Quality Focused Billing and Coding Specialist who performs all aspects of medical billing, including coding, charge entry, transmission, correction and resubmission. Brings 16 years of experience in working hand-in-hand with front office to validate proper information for claims processing. Detail-oriented and helpful professional with expertise in resolving billing issues and reviewing claim denials.
Skills
Operations support
Self motivated
Fast Learner
Claim review
Knowledgeable in Athena
Multi-tasking
Experience
03/2021 to Current
Medical Billing SupervisorU.S. Physical Therapy – Boynton Beach, FL,
Applied HIPAA privacy and security regulations while handling patient information.
Completed and submitted appeals for denied claims.
Coordinated communications between patients, billing personnel and insurance carriers.
Manage a team of 7 employees.
Timely and accurate documentation of any activity within a patient account.
Report pending encounter data to 7 physicians on a weekly basis.
Review accounts for accuracy and submit refund requests to the finance team.
Create claims and charges for office visits and surgeries performed by the podiatrist.
Reviewed and refiled claims to insurance carriers.
Managed customer complaints and rectified issues to complete satisfaction.
Trained new staff on correct procedures, compliance requirements and performance strategies.
Answered customer invoice questions and resolved issues discovered during invoicing and collection process.
Managed medical coding, charge entry, claims, and other day-to-day operations of billing department.
Quickly responded to staff and patients regarding billing and coding.
Assigned additional diagnosis codes based on specific clinical findings (laboratory, radiology and, pathology reports as well as clinical studies) in support of existing diagnoses.
Review and accurately file claims for 6 clinics for the Front End.
Report coding errors to the Director of Revenue Cycle.
Maintained current working knowledge of CPT and ICD-10 coding principles, government regulation, protocols and third-party billing requirements.
Assigned procedure and diagnosis codes for insurance billing using Athena.
05/2019 to 03/2021
Business Office SupervisorCamp Recovery – Shickshinny, PA,
Generate and submit over 100 claims daily for 7 Internists and 1 Podiatrist.
Processed and sent invoices, adjustments and credit memos to customers.
Answered patient invoice questions and resolved issues discovered during invoicing and collection process.
Researched and resolved denials and explanations of benefit rejections.
Processed refunds on credit balances to patients.
Contacted customers to obtain payments.
Accurately and concisely documented notes in patient files in adherence with HIPAA regulations.
Assigned procedure and diagnosis codes for insurance billing using Athena and Aprima.
Quickly responded to staff and patient inquiries regarding CPT codes.
Researched claim denials, identified causes and resolved issues to promote prompt insurance payment.
Maintained current working knowledge of CPT and ICD-10 coding principles, government regulation, protocols and third party billing requirements.
Review documentation to verify and correct place of service, billing and service providers.
Use CCI edit software to check bundling issues, modifier appropriateness and LCD/NCD's for medical necessity.
Assigned additional diagnosis codes based on specific clinical findings (laboratory, radiology and, pathology reports as well as clinical studies) in support of existing diagnoses.
Added modifiers as appropriate, coded narrative diagnoses and verified diagnoses.
04/2017 to 05/2019
Accounts Receivable SpecialistArdent Health Services – Montclair, NJ,
Performed various accounts receivable functions, handled cash receipts posting, updated cash flow reports and researched chargebacks and write-offs.
Evaluated open accounts to look for past-due balances and pursue collection strategies.
Interfaced with customers to bring accounts current with suitable repayment plans.
Oversaw daily collections and accounts receivable activities, developing robust strategies to maximize collections and reduce aged accounts.
Protected medical office operations and integrity by keeping patient information confidential.
Processed claims and forwarded information to Medicare, Medicaid and commercial insurance companies.
Took billing calls, questions and concerns from patients and third party carriers.
Identified errors and re-filed denied or rejected claims quickly to prevent payment delays.
Posted charges, payments and adjustments.
Added modifiers as appropriate, coded narrative diagnoses and verified diagnoses.
Completed and submitted appeals for denied claims.
Prepared and submitted claims to insurance companies electronically and manually.
Maintained current working knowledge of CPT and ICD-10 coding principles, government regulation, protocols and third-party billing requirements.
Prepared and attached referrals, treatment plans or other required correspondence to reduce incidence of denials.
Submitted refund requests for claims paid in error.
Responsible for submitting entering charges and billing for 7 Internists and 1 Podiatrist.
Submitting over 100 claims daily.
Communicated with healthcare personnel, including practitioners to promote accuracy.
Assigned additional diagnosis codes based on specific clinical findings (laboratory, radiology and, pathology reports as well as clinical studies) in support of existing diagnoses.
Education and Training
Expected in 05/2005
Certificate: Medical Billing And Coding Bryman College - New Orleans, LA GPA:
Expected in
: Health And Physical Education University of Louisiana At Lafayette - Lafayette, LA GPA:
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