical charts and/or electronic medical record (filing, Op Reports, test results, home care forms). Prepared patient charts, pre-screening and consent forms as necessary. Reviewed, analyzed and managed coding of diagnostic and treatment procedures contained in outpatient medical records. Managed collections claims for unpaid bills against the estates of debtors. Identified and resolved patient billing and payment issues. Printed and reviewed monthly patient aging report and solicited overdue payments.
Billing and follow up on DME and home health equipment claims. Precisely completed appropriate claims paperwork, documentation and system entry. Meticulously identified and rectified inconsistencies, deficiencies and discrepancies in medical documentation. Verified patients' eligibility and claims status with insurance agencies. Posted and adjusted payments from insurance companies.
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