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Medical Insurance Biller resume example with 16+ years of experience

Jessica
Claire
resumesample@example.com
(555) 432-1000,
Montgomery Street, San Francisco, CA 94105
:
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
  • FQHC, OB/GYN, Neurology, Pediatric & Pediatric Cardiology, Pain Management, Anesthesiology, Radiology, and Chiropractic billing knowledge
  • 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 College San Luis Obispo, CA Expected in : - GPA :
Estes Institute of Cosmetology Arts And Science Visalia, CA Expected in 1992 Cosmetology Licence : Cosmetology - GPA :
Tulare Union High School Tulare, CA Expected in 1991 High 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
Healthcare Billing & Bookkeeping Servies - Billing Administrator
City, STATE, 10/2003 - 08/2006
  • 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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Resume Overview

School Attended

  • Cuesta College
  • Estes Institute of Cosmetology Arts And Science
  • Tulare Union High School

Job Titles Held:

  • Medical Insurance Biller
  • Medical Billing Specialist II
  • Medical Account Biller
  • Billing Administrator

Degrees

  • Some College (No Degree)
  • Cosmetology Licence
  • High School Diploma

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