patient financial services denial specialist resume example with 13+ years of experience
JessicaClaire
Montgomery Street, San Francisco, CA94105609 Johnson Ave., 49204, Tulsa, OK
H: (555) 432-1000
C:
resumesample@example.com
Date of Birth:
India:
:
single:
:
Summary
Motivated individual looking for a challenging role in the medical billing and coding field where my skills and knowledge can be utilized to the fullest while providing excellent customer service.
Reviewing claims for appropriate uses for the procedure, modifiers, diagnostic codes, calculating Medicaid outliers and removing duplicate charges to ensure maximum reimbursement.
Sending a request to coder for claim review and necessary corrections on charges/coding for HIPPA compliance.
Fixed claims edits, provided timely follow-up of the regulated payer, and maintained current knowledge of federal and state regulations to ensure compliance (HIPPA training).
Researched and resolved incorrect payments, EOB rejections, and other issues with outstanding accounts.
Worked independently and effectively managed time and resources to ensure all reviewed assigned accounts to ensure that all information, codes, and other relevant information are correct and charges have been billed within guidelines.
Monitoring corrected claims to payors to seek the most up to date billing guidelines.
Worked close with coders on Medicare FQHC Radiology and changing revenue codes where need to be applied, then sending updated report to coders for review in success of bringing down AR for daily EBEW Aging Report.
Sent out PDR’s for denied in error Anesthesia claims, working close with supervisors and leads from each department.
Managed record storage (PCR filing and recovery, medical records/ subpoena requests.
Requested Addendum Paperwork from Operations when needed.
Worked full cycle billing
Backup cash posting when needed.
Conducted research as needed and assisted in special projects on an as needed basis.
Maintained compliance with all required HIPAA rules, regulations and guidelines.
Communicated effectively with the Billing Department and Director of Business Administration, keeping everyone informed and up to date on issues, and any relevant information.
Responded to staff and client inquiries regarding CPT, diagnosis codes.
Managed incoming mail, open and distribute accordingly, scan checks/denials and any appropriate correspondence received.
Collected, posted, and managed patient account payments, and prepared and submitted claims forms to insurance companies and other third-party payers.
Performed insurance verification, pre-certification, and pre-authorization.
Ensured Key Charges were entered in system in a timely manner.
Knowledgeable in timely filing restrictions.
Medical Billing Specialist, 06/2017 - 09/2017 Oasis Pain Management & Wellness Center – City, STATE,
Reviewed billing edits and provided insurance providers with corrected information.
Researched and resolved incorrect payments, EOB rejections, and other issues with outstanding accounts.
Provided tenacious follow-up to ensure proper payments were fully collected.
Greeted clients in a professional, courteous manner.
Retrieved and organized patient charts.
Maintained current working knowledge of CPT and ICD-10 coding principles, government regulation, protocols and third-party billing requirements.
Performed insurance verification, pre-certification and pre-authorization.
Reviewed and abstracted relevant clinical data from electronic medical records to select appropriate code for procedures.
Documented and filed patient data and medical records.
Updated group medical records and technical library to support smooth office operations.
Scheduled and confirmed patient appointments for diagnostic, surgical and consultation services.
Contacted insurance providers to verify correct insurance information and obtain authorization for proper billing codes.
Server/ Head Bartender, 10/2005 - 06/2017 Applebee’s Neighborhood Bar And Grill – City, STATE,
Waited on multiple customers at the bar and throughout bar area.
Enthusiastically and appealingly described food and drink specials to guests.
Upheld strict cash handling procedures.
Managed bar revenues, ensuring all patrons were billed and all cash properly accounted.
Verified guests at the bar were of legal age.
Served each guest courteously, quickly, and efficiently.
Consistently used suggestive selling techniques.
Processed orders on a computerized point of sale system.
Monitored patrons to keep alcohol consumption at designated levels.
Upsold customers from shelf to premium brands to help boost sales.
Produced and balanced daily and weekly sales reports to assess and coordinate staff.
Education and Training
Degree in Medical Billing And Coding: MBC, Expected in 09/2017 - Carrington College - San Leandro, CA, GPA: Status -
GED: , Expected in 06/2005 - Horizon High School - Pleasanton, CA, GPA: Status -
Activities and Honors
Presented the President's List Award while attending Carrington College in 2017
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