Detail-oriented professional with a focus on deadlines and the assurance that all medical clams are handled efficiently and without errors. Confident Medical Biller knowledgeable in data confidentiality and privacy practices when reviewing patient information. Reliable medical professional with coding and medical terminology knowledge. Polished and hardworking performer with a background overseeing accounts and handling records management tasks. Considered a team-oriented person with great decision-making skills.
Skills
Insurance practices
Interdepartmental collaboration
Medical terminology
Claims Processing
Documentation
Verbal and written communication
Decision making
Proficient in Word
Proficient in Excel
CPT Coding
HIPAA Compliance
Billing
Insurance Knowledge
Medical Coding
Spreadsheets
Medical Records Review
Billing Inquiries
Claims Adjustments
Patient Contact
Understanding of insurance details
Benefit Coverage
Retro-Authorizations
Authorizations
Claim research
Customer inquiries
Customer service
Team management
Supervision
Problem resolution
Organizational standards
Work History
PCA, 03/2015 to Current Edgewood Summit – Charleston, WV,
Supported patient mobility needs with correct assistive devices and proper body mechanics to prevent injuries.
Monitored ongoing care and proactively corrected problems.
Completed documentation of care, hospital actions and patient activities.
Monitored and assisted residents through individual service plans.
Planned, prepared and served meals and snacks according to prescribed diets.
Helped clients manage money, pay bills and shop for groceries or personal items.
Ran errands for customers, including shopping, and picking up other necessities.
Helped clients with hygiene-related tasks such as brushing teeth, bathing, grooming and toileting.
Remained alert to problems or health issues of clients and competently responded.
Determined specific needs and provided most appropriate level of services for patient well-being.
Recorded vital signs, such as temperature, blood pressure, pulse, or respiration rate, as directed by medical or nursing staff.
Performed household tasks such as laundry, dusting, washing dishes and vacuuming.
Documented residents' behavior in terms of mental status, sleeping and eating patterns in medical record books.
Scheduled and accompanied clients to medical appointments.
Shopped for groceries regularly in order to keep house stocked with necessities.
Maintained confidentiality of patient data and condition at all times to safeguard health information.
Childcare Provider, 09/2012 to 07/2013 The Edge Fitness Clubs – Warrington, PA,
Created and implemented diverse educational strategies to boost development.
Maintained group discipline through positive reinforcement, behavior modeling and collaboration with parents.
Applied positive behavior management techniques to enhance social interactions and emotional development.
Developed lessons and activities to promote children's physical and emotional development.
Prepared healthy foods and beverages for children based on optimal dietary guidelines and individual restrictions.
Monitored entrances and exits to maintain safety and organized environments.
Maintained effective schedule balance between rest periods, active play and instruction.
Prepared group activities to enhance socialization, communication, and problem-solving skills for children.
Kept notes of behavior issues, food served and medications administered to children.
Enforced rules and managed behavior through developmentally appropriate discipline.
Sanitized dishes, tabletops, toys and frequently touched surfaces to prevent spreading of germs.
Created safe and engaging learning environment for groups of diverse children with various learning styles.
Led activities for over 6 children ages 0 to 12.
Managed safety and security of all children under care.
Kept all areas neat, clean and properly sanitized.
Met with parents about daily activities, positive developments and issues.
Helped children develop motor skills in preparation for preschool and kindergarten.
Provider Appeals Claims, 07/2005 to 06/2012 Francisan Health – Merrillville, IN,
Reviewed patient diagnosis codes to verify accuracy and completeness.
Complied with all HIPAA Privacy and Security Regulations to protect patients' medical records and information.
Reviewed patient records, identified medical codes and created invoices for billing purposes.
Liaised between patients, insurance companies and billing office.
Processed insurance company denials by auditing patient files, researching procedures and diagnostic codes to determine proper reimbursement.
Oversaw all billing for Medicaid PCA, waiver and skilled claims, commercial insurance and private pay clients.
Translated and interpreted medical billing codes with strong accuracy to enable swift payment from insurance agencies.
Guarded against fraud and abuse by verifying all coded data accurately reflected services provided.
Devised new methods to make workflows more efficient and brought suggestions to attention of Claims Manager.
Processed electronic and paper claims for payment by Medicaid.
Participated in workshops and other training opportunities to remain current on billing procedures, regulations and industry updates.
Communicated with insurance providers to resolve any denied claims and resubmit.
Researched and followed up on denied Medicaid claims.
Efficiently collected payments and communicated with clients.
Verified proper ICD-9 coding on claims.
Adhered to established standards to safeguard all patients' health information.
Prevented financial delinquencies by working closely with managers to resolve billing issues before becoming unmanageable.
Prior Authorization Specialist, 07/2005 to 06/2012 Xerox Corporation – City, STATE,
Prepared and distributed denial letters, detailing reasons for denial and possible appeal measures.
Fielded telephone inquiries on authorization details from plan members and medical staff.
Verified eligibility and compliance with authorization requirements for service providers.
Authorized surgical and MRI's requests in accordance with applicable plan guidelines.
Input all patient data regarding claims and prior authorizations into system accurately.
Reviewed insurance coverage for patients to determine which party was liable for payment.
Edited letters and written material for correspondence.
Education
High School Diploma: , Expected in Benny Benson - Anchorage, AK, GPA:
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