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Jessica Claire
, , 100 Montgomery St. 10th Floor
Home: (555) 432-1000 - Cell: - resumesample@example.com - -
Summary

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 Supervisor U.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 Supervisor Camp 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 Specialist Ardent 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:
Certifications
  • Certified Professional Coder

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Resume Overview

School Attended

  • Bryman College
  • University of Louisiana At Lafayette

Job Titles Held:

  • Medical Billing Supervisor
  • Business Office Supervisor
  • Accounts Receivable Specialist

Degrees

  • Certificate
  • Some College (No Degree)

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