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Patient Financial Services Denial Specialist Resume Example

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PATIENT FINANCIAL SERVICES DENIAL SPECIALIST
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.

Skills
  • ICD-9, ICD- 10, CPT, HCPCS
  • Medicare/ Medi-Cal/ HMO/ PPO/ Facility/ VA/ Workers Compensation Billing
  • Medical Terminology
  • HIPAA Compliance
  • Excellent Phone Skills
  • Microsoft Word, Excel
  • Anatomy and Physiology
  • High Attention to Detail
  • CMS 1500, UB-04
  • Multi- Tasked
  • Positive Attitude
  • Committed Team Player
  • Streamline, Research
  • Billing, Staffing
  • Cash handling
  • Charts, Excellent Phone Skills
  • Data entry experience
  • Invoicing and billing
Experience
03/2019 to 09/2019
Patient Financial Services Denial SpecialistInsight Global / Alameda Heath Systems － San Leandro, CA
  • 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).
  • Provided follow-up for all insurance carriers, including Medicaid, Medicare, commercial, and workers' compensation.
  • 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.
  • Followed-up on all billed claims in a timely manner to ensure accurate, timely payment and disposition of account according to the payer contract or 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.
  • Processed patient payments and scanned identification and insurance cards.
02/2018 to 11/2018
Accounts Receivable SpecialistRoyal Ambulance － San Leandro, CA
  • 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.
  • Posted and distributed denials within two (2) days of receipt Print and mail Daily Rescue Net Form (CMS 1500-primary and secondary, bill patient and facility invoices).
  • 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.
  • Entered procedure and diagnosis codes, and requisite patient information into billing software to streamline invoicing and account management; added modifiers, verified diagnosis, and coded narrative diagnosis.
07/2017 to 09/2017
Medical Billing SpecialistOasis Pain Management & Wellness Center － Pleasanton, CA
  • Checked patient insurance verification.
  • Reviewed billing edits and provided insurance providers with corrected information.
  • Accurately applied payments to patient accounts.
  • 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.
10/2005 to 07/2017
Server/ Head BartenderApplebee's Neighborhood Bar and Grill － San Ramon, CA
  • 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
09/2017
Degree in Medical Billing And Coding: MBCCarrington College － San Leandro, CA
06/2005
GEDHorizon High School － Pleasanton, CA
Activities and Honors

Presented the President's List Award while attending Carrington College in 2017

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Resume Overview

Companies Worked For:

  • Insight Global / Alameda Heath Systems
  • Royal Ambulance
  • Oasis Pain Management & Wellness Center
  • Applebee's Neighborhood Bar and Grill

School Attended

  • Carrington College
  • Horizon High School

Job Titles Held:

  • Patient Financial Services Denial Specialist
  • Accounts Receivable Specialist
  • Medical Billing Specialist
  • Server/ Head Bartender

Degrees

  • Degree in Medical Billing And Coding : MBC
    GED

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