Medical Insurance Biller resume example with 16+ years of experience
Jessica
Claire
resumesample@example.com
(555) 432-1000,
Montgomery Street, San Francisco, CA94105
:
Professional Summary
Results driven medical insurance billing professional with over 17 years of hands-on experience in account management, revenue generation and medical billing and coding. Accomplished in developing strategies to improve workflows and processes, and actualizing procedures to enhance revenue generation. Demonstrated leadership skills guide teams towards success, optimize performance and sustain organizational success.
Skills
Proficiency in NextGen Practice Management / EHR, Mega View Billing Software, CalMed Billing Software, GE Centricity Practice Management Software, Raintree Practice Management Software and Medical Manager Billing Software
Medi-Cal, Medi-Cal Managed Care, Medi-Cal Programs FPACT, EWC, CHDP, CCS, Medicare, Medicare HMO, Work Comp, and all Commercial Insurance
A/P and A/R expertise
EMR / EHR
Medical billing code accuracy
Medical claims submission
Payment posting
HIPPA Compliant
Insurance Websites and Portal
MS Office
Education
Cuesta CollegeSan Luis Obispo, CAExpected in ā ā: - GPA:
Estes Institute of Cosmetology Arts And ScienceVisalia, CAExpected in 1992 ā āCosmetology Licence:Cosmetology - GPA:
Tulare Union High SchoolTulare, CAExpected in 1991 ā āHigh School Diploma:Cosmetology - GPA:
Work History
Avalon Health Care Group - Medical Insurance Biller Brigham City, UT, 05/2019 - 01/2020
Oversaw billing for Neurologist Physician and Pediatric Cardiologist. Interacted and communicated effectively with physicians and outside agencies
Responsible for accurate and complete registration of patient demographics and insurance information into billing system
Procedure and diagnosis coding of charges, verify eligibility and authorizations for claims billing
Posted payment and adjustments
Facilitate sending timely electronic claim submissions and paper claims, all Commercial Insurances, HMO, Medicare, Medi-Cal and Managed Care IPA, Capitation plans and monthly billing to patients
Coordinated follow-up on account aging and account receivable
Completed appeals, reconsideration request, Medi-Cal CIFs, insurance and patient refunds
Assisted patient with insurance questions and denials
Contributed to development and analysis of month-end closing statements
Accurately interpreted explanations of benefits, deductible, write-offs and balance billing
Demonstrated knowledge of HIPPA privacy and security regulations by appropriately handling all patient information
Community Health System - Medical Billing Specialist II Hernando, FL, 04/2007 - 04/2019
Handled all aspect of medical billing for FQHC including EHR, coding, charge entry, paper & electronic claim filing, corrections and re-submissions of claims as required, posting of payment including patient/mail and ERA
Interacted with providers and other medical professionals regarding billing and documentation policies, procedures and regulation
Quickly identified and resolved medical billing, coding and insurance discrepancies
Selected to be responsible for all provider billing that required special account receivable clean up for A/R over 120 days
Proven expertise in billing with Commercial Insurances including HMO, Medicare, Medicare Advantage Plans, Medi-Cal, Medi-Cal Managed Care, CCS, CHDP, FPact, EWC, Sliding fee scale and private pay
Coding of outpatient and inpatient OB/GYN procedures from operative reports by using ICD-10 and CPT Codes and applying modifiers when needed. Responsible for all claim and payment follow-ups including working all denied claims
Maintained the highest levels of accuracy and patient confidentiality under HIPPA regulations
Answer and resolve incoming calls and request from patients, insurance companies, and clients
Demonstrated the ability to determine priorities, establish timelines, and effectively manage workflow
Alliance Shippers, Inc. - Medical Account Biller Cincinnati, OH, 08/2006 - 04/2007
Managed billing of two pediatric offices including payment posting and charges, sending electronic claim submissions and paper claims, all Commercial Insurances, HMO, Medi-Cal, Capitation plans and monthly billing to patients
Coordinated follow-up on account aging and account receivable
Assisted patient with insurance questions and denials
Contributed to development and analysis of month-end closing statements
Accurately interpreted explanations of benefits, deductible, write-offs and balance billing
Executed all aspect of professional billing activities for 4 physician of Pain Management Clinic including Anesthesiology, Radiology and Chiropractic billing
Provided follow-up on account aging and accounts receivable (60-120)
Proven success in working with ICD-9, HCPCS, CPT codes, and National Correct Coding initiative edits, reconsideration and appeal submissions
Entered geographical data as well as insurance data for patients; insurance verification
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