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medical bill processor resume example with 20+ years of experience

Jessica Claire
  • Montgomery Street, San Francisco, CA 94105 609 Johnson Ave., 49204, Tulsa, OK
  • H: (555) 432-1000
  • C:
  • resumesample@example.com
  • Date of Birth:
  • India:
  • :
  • single:
  • :
Summary

Professional Skills:




Committed and motivated Billing Specialist with exceptional customer service and decision making skills. Strong work ethic, professional demeanor and great initiative.

Highlights
  • Strong work ethic
  • Team player with positive attitude
  • Good written communication
  • Exercises good judgment
  • Medical terminology
  • Medical billing
  • Meticulous attention to detail
  • Results-oriented
Experience
Medical Bill Processor, 11/2014 - Current
Sedgwick Claims Management Services, Inc. Santa Rosa, CA,

•Responsible for making bill review processing determination according to rules and regulations and or third party partner.

•Evaluates medical bills and corresponding EOR's for accuracy and compliance with state mandated fee schedule(s) and our business rules and guidelines.

•Reviews inpatient hospital, outpatient hospital and multiple surgery billings

.•Refers to reference library of fee schedules, CPT, ICD-9 (10), HCPCS and other industry publications to support findings.

•Apply contracted rates for specialty network and pricing bills.

•Identifies system and/or bill review processing issues and reports findings to Supervisor or Manager.

•Demonstrates a dependable work ethic.

•Manages confidential client information with discretion and good judgment in accordance with department and company guidelines.

•Collaborates with supervisor to develop skills and knowledge.

•Responds to written or verbal provider inquiries relating to our bill review analysis. Analyzes problems using problem solving methodology skills to determine root cause; communicates and implements solutions.


A/R Specialist, 03/2014 - 05/2014
Dlt Solutions, Inc. Phoenix, AZ,
  • Review of workers compensation claims from froi
  • Review of physician's operative reports and charge entry sheets to ensure correct diagnosis and procedure codes are billed
  • Review of patient's workers compensation case file via bwc website to ensure diagnosis codes are allowed
  • Assigned additional diagnosis codes based on specific clinical findings (laboratory, radiology and, pathology reports as well as clinical studies) in support of existing diagnoses.
  • Analyzed and interpreted patient medical and surgical records to determine billable services.
  • Added modifiers as appropriate and verified diagnoses.
Self Pay & Collections Coordinator, 09/2012 - 09/2013
Gallagher Bassett Nz Ltd El Centro, CA,
  • Communicated with patients via phone, email and in person to obtain payments on outstanding accounts or accounts requiring deductibles or co-pays.
  • Thoroughly investigated past due invoices and minimized number of unpaid accounts.
  • Posted charges, payments and adjustments.
  • Carefully prepared, reviewed and submitted patient statements.
  • Consistently informed patients of their financial responsibilities prior to services being rendered.Performed quality control of the data entry system to verify that claims and payments were posted correctly.
Accounts Specialist, 2009 - 08/2009
Kemper Berkeley, CA,
  • Performed full-cycle medical billing in a fast-paced medical billing company.
  • Prepared and attached all required claims documentation including referrals, treatment plans or other required correspondence to reduce incidence of denials.Remained up-to-date with all insurance requirements, including the details of patient financial responsibilities, fee-for-service and managed care plans.Submitted refund requests for claims paid in error.
  • Applied payments, adjustments and denials into medical manager system.Posted charges, payments and adjustments.
  • Completed appeals and filed and submitted claims.
  • Confirmed patient information, collected copays and verified insurance.
  • Thoroughly reviewed remittance codes from EOBS/AR's.
Medical Claims Processor, 08/2001 - 2009
Acco Engineering Systems Santa Cruz, CA,
  • Evaluated the accuracy of provider charges, including dates of service, procedures, level of care, locations, diagnoses, patient identification and provider signature.
  • Posted charges, payments and adjustments.
  • Ensured timely and accurate charge submission through electronic charge capture, including the billing and account receivables (BAR) system and clearing house.
  • Applied payments, adjustments and denials into medical manager system.
  • 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.
Billing Specialist, 01/1990 - 04/2001
First National Life Insurance City, STATE,
  • 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
  • Thoroughly reviewed remittance codes from EOBS/AR's.
  • Evaluated the accuracy of provider charges, including dates of service, procedures, level of care, locations, diagnoses, patient identification and provider signature.
  • Applied payments, adjustments and denials into medical manager system.
  • Remained up-to-date with all insurance requirements, including the details of patient financial responsibilities, fee-for-service and managed care plans.
  • 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.
Education
Diploma: Advanced Computer Applications, Expected in 1992
-
Riley College - ,
GPA:
Status -

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Resume Overview

School Attended

  • Riley College

Job Titles Held:

  • Medical Bill Processor
  • A/R Specialist
  • Self Pay & Collections Coordinator
  • Accounts Specialist
  • Medical Claims Processor
  • Billing Specialist

Degrees

  • Diploma

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