Montgomery Street, San Francisco, CA94105609 Johnson Ave., 49204, Tulsa, OK
Home: (555) 432-1000
Cell:
resumesample@example.com
Professional Summary
Certified Medical Billing Specialist with 8 years experience in a fast-paced, multiple client medical billing company. Researched and denied claims and submitted appeals. Familiar with health billing and collections.
Skills
Medical terminology expert
ICD-10 (International Classification of Disease Systems)
Billing and collection procedures expert
Hospital inpatient and outpatient records
Understands insurance benefits
Office support (phones, faxing, filing)
HCPCS Coding Guidelines
Familiar with commercial and private insurance carriers
Insurance and collections procedures
DRG and PC grouping
Composed and professional demeanor
Excellent problem solver
Close attention to detail
Work History
Medical Billing and Follow-Up Specialist, 04/2011 to 06/2014 Pgim Global Short Duration High Yield Fund, Inc. – Myrtle Beach, SC,
Medical claim billing and Follow-up with experience billing Medicare, Medicaid and Commercial Insurance.
Answering client inquiries and solving client problems.
Precisely completed appropriate claims paperwork, documentation and system entry.
Correctly coded and billed medical claims for various hospital and nursing facilities.
Meticulously identified and rectified inconsistencies, deficiencies and discrepancies in medical documentation.
Verified patients’ eligibility and claims status with insurance agencies.
Diligently filed and followed up on third party claims.
Researched questions and concerns from providers and provided detailed responses.
Researched CPT and ICD-9 coding discrepancies for compliance and reimbursement accuracy.
Maintained strict patient and physician confidentiality.
Resourcefully used various coding books, procedure manuals and on-line encoders.
Actively maintained current working knowledge of CPT and ICD-9 coding principles, government regulation, protocols and third party requirements regarding billing.
Conscientiously reviewed medical record information to identify appropriate coding based on CMS HCC categories.
Accurately posted and sent out all medical claims.
Submitted electronic/paper claims documentation for timely filing.
Performed billing and coding procedures for ambulance, emergency room, impatient and outpatient services.
Precisely evaluated and verified benefits and eligibility.
Responded to correspondence from insurance companies.
Posted and adjusted payments from insurance companies.
Confidently and adeptly handled claim denials and/or appeals.
Electrician/Field Technician, 2009 to Current New Electric – City, STATE,
Installation of residential and commercial wiring systems, customer service, troubleshooting and repair.
This included high voltage wiring, Telephone, CATV and Security Systems.
Up-to-date knowledge of current electrical codes was required.
Customer Service Representative, 2008 to 2009 Circle K Corp – City, STATE,
Cashier duties including but not limited to shift cash reporting and accuracy.
Receiving, stocking of inventory and theft reporting.
Electrician/Field Technician, 1998 to 2007 RB Electric/RDB Construction – City, STATE,
Installation of residential and commercial wiring systems, customer service, troubleshooting and repair.
This included high voltage wiring Telephone, CATV and Security Systems.
Up-to-date knowledge of current electrical codes was required.
WIN System Administrator, 1998 to 1998 Jennifer Loomis & Assoc./OSI Inc – City, STATE,
Building and maintaining medical billing system modifications as needed by the staff and management.
This included solving and correcting problems as they arise, writing reports based on user needs, creating and implementing improvements and helping users with specific questions or needs.
Training included 24 classroom hours as a System Administrator, using the FACS computer system.
M Technology, MS DOS, Windows95/98 and network knowledge are essential job functions.
Advanced working knowledge of Word, Word Perfect and Excel was also required.
Medical Biller/Team Leader, 1994 to 1998 Jennifer Loomis & Assoc./OSI Inc – City, STATE,
Precisely completed appropriate claims paperwork, documentation and system entry.
Correctly coded and billed medical claims for various hospital and nursing facilities.
Meticulously identified and rectified inconsistencies, deficiencies and discrepancies in medical documentation.
Adeptly managed a multi-line phone system and pleasantly greeted all patients.
Verified patients’ eligibility and claims status with insurance agencies.
Diligently filed and followed up on third party claims.
Determined prior authorizations for medication and outpatient procedures.
Performed qualitative analysis of records to ensure accuracy, internal consistency and correlation of recorded data.
Reviewed, analyzed and managed coding of diagnostic and treatment procedures contained in outpatient medical records.
Researched CPT and ICD-9 coding discrepancies for compliance and reimbursement accuracy.
Resourcefully used various coding books, procedure manuals and on-line encoders.
Actively maintained current working knowledge of CPT and ICD-9 coding principles, government regulation, protocols and third party requirements regarding billing.
Conscientiously reviewed medical record information to identify appropriate coding based on CMS HCC categories.
Accurately posted and sent out all medical claims.
Submitted electronic/paper claims documentation for timely filing.
Responded to correspondence from insurance companies.
Posted and adjusted payments from insurance companies.
Confidently and adeptly handled claim denials and/or appeals.
Prepared billing correspondence and maintained database to organize billing information.
Education
High School Diploma: , Expected in 1988 Pembroke Academy - NH, GPA: Special emphasis was placed on accelerated Math and Science courses.
ABA General Banking Diploma: , Expected in 1 1991 New Hampshire Technical Institute - Concord, NH GPA:
Macro and Micro Economics, The Federal Reserve System, Bank Lending and Overall banking operations.: Electrical Engineering, Expected in 1 1993 DeVry Institute of Technology - Phoenix, AZ GPA: Electrical Engineering Advanced Mathematics, Circuit Logic, Circuit Troubleshooting and Repair and Structured Computer Programming.
I hold a FCC Technician NC class amateur radio operator license, N1NVR (expires 12/2022). I also build, repair and upgrade computers in my spare time
Skills
banking, billing, Cashier, CPT, client, customer service, customer service, Economics, ICD-9, Insurance, inventory, Logic, Math, Mathematics, medical billing, medical terminology, medical terminology, Excel, Windows95, 98, Word, MS DOS, network, Computer Programming, coding, radio, Receiving, reporting, Structured, System Administrator, Technician, Telephone, Troubleshooting, upgrade, wiring, Word Perfect
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School Attended
Pembroke Academy
New Hampshire Technical Institute
DeVry Institute of Technology
Job Titles Held:
Medical Billing and Follow-Up Specialist
Electrician/Field Technician
Customer Service Representative
Electrician/Field Technician
WIN System Administrator
Medical Biller/Team Leader
Degrees
High School Diploma
ABA General Banking Diploma
Macro and Micro Economics, The Federal Reserve System, Bank Lending and Overall banking operations.
