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Medical Billing and Follow-Up Specialist Resume Example

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MEDICAL BILLING AND FOLLOW-UP SPECIALIST
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, 05/2011 to 07/2014
 EGS Corporation – Phoenix, AZ
  • 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, 01/2009
New Electric – Phoenix, AZ
  • 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, 01/2008 to 01/2009
 Circle K Corp – Phoenix, AZ
  • Cashier duties including but not limited to shift cash reporting and accuracy.
  • Receiving, stocking of inventory and theft reporting.
Electrician/Field Technician, 01/1998 to 01/2007
 RB Electric/RDB Construction – Phoenix, AZ
  • 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, 01/1998 to 01/1998
 Jennifer Loomis & Assoc./OSI Inc – Phoenix, AZ
  • 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, 01/1994 to 01/1998
 Jennifer Loomis & Assoc./OSI Inc – Phoenix, AZ
  • 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: 1988
 Pembroke Academy - NH
Special emphasis was placed on accelerated Math and Science courses.
ABA General Banking Diploma: 1 1991
 New Hampshire Technical Institute - Concord, NH
Macro and Micro Economics, The Federal Reserve System, Bank Lending and Overall banking operations.: Electrical Engineering, 1 1993
 DeVry Institute of Technology - Phoenix, AZ
 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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Resume Overview

Companies Worked For:

  • EGS Corporation
  • New Electric
  • Circle K Corp
  • RB Electric/RDB Construction
  • Jennifer Loomis & Assoc./OSI Inc

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
  • WIN System Administrator
  • Medical Biller/Team Leader

Degrees

  • High School Diploma : 1988
    ABA General Banking Diploma : 1 1991
    Macro and Micro Economics, The Federal Reserve System, Bank Lending and Overall banking operations. : Electrical Engineering , 1 1993

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