Physician Billing Representative Resume Example
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PHYSICIAN BILLING REPRESENTATIVE
Professional Summary
I have an extensive background and knowledge working with commercial health insurance carriers as well as Workman's Compensation, Auto insurance and Government payers. I have in depth knowledge of the use of ICD-9 coding, CPT codes, hospital billing and medical terminology. I am an experienced account receivable and follow up representative with a great attention to detail and quality. I have excellent customer service skills, excellent knowledge of the use of several software applications and most importantly, I am a team player.
Licenses
Certified Medical Billing Specialist
Skill Highlights
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Professional Experience
Children's Hospital Of The King's DaughtersPhysician Billing Representative
- Responsible for effectively following up on accounts / invoices for assigned Payors, Aetna, United Healthcare, Cigna, Coventry Healthcare, Golden Rule, Health Assurance, Health America & all payors for Behavioral Health, resulting in payment or final adjustment.
- Proficiency in assigned Payors billing and payment guidelines is required, to ensure the departmental collection goals are met or exceeded as established by management.
- Work accounts / invoices until all charges are paid or denied by the insurance carrier.
- Process insurance / patient correspondence, deductibles, medical records request, non-covered services, adjustments and appeals.
- Process request for adjustments, account type changes, guarantor merges, and transfers when necessary according to enterprise guidelines.
- Accurately enter patient demographics, guarantor and coverage information into Epic system.
- Accurately perform retroadjudication, change filing order, request necessary adjustments / reversal of adjustments, or refile claims.
- Distribute payments for assigned financial class to ensure payments are posted to correct service dates and request changes if needed.
- Identify and report payor trends and issues in order to effect timely resolution.
- Know and use data entry ground rules, Stand Business Practice, Nemours Intranet, Managed Care Manual and where to locate any hard copy or electronic versions.
- Keep abreast of all insurance and system changes, Payor Plan Standards, Just in Time Learning's, News to Use, etc.
- Demonstrate excellent customer service that promotes patient, staff and customer satisfaction, and reflects the Mission, Vision, and Values of Nemours.
State Of OklahomaFollow-up Coordinator04/2002 to 09/2003
- Responsible for entering charges for Neurosurgery Commercial, PPO and Automobile charges.
- Responsible for billing Psychiatry services to Commercial, PPO, HMO, Medicare, Medicaid, Tri-care and Workers' Compensation carriers.
- Delegate insurance and medical billing issues relating to outstanding invoices and deficiency balances.
- Researched and resolved client billing discrepancies, performed follow-up with insurance companies and post any necessary account adjustments, including unapplied and misapplied payments, and performed charge entry for unprocessed claims.
Good Shepherd RehabPatient Account Representative07/2000 to 04/2002
- Oversee Account Receivable payments and delinquent hospital charges.
- Delegate insurance and medical billing issues relating to past due payments and deficiency balances for commercial, third party and government insurance.
- Coordinated and communicated with personnel in satellite centers to exchange information and update controls.
- Maintained high telephone and mail correspondence with all delinquent customers to obtain payment on the accounts.
National Data CorporationMedical Coder/Payment Poster01/1998 to 07/2000
- Responsible for ICD-9CM & CPT 4 Emergency Coding, medical billing, payment posting, charge entry, claims processing, account receivable payment, and correspondence for commercial, third party, and government insurance.
- Troubleshooting and expediently resolving disputed account receivable issues in an ethical and professional manner.
- Performed detailed research to process client account request and billing adjustments adhering to company protocol.
Education and Training
June 1983Neshoba Central High School, City, State
Meridian Community College, City, State
Skills
10 key by touch, Adobe Acrobat, balance, Behavioral Health, billing, CPT 4, client, customer satisfaction, excellent customer service, data entry, E-mail, filing, financial, government, insurance, medical billing, Medical Manager, Medical Terminology, exchange, mail, Microsoft Office, Microsoft Word, Mims, enterprise, personnel, Process request, Coding, Psychiatry, research, Rims, telephone, Troubleshooting, typing skills, type, Vision, Word Perfect
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Resume Overview
School Attended
- Neshoba Central High School
- Meridian Community College
Job Titles Held:
- Physician Billing Representative
- Follow-up Coordinator
- Patient Account Representative
- Medical Coder/Payment Poster
Degrees
- June 1983
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