Medical Billing And Credentialing Specialist Resume Example G & S PT LLC

MEDICAL BILLING AND CREDENTIALING SPECIALIST

Professional Summary

Diligent and skilled medical biller/credentialing specialist with solid experience and knowledge in the medical field. Highly ambitious motivated person seeking for a company who can offer growth for their team members. Familiar with the following software and vendors, Medisoft, Ez-Bis, Navinet, WebPT, Novitasphere,and Emdeon-Change HealthCare. I'm looking to be part of a great team where i can utilize my strong work ethics and skills as a medical biller and credentialing specialist.

Skills

Self-motivated and great problem solver
In-depth knowledge of medical terminology, billing procedures, and insurance guidelines
Knowledge of medical coding terminology and billing standards and practices
Possess excellent leadership, communication, and management skills
Experience 10 years in field of medical billing for multi specialty physicians
Strong ability to analyze with deep knowledge of billing, medical terminology,Medicaid,Medicare,Commercial Insurance, Worker Compensation, PIP Claim's, etc
Exceptionally good at dealing customer's queries and complaints with strong power to resolve problems
Profound ability to demonstrate and presentation with good interpersonal skills
Staff development plans

Great communication skills both verbally and written
Insurance credentialing processes
Provider enrollment
Training and development
File and records management
Business Administration, Microsoft Excel,Organizational Skills
Medical billing and coding
Business operations

Work History

May 2018-CurrentMedical Billing and Credentialing Specialist | G & S PT LLC | Paterson, New Jersey

Accurately posted and sent out all medical claims
Maintained and updated collections tracking spreadsheet to help organize payment information
Precisely evaluated and verified benefits and eligibility
Posted and adjusted payments from insurance companies
Printed and reviewed monthly patient aging report and solicited overdue payments
Researched CPT and ICD-10 coding discrepancies for compliance and reimbursement accuracy
Precisely completed appropriate claims paperwork, documentation and system entry
Determined prior authorizations for medication and outpatient procedures
Promptly sent out and posted all medical claims
Evaluated patients' financial status and established appropriate payment plans
Managed collections claims for unpaid bills against estates of debtors
Managed invoicing and payment processing operations
Executed billing tasks and recorded information in company databases
Obtained NPI numbers for providers and facilities and updated existing profiles
Received and evaluated applications to look for missing and inaccurate information
Enrolled providers and Medicaid, Medicare and private insurance plans
Received and evaluated applications to look for missing and inaccurate information.
Enrolled providers and Medicaid, Medicare and private insurance plans.

March 2009-April 2019Medical Billing Manager | Sportsmed Physical Therapy | 784 Franklin Avenue, NJ

Worked for over10 years directly with health insurance companies, insurance handlers, claim adjuster, supervisor's ,patients ,medical providers, hospitals, attorneys and staff to achieve best possible result's to improve company revenue
Handling cash and entering accurate records for billing procedures for multiple accounts
Handle multi provider credential's efficiently ,as well as insurance credentialing for participating and non participation providers
Perform responsibilities of managing and controlling department budget, cash flow, and account receivables
Responsible for maintaining billing procedures, electronic billing functions as well as ensuring accurate billing activities
Assigned responsibilities of supervising billing staff and establishing implementing standard medical billing procedures
Prepare and distributed customer's invoice and bills
Responsible for analyzing, researching and resolving customer issues
Conducted research and reconciliation on numerous billing issues
Manages reconciliation of accounts receivable on daily basis
Responsible for Medicaid ,Medicare, All commercial insurance's ,Workers Compensation, Medical Pip Claims billing utilizing Medisoft and Ez-bis software management system
Responsible for interview, hire and train medical billing staff
Responsible for maintenance of customer bills and special reports, answer customer queries, complaints and problems on phone
Manage multiple accounts efficiently for multiple doctors
Billing and coding for ,Acupuncture,Occupational, Chiropractic, and Physical Therapy services
Handle multiple appeals to insurance carriers, follow ups on medical bills submitted to insurance carrier's, insurance verifications, manage patient scheduling, assisted patients with insurance problems as best possible
Analyze multi practice revenue and collections on monthly basis, arbitration handler, investigated new ways to improve billing production, entered new demographics to system, data entry savvy, generated multi reports for production purposes
Precisely evaluated and verified benefits and eligibility
Conducted orientation sessions and organized on-the-job training for new hires.

January 2008-May 2009Point of Sale Associate | Love Culture Inc. | Wayne, NJ

Checked prices for customers and processed items sold by scanning barcodes.
Helped customers complete purchases, locate items and join reward programs to promote loyalty, satisfaction and sales numbers.
Restocked, arranged and organized merchandise in front lanes to drive product sales.
Operated cash register for cash, check and credit card transactions with accuracy.
Helped guests every day by processing payments, monitoring reward accounts and resolving service concerns.
Assisted customers with special services, account updates and promotional options.
Maintained current knowledge of store promotions and highlighted sales to customers.
Counted cash in register drawer at beginning and end of shift.
Increased sales [20]% by offering advice on purchases and promoting additional products.
Mentored new team members on POS system operation, customer service strategies and sales goals.

Education

2019Bachelor of Arts: FinanceWilliam Paterson University , Wayne, NJ

June 2009Certification : Medical Billing And Coder Berdan Institute , Wayne, NJ

Resume Overview

Companies Worked For:

G & S PT LLC
Sportsmed Physical Therapy
Love Culture Inc.

School Attended

William Paterson University
Berdan Institute

Job Titles Held:

Medical Billing and Credentialing Specialist
Medical Billing Manager
Point of Sale Associate

Degrees

Bachelor of Arts : Finance
Certification : Medical Billing And Coder

Medical Billing and Credentialing Specialist Resume Example

Resume Score: 80%

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