Patient Account And Billing Representative Resume Example

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(555) 432-1000,
, , 100 Montgomery St. 10th Floor

Analytical-thinking Medical Biller proudly offering over 20 years' experience in reviewing accounts and maintaining patient records. Driven professional with a background in medical terminology and coding. Offering task prioritization expertise in fast-paced environments. Able to adapt to change and excel at any task or job title given. Fast learner and ability to comprehend and preform multi-faceted jobs with detail and proficiency.

  • Multitasking and prioritization
  • Tech-savvy
  • PC proficient
  • Professional and polished presentation
Education and Training
Charle Page High School Sand Springs, OK, Expected in GED : - GPA :
Healthdrive Corporation - Patient Account and Billing Representative
Reading, PA, 01/2018 - Current
  • Reviewed medical records to meet insurance company requirements.
  • Assessed medical codes on patient records for accuracy.
  • Interpreted medical terminology and pharmacological information to translate information into coding system.
  • Maintained accurate and timely charge submissions utilizing electronic charge capture practices, including billing and account receivables (BAR) system and medical billing clearinghouse accounts.
  • Addressed and responded to staff and client inquiries regarding CPT and diagnosis codes.
  • Researched and communicated insurance requirements, including patient financial responsibilities and fee-for-service
  • Filed and submitted insurance claims.
  • Added modifiers, coded narrative diagnosis and verified diagnoses.
  • Flagged return claims and dealt with insufficient payments.
  • Preformed day-to-day operations of billing department, including medical coding, charge entry, and claims.
  • Completed and submitted appeals.
  • Maintained knowledge of new or revised codes and industry regulations to complete accurate coding services, including local coverage determinations.
  • Performed with precision by entering data accurately and researching to resolve questions.
  • Investigated denials and collaborated with internal team members and third-party representatives to identify solutions.
  • Reviewed all claims for accurateness and appropriateness.
  • Applied HIPAA Privacy and Security Regulations while handling patient information.
  • Reviewed account information to confirm patient and insurance information is accurate and complete.
  • Reviewed received payments for accuracy and applied to intended patient accounts.
  • Effectively coordinated communications between patients, billing personnel and insurance carriers.
  • Researched and rectified account discrepancies.
  • Assigned CPT procedure and evaluation and management (E&M) codes for services to assure appropriate billing and reimbursement.
  • Contacted insurance providers to verify correct insurance information and obtain authorization for proper billing codes.
Common Spirit - Medical Billing Representative
Cameron Park, CA, 03/2009 - 12/2018
  • Completed appeals and filed and submitted claims.
  • Evaluated accuracy of provider charges, including dates of service, procedures, level of care and diagnoses.
  • Posted surgeries, hospital visits and payments for assigned carriers.
  • Posted surgeries, hospital visits and payments for assigned carriers.
  • Performed quality control of data entry system to verify proper posting of claims and payments.
  • Accurately posted and sent out all medical claims.
  • Prepared and submitted claims to insurance companies electronically and manually.
  • Posted charges, payments and adjustments.
  • Prepared and attached all required claims documentation including referrals, treatment plans or other required correspondence to reduce incidence of denials.
  • Performed full-cycle medical billing for fast-paced company.
  • Confirmed patient demographics, collected copays and verified insurance.
  • Maintained timely and accurate charge submission through electronic charge capture, including billing and account receivables (BAR) system and clearing house.
  • Consistently informed patients of financial responsibilities prior to services being rendered.
  • Analyzed and interpreted patient medical and surgical records to determine billable services.
  • Determined customer eligibility for benefit programs and services.
  • Remained up-to-date with all insurance requirements, including details of patient financial responsibilities, fee-for-service and managed care plans by participating in training programs.
  • Maintained current working knowledge of CPT and ICD-10 coding principles, government regulation, protocols and third-party billing requirements.
  • Tracked and recorded status of delinquent accounts and sent follow-up letters to request payment.
  • Verified proper coding, sequencing of diagnoses and procedures.
  • Meticulously tracked and resolved underpayments.
  • Entered procedure codes, diagnosis codes and patient information.
  • Applied payments, adjustments and denials into medical manager system.
Chubb - Medical Receptionist
Indianapolis, IN, 05/2007 - 02/2009
  • Scheduled and confirmed patient appointments and consultation services.
  • Answered phone calls to provide assistance, information and medical personnel access to maximize office efficiency.
  • Processed patient payments and scanned identification and insurance cards.
  • Communicated with all partners throughout practice, including physicians, nursing staff, technicians and medical assistants.
  • Set up appointments for physician visits and procedures using calendar software.
  • Supported administrative and healthcare staff, providing order fulfillment and inventory management services to ease operations.
  • Conducted patient intake interviews to collect medical information and insurance details.
  • Straightened up waiting room to maintain neat and organized space.
  • Scheduled and followed up on patient appointments, collected and processed patient payments and maintained patient files.
  • Informed patients of financial responsibilities prior to rendering services.
  • Delivered high-quality administrative and customer service to sustain patient and work flows.
  • Entered patient information, including insurance, demographic and health history into system to keep all records up-to-date.
  • Compiled physical and digital documents, charts and reports to meet business and patient need.
  • Greeted callers with enthusiasm, answering all phone calls by second ring.
  • Took messages from patients and promptly relayed to appropriate staff.
  • Answered multi-line phone system and directed callers to requested personnel and departments.
  • Observed strict HIPAA guidelines at all times according to company policy.
  • Handled all office supply ordering including ink cartridges, toner and paper
  • Pleasantly greeted each patient and offered the desk sheet for easy sign-in.
  • Prepared and sent financial statements to support bookkeeping functions.
  • Updated group medical records and technical library to support smooth office operations.
Blue Cross And Blue Shield - Medical Claims Analyst
City, STATE, 01/1996 - 12/2005
  • Reviewed administrative guidelines whenever questions arose during processing of claims.
  • Reviewed claims for accuracy before submitting for billing.
  • Sent clinical request and missing information letters to obtain incomplete information.
  • Administered standard contract benefits to process pending claims for medical benefits.
  • Used contract notes and processing manual to correctly apply group-specific classifications to claims.
  • Evaluated pending claims to identify and resolve problems blocking auto-adjudication.
  • Based payment or denials of medical claims upon well-established criteria for claims processing.
  • Documented file notes clearly and concisely.
  • Accurately processed large volume of medical claims every shift.
  • Inputted data into the system, maintaining accuracy of provider coding information and reported services.
  • Stayed current on HIPAA regulations, benefits claims processing, medical terminology, and other procedures.
  • Tracked differences between plans to correctly determine eligibility and assess claims against benefits and data entry requirements.
  • Corresponded with insurance customers and agents to obtain or relay information on account status changes.
  • Created master spreadsheet to record procedures, denials and approvals.
  • Modified, updated and processed existing policies and claims to reflect changes in beneficiary, amount of coverage and type of insurance.
  • Composed business correspondences for supervisors, managers and other professionals.
  • Analyzed insurance organizational structures, business and intermediaries; studied basic documents, including common clauses, policies and insurance contracts.
  • Prioritized daily tasks to complete workloads within department's expected timeframe.
  • Assessed insurance claims and reviewed eligibility information for members to determine if payments had been properly made.
  • Remained professional at all times, especially when speaking to customers or responding to messages to represent company's high level of service.
  • Analyzed claims processing errors, gleaning information to determine origin of issues and initiated corrective action.
  • Reviewed claims to ensure accuracy, resulting in multiple claim reductions.
  • Supervised independent adjusters to promote adherence to guidelines.
  • Paid and processed claims within designated authority level.
  • Researched and followed up on denied insurance claims.
  • Completed required investigations on referred files within established timeframes.
  • Maintained thorough understanding of fraudulent and illegal practices.
  • Double-checked and reviewed documentation for denied and accepted insurance claims.

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Resume Overview

School Attended
  • Charle Page High School
Job Titles Held:
  • Patient Account and Billing Representative
  • Medical Billing Representative
  • Medical Receptionist
  • Medical Claims Analyst
  • GED

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