Medicare Billing Specialist Resume Example
- www.linkedin.com/in/stacybhajan
- Revenue Cycle Solutions - Process improvement
- Account reconciliation - Policy Implementation - Organizational skills
- Medicare billing and eligibility - Verify on HIQA (Medicare Coverage)
- Knowledgeable of Medicare rules and regulations
- Work (RTP) Return to provider claims and issues using resources and DDE/FISS Medicare
- Ability to read explanation of benefits (EOB) and assigned patient liability including secondary/tertiary assignments
- Proficient with ICD-9 and CPT coding
- Experienced with diagnosis-related groups (DRGs) billing
Medical terminology knowledge, HCPCS and Modifiers - Analyze denied claims, resubmit claims, document claim statuses, request medical records, file appeals, redeterminations, etc
- High level of accuracy of follow-up while maintaining thorough and concise notes documenting communication with all involved parties
- HIPAA/Patient confidentiality
- Microsoft Office Suite - Advanced primarily Excel (V-lookups and Pivot Tables) and Word. Proficient in Access and PowerPoint
- High level of autonomy
Excellent knowledge of various Patient Accounting systems:
- RCMS
- MEDITECH
- EPremis
- SMS NET
- NEBO
- SSI Billing
- McKesson HBOC
- CAREMEDIC
- I-SUITES
- Document Imaging, Monarch
- Information gathering - Document reviews
Carroll Hospital Westminster, MD
Medicare Biller Patient Accounting
3/2002 - 09/2003
Accountable for accurate and timely submission and collections of Medicare claims to government intermediaries for reimbursement. Systematic inpatient and outpatient Medicare billing and follow-up, involving revision and preparation of claims for electronic billing. Rigorous monitoring and/or rectified submitted claims to ensure precise and efficient reimbursement of claims to ensure consistency for expedited turnaround time.
Clerical Assistant - Patient Accounting
10/2001- 03/2002
Maintained reception area. Ordered and distributed office supplies while adhering to fixed budget. Managed incoming and outgoing calls, recorded accurate messages. Directed guests, routed deliveries and courier services. Greeted numerous visitors, including VIPs, vendors and interview candidates. Distributed employee notices and mail. Submitted electronic/paper claims documentation for timely filing.
Sterile Processing Technician I
01/2000 - 10/2001
Replenishment of all supply carts, nurse-servers and clinical areas with supplies, linen and equipment efficiently, accurately, and punctually.
Detail-oriented Revenue Cycle Specialist with a systematic nature and good grasp of billing processes. Successful planner and problem-solver. Senior Specialist versed in balancing priorities and meeting deadlines under pressure. Adapts quickly to challenges and changing environments. Driven to make continuous improvements generating efficiency and accuracy of internal processes. Responds to shifting business needs and priorities methodically and effectively. Ready to apply over 12 years' experience and take on a challenging role.
Moffitt Cancer Center - Tampa , FL
Extensive Medicare billing experience; Appointed to facilitate Medicare billing for over 5+ providers by providing sufficient review, billing and follow-up for accurate and prompt reimbursement of claims, to ensure high quality for turnaround time of all accounts worked.
- Analyzed Medicare remittance for payment errors, rejections and denials, while following protocols and communicating issues with management team
- Methodical review from electronic billing through final payment, extensive online intermediary follow-up as well as monitoring of suspended claims and adjusting accordingly
- Diligently worked hundreds of accounts for multiple facilities to provide efficient billing to meet and exceed expectations
Common Spirit - Woodland , CA
Provided leadership and direction for for 5-8 employees, supervising activities to drive productivity and efficiency. Accountable for accurate and timely submission and collections processes of Medicare claims to government intermediaries for reimbursement. Systematic inpatient and outpatient Medicare billing and follow-up, involving revision and preparation of claims for electronic billing.
- Performed rigorous monitoring and/or rectified submitted claims for over 10 facilities and various Hospital billing systems to ensure precise and efficient reimbursement of claims to ensure consistency for expedited turnaround time
- Assigned tasks to team, staffed projects, tracked progress and provided updates to managers
- Trained new employees on internal process to support team efficiency
- Monitored employee time-sheet, performance, conducting retraining to correct problems and optimize productivity
Cancer Treatment Centers Of America - Chicago , IL
Worked closely with revenue cycle management team analyzing financial data by working directly with internal operations team in order to cultivate revenue cycle functions by evaluating reports, distinguishing recourse and processing for accuracy.
- Initiated project review and validation of data of hundreds of accounts for multiple hospitals from various states to affirm compliance with implemented processes
- Facilitated multiple projects with implementation and integration of fundamental rules
- Coordinated with IT system analysts and other departmental analysts establishing and executing functions to sustain operations of revenue cycle methodology
- Formulated and distributed process training and direction improving quality and efficiency
- POC (Client Point of contact) in many cases where information is time-sensitive and accuracy is important, coordinator of information concerning user sign-on and granting access for 100+ employees by making sure forms were filled out correctly in-house before submitting to client
- Rendered analytical support when discrepancies or areas of opportunity were evident, and identified, recommend and implemented action
- Maintained operations of cash posting and referral files, regulated influenced, and rectified financial outcome through reconciliation and analytical innovation
- Developed spreadsheet models for diverse projects and analysis
Sutherland Healthcare Solutions - City , STATE
Senior Specialist, Provider Solutions Team. Worked alongside Senior Manager. Collaborated closely with IT and the IBO (India Business Office) to promote team-oriented approach in daily activities, developing internal revenue cycle processes, streamlining on-boarding of new clients, implemented rules and tested internal account system before going live to Billing and/or Follow-up Departments.
- Methodically reviewed Trial Balance Reports for 10+ Hospital Facilities for payment posting errors and other discrepancies, analyzed projects throughout project life cycle
- Evaluated revenue cycle processes and established actionable methods to increase productivity and efficiency
- Communicated extensively with executives and management team to provide assistance, instructions and support
- Developed automated process with IT to immediately identify FAILED updates (status/new follow-up date) to Sutherland's billing software. Significantly reduced time spent (2-8 hours) manually looking up hundreds of accounts to identify errors
- Boosted job efficiency by working closely with other analysts so that tasks and processes could be streamlined and error was avoided
Pace Online Degree Completion
In Progress BBA Business Studies
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Resume Overview
School Attended
- Pace University
Job Titles Held:
- Medicare Billing Specialist
- Medicare Team Lead
- Quality Analyst
- Senior Specialist
Degrees
- BBA : Accounting And Auditing
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