Medical Billing Specialist Resume Example Aspire Healthcare Consultants

MEDICAL BILLING SPECIALIST

Summary

Successful at developing, implementing and strengthening billing practices to address changing needs, reduce errors and maintain smooth and efficient operations. Excel in training and performance optimization. Responsive, flexible and goal-oriented.

Knowledgeable about related laws and insurance, managed care and federal program practices. Maintain full compliance with HIPAA and other requirements.

Skills

CPAR Certified
24 years of medical billing experience
Interpersonal Skills
Skilled Nursing, Hospital, Physician, and Lab billing experience

Client Relations
Account Management
Customer Service
Denial Management

Experience

Medical Billing Specialist08/2017 to CurrentAspire Healthcare ConsultantsAtlanta, GA

Contacted insurance providers to verify correct insurance information and obtain authorization for proper billing codes.
Maintained current working knowledge of CPT and ICD-10 coding principles, government regulation, protocols and third-party billing requirements.
Prepared and attached all required claims documentation including referrals, treatment plans or other required correspondence to reduce incidence of denials.
Contacted patients for unpaid claims for HMO, PPO and private accounts and performed friendly follow-ups to ensure proper payments were made according to contracts.
Reviewed patients' insurance coverage, deductibles, possible insurance carrier payments and remaining balances not covered under policies.
Entered procedure codes, diagnosis codes and patient information into AdvancedMD.
Identified errors and re-filed denied or rejected claims quickly to prevent payment delays.
Completed appeals and filed and submitted claims.
Applied payments, adjustments and denials into medical manager system.
Performed full-cycle medical billing.
Posted charges, payments and adjustments.

AR Team Lead/Medical Billing and Collections Specialist04/2012 to 05/2017Nuesoft Technologies Inc.Marietta, GA

Created, oversaw, and updated policies, information, standards, and guidelines on regular basis.
Developed streamlined task system to provide more effective workflow's for both peers and management staff.
Observed staff to study daily tasks regarding information processing and performance to better understand business system needs.
Oversaw multiple accounts and worked diligently to meet and exceed performance goals.
Developed relationships with billing clients and provided individualized customer service to maintain longevity of accounts.
Exceeded department expectations for productivity and accuracy levels by creating teams, which consisted of Lead Billers, Co-Billers, Denial Management, and Auditors.
Trained and developed departmental employees on software systems.
Called insurance companies to ascertain pertinent information regarding policies and payment benefits for patients.
Retained strong medical terminology understanding in effort to better comprehend procedures.
Monitored records and files transmissions to insurance payers to ensure smooth and error-free deliveries.
Minimized issues by helping train team members in methods for supporting EDI activities.
Liaised with customers, addressed inquiries, handled meeting requests and answer billing questions to provide outstanding customer care.
Oversaw training and daily performance of staff.

Support Agent - Level 2/Quality Assurance Analyst01/2012 to 05/2017Nuesoft TechnologiesMarietta, GA

Observed system functioning and entered commands to test different areas of operations.
Assisted online users via live chat, web conference and phone to resolve issues related to NueMD use and access.
Researched, documented and escalated support cases to higher levels of support when unable to resolve issues using available resources.
Assisted end-users with software and hardware troubleshooting to determine causes of system malfunction.
Responded to support tickets within to improve customer service.
Kept customers informed about issue resolution progress and provided updated estimated times of resolution on ongoing basis.
Maintained composure and patience in face of difficult customer situations, applying de-escalation techniques and positive customer support.
Consistently responded to customer service emails within standard window for optimal response.
Served as level-two support escalation point for support staff.
Consulted with developers to fully understand intended features and functionality.
Managed onsite testing for customers as required by project's specifications.
Tracked software bugs and detailed all information regarding findings and resolution techniques in documentation for product and developer teams.
Documented identified defects using NueMD and helped developers complete further testing and resolve issues.

Senior Billing Specialist07/2008 to 12/2011Park SpringsAtlanta, GA

Developed performance improvement plans based on deep reviews of current work.
Resolved billing issues by applying knowledge and completing in-depth research.
Developed improved standard operating procedures to increase billing accuracy and cash flow.
Conducted insurance verification and pre-authorization.
Managed billing calendar and scheduled claims for payments.
Engaged in oversight of all billing for Skilled Nursing, Assisted Living, and Independent Living.
Facilitated payment of invoices due by sending bill reminders and contacting clients.
Trained new team members on company policies and accounting systems to keep team operations productive and efficient.
Maintained accounting ledgers by verifying and posting account transactions.
Prepared monthly statements, and financial documents.
Assessed medical codes on patient records and prepared invoices to be submitted to insurance companies.
Reviewed account information to confirm patient and insurance information is accurate and complete.
Maintained accurate and timely charge submissions utilizing, billing and account receivables system and medical billing clearinghouse accounts.
Verified final claim submissions by comparing account charges with documentation.
Accurately input procedure codes, diagnosis codes and patient information into billing software to generate up-to-date invoices.
Investigated denials and collaborated with internal team members and third-party representatives to identify solutions.
Reviewed all claims for accurateness and appropriateness.
Contacted insurance providers to verify correct insurance information and obtain authorization for proper billing codes.
Completed and submitted appeals.
Collected, posted and managed patient account payments.
Submitted claims to insurance companies.
Prepared, distributed and reviewed all insurance payments and recorded in company database.
Downloaded, printed and batched electronic funds transfers and remits.
Posted payments and denials.
Documented payment denials in appropriate billing system and updated account managers swiftly.
Handled all electronic and manual payments and adjustments, ensuring that data was accurately posted.

Education

Some College (No Degree): Computer ScienceClark Atlanta UniversityAtlanta, GA

Resume Overview

Companies Worked For:

Aspire Healthcare Consultants
Nuesoft Technologies Inc.
Nuesoft Technologies
Park Springs

School Attended

Clark Atlanta University

Job Titles Held:

Medical Billing Specialist
AR Team Lead/Medical Billing and Collections Specialist
Support Agent - Level 2/Quality Assurance Analyst
Senior Billing Specialist

Degrees

Some College (No Degree) : Computer Science

Medical Billing Specialist Resume Example

Resume Score: 80%

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