Medical Billing Specialist Resume Example Delorenzi Orthopaedic Center

MEDICAL BILLING SPECIALIST

Professional Summary

Well rounded healthcare professional interested in transitioning from medical billing and collections into healthcare administration. Recently graduated with a Bachelors of Applied Science degree focusing on

Skill Highlights

Extensive knowledge of HMOs, Medicare, Medicaid, Tricare Nextgen software and the VA Electronic CPT and HCPCS coding ICD-9 coding Medical Record (EMR) software CPT and HCPCS coding Extensive knowledge of E-clinicals, NextGen, NexTech Multi-specialty billing Excellent written and oral communication skills Knowledge of Outlook, Power Point, Word and Excel

Professional Experience

Medical Billing Specialist10/2013 to 05/2015DeLorenzi Orthopaedic CenterViera, Florida

Thoroughly investigated past due invoices and minimized number of unpaid accounts.
Recorded and filed patient data and medical records.
Examined diagnosis codes for accuracy, completeness, specificity and appropriateness according to services rendered.
Carefully reviewed medical records for accuracy and completion as required by insurance companies.
Acquired insurance authorizations for procedures and tests ordered by the attending physician.
Scheduled patient appointments.
Accurately entered procedure codes, diagnosis codes and patient information into billing software.
Reviewed diagnostic and procedural terminology for consistency with acceptable medical nomenclature.
Consistently ensured proper coding, sequencing of diagnoses and procedures.
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 from insurance companies.
Added modifiers as appropriate, coded narrative diagnoses and verified diagnoses.
Thoroughly reviewed remittance codes from EOBS/AR's.
Completed appeals and filed and submitted claims.
Posted charges, payments and adjustments.
Submitted refund requests for claims paid in error.
Remained up-to-date with all insurance requirements, including the details of patient financial responsibilities, fee-for-service and managed care plans.
Ensured timely and accurate charge submission through electronic charge capture, including the billing and account receivables (BAR) system and clearing house.
Performed quality control of the data entry system to verify that claims and payments were posted correctly.

Patient Accounts Specialist06/2006 to 10/2012Wuesthoff Health Systems/HMARockledge, Florida

Accurately entered procedure codes, diagnosis codes and patient information into billing software.
Appropriately and correctly identified errors and re-filed denied/rejected claims as they were received.
Added modifiers as appropriate, coded narrative diagnoses and verified diagnoses.
Confirmed patient information, collected copays and verified insurance.
Evaluated the accuracy of provider charges, including dates of service, procedures, level of care, locations, diagnoses, patient identification and provider signature.
Completed appeals and filed and submitted claims.
Posted charges, payments and adjustments.
Applied payments, adjustments and denials into medical manager system.
Submitted refund requests for claims paid in error.
Carefully prepared, reviewed and submitted patient statements.
Ensured timely and accurate charge submission through electronic charge capture, including the billing and account receivables (BAR) system and clearing house.
Consistently informed patients of their financial responsibilities prior to services being rendered.
Kept 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.
Examined diagnosis codes for accuracy, completeness, specificity and appropriateness according to services rendered.
Scheduled patient appointments.
Acted as a liaison between the business department, billers and third party payers in resolving billing and reimbursement accuracy.

Office Manager03/2004 to 06/2006Brevard Medical GroupCocoa, FL

Carefully selected, developed and retained qualified staff, as well as trained 22 staff annually.
Jumped in to fill gaps for on call rotation when necessary.
Created annual goals, objectives and budget and made recommendations to reduce costs.
Actively maintained up-to-date knowledge of applicable state and federal laws and regulations.
Sourced and implemented new performance appraisal process.
Maintained physicians' contracts with various commercial insurance companies which included credentialing of new physicians as well as the re-credentialing of established physicians.
Minimized staff turnover through appropriate selection, orientation, training, staff education and development.
Evaluated patient care procedural changes for effectiveness.Kept abreast of advances in medicine, computerized diagnostic and treatment equipment, data processing technology, government regulations, health insurance changes and financing options.Analyzed facility activities and data to properly assess risk management and improve services.
Assigned staff to meet patient care needs and address productivity standards, while adjusting for census, skill mix and sick calls.

referral/authorization/pre-certification coordinator, appointment scheduler02/1996 to 06/2006Brevard Medical GroupCocoa, Fl

Recorded and filed patient data and medical records.
Carefully reviewed medical records for accuracy and completion as required by insurance companies.
Strictly followed all federal and state guidelines for release of information.
Acquired insurance authorizations for procedures and tests ordered by the attending physician.
Directed patient flow during practice hours, minimizing patient wait time.
Retrieved physician correspondence from dictation service and made edits when necessary.
Scheduled patient appointments.
Confirmed patient information, collected copays and verified insurance.
Efficiently performed insurance verification and pre-certification and pre-authorization functions.

Education and Training

Bachelor of Science: Health Services Administration2018Eastern Florida State CollegeCocoa, FL, USA

Bachelors of Applied Sciences (B.A.S)

Skills

AR, billing, budget, oral communication, contracts, CPT, data entry, diagnosis, documentation, financial, ICD-9, insurance, medical manager, Excel, Outlook, Power Point, Word, performance appraisal, coding, quality control, treatment plans, Excellent written

Resume Overview

Companies Worked For:

DeLorenzi Orthopaedic Center
Wuesthoff Health Systems/HMA
Brevard Medical Group

School Attended

Eastern Florida State College

Job Titles Held:

Medical Billing Specialist
Patient Accounts Specialist
Office Manager
referral/authorization/pre-certification coordinator, appointment scheduler

Degrees

Bachelor of Science : Health Services Administration 2018

Medical Billing Specialist Resume Example

Resume Score: 100%

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