Medical Reimbursement Specialist Resume Example

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Jessica Claire
  • Montgomery Street, San Francisco, CA 94105
  • Home: (555) 432-1000
  • Cell:
Professional Summary
Medical Biller with 4 years experience in home health care and assisted living facilities. Accurate and detail-oriented with knowledge of benefits, eligibility and appeals.
  • Microsoft Office software
  • Motivational and leadership management skills
  • Self-starter and focused; driven and goal-oriented, excellent time management skills
  • Excellent verbal and written communication skills and an ability to learn quickly
  • Managed Care Organizations - AmeriHealth, United Health Care, Amerigroup
  • Navinet, Availity, Optum
  • Allscripts, Pro32, Haven, CGS, Ability, Quick books, Fidelity/ Alltel System/CPI/LPS, World port , AS400, Intergal, Kronos, Microsoft Office, Boston Post.
  • Billing and collection procedures expert
  • Familiar with commercial and private insurance carriers
  • Insurance and collections procedures
  • Understands insurance benefits
  • Office management professional
  • Resourceful and reliable worker
  • Close attention to detail
  • Office support (phones, faxing, filing)
  • Billing and collection procedures expert
  • Research and data analysis
  • Excellent problem solver
  • OASIS billing and coding
  • Records maintenance professional
  • HCPCS Coding Guidelines
  • ICD-10 (International Classification of Disease Systems)
  • Medical terminology expert
  • Composed and professional demeanor
  • Adept multi-tasker
  • Resourceful and reliable worker
  • Excellent verbal communication
Work History
Medical Reimbursement Specialist, 06/2012 to Current
Pain Stop ClinicsSurprise, AZ,
  • Review client claims : correct and resubmit billing errors, process denied claims appropriately to Managed Care Organizations, Medicare, Medicaid, Veterans Administration and HCBS waivers for optimal levels of reimbursement Process Claims and Invoices: run claims report, print, review claims and invoices, mail or electronically transmit to appropriate carrier.
  • Upload or down loan Remittance Advices to reconcile A/R Enrollment paperwork for Managed Care Organizations, Medicare and Medicaid Work Denials: Perform all duties and responsibilities in compliance with all state, federal, and company policies.
  • Work monthly aging reports: research unpaid claims to determine trends.
  • Decide whether a claim can be appealed, adjusted, or is non-collectable.
  • Respond to billing and insurance questions from internal and external customers Responsible for reviewing insurance policy regulations at the state/federal level, informing those necessary of any changes to stay in compliance.
  • Communicating with clients via telephone, e-mail, or regular mail; managing database records.
  • Understanding the billing software capabilities, lead efforts to enhance efficiencies, knowledge of regulatory requirements for transmitting claims to the various third party payers.
  • Monitors facility receivable balances and maintains receivable balances within acceptable limits, as well as, assists with collection of problem accounts.
  • Update the fee schedules for various payers.
  • Precisely completed appropriate claims paperwork, documentation and system entry.
  • Correctly coded and billed medical claims for various hospital and nursing facilities.
  • Maintained updated knowledge of coding requirements, through continuing education and certification renewal.
  • Verified patients’ eligibility and claims status with insurance agencies.
  • Diligently filed and followed up on third party claims.
  • Researched questions and concerns from providers and provided detailed responses.
  • Researched CPT and ICD-9 coding discrepancies for compliance and reimbursement accuracy.
  • Maintained strict patient and physician confidentiality.
  • Resourcefully used various coding books, procedure manuals and on-line encoders.
  • Actively maintained current working knowledge of CPT and ICD-9 coding principles, government regulation, protocols and third party requirements regarding billing.
  • Conscientiously reviewed medical record information to identify appropriate coding based on CMS HCC categories.
  • Managed collections claims for unpaid bills against the estates of debtors.
  • Interacted with providers and other medical professionals regarding billing and documentation policies, procedures and regulations.
  • Accurately posted and sent out all medical claims.
  • Submitted electronic/paper claims documentation for timely filing.
  • Performed billing and coding procedures for ambulance, emergency room, impatient and outpatient services.
  • Precisely evaluated and verified benefits and eligibility.
  • Responded to correspondence from insurance companies.
  • Posted and adjusted payments from insurance companies.
  • Identified and resolved patient billing and payment issues.
  • Maintained and updated collections tracking spreadsheet to help organize payment information.
  • Confidently and adeptly handled claim denials and/or appeals.
  • Evaluated patients’ financial status and established appropriate payment plans.
  • Reviewed and resolved claim issues captured in TES/CLAIMS edits and the clearing house.
  • Treated all patients, their families, visitors, peers, staff and providers in a pleasant and courteous manner.
  • Compiled and tracked outstanding balances owed to medical facilities.
  • Printed and reviewed monthly patient aging report and solicited overdue payments.
  • Prepared billing correspondence and maintained database to organize billing information.

Student Work , 08/2011 to 05/2013
Beth Israel Lahey HealthNewark, NJ,
  • Institutional and Federal Work Study Filing students records Helping students Front desk answer phones and greet students Help staff with various work.

Payroll Assistant, 11/2010 to 06/2012
Clean Harbors, Inc.San Antonio, TX,
  • Batching timecards 10 key calculation timecards Alphabetizing and filing of timecards Research and file paperwork in employees file Data Entry in Kronos.

Customer Service Rep, 06/XXX9 to 04/2010
SpherionCity, STATE,
  • Rate and invoice assigned accounts on a daily basis.
  • Prepare billing statements and transmit statements to customers.
  • Audit daily domestic House Airway Bills and invoices.
  • Research and resolve data entry problems.
  • Maintain customer profile and tariff books.
  • Audit invoices and accounts receivable report for accuracy in revenue.
  • Rate invoices for assigned accounts.
  • Prepare, print and mail customer invoices and billing statements and transmit charges to customer.
  • Enter and review billing information in computer.
  • Answer routine customer questions.
  • Perform other duties as assigned.
  • Tracking and tracing cargo Analyzing and verifying documents Updating shipment information in the computer system Advising accounts/customers of shipment information Complying with customer requirements and procedures Schedule pick-ups and deliveries with customers/ vendors to ensure work is performed according to customer/ vendor requirements.

Diploma: Medical Billing/ Encoding , Expected in 2011
National American University - Bloomington, MN
  • Coursework in Healthcare Management
  • Health Information Technician (RHIT) coursework
  • Coursework in Healthcare Administration
  • Coursework in Business, Accounting and Healthcare Administration

Bachelor of Science: HealthCare Management, Expected in 2015
National American University - Bloomington, MN
  • Coursework in Healthcare Administration
  • Certificate in Health Information Administration
  • Coursework in Business, Accounting and Healthcare Administration
  • Coursework in Healthcare Management

Healthcare Management Coursework Included: ICD 9, ICD 10 Healthcare Reimbursement Medicare Managed Care Organizations Medicaid Health Care Management and Supervision : , Expected in
- ,
  • Coursework in Healthcare Administration
  • Certificate in Health Information Administration
  • Health Information Technician (RHIT) coursework
  • Coursework in Business, Accounting and Healthcare Administration

Associate of Science: Health Information Technology , Expected in 2013
National American University - Bloomington, Mn

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Resume Overview

School Attended
  • National American University
  • National American University
  • National American University
Job Titles Held:
  • Medical Reimbursement Specialist
  • Student Work
  • Payroll Assistant
  • Customer Service Rep
  • Diploma
  • Bachelor of Science
  • Healthcare Management Coursework Included: ICD 9, ICD 10 Healthcare Reimbursement Medicare Managed Care Organizations Medicaid Health Care Management and Supervision
  • Associate of Science