Service-oriented Billing Specialist with 20 year background in medical billing. Core competencies
include Internal Medicine, Podiatry, Cardiology, Radiation Oncology and Hospitalist billing as well
as excellent communication and time management skills. Handles tasks with accuracy and
efficiency.
Education and Training
University Of Phoenix Borough of Manhattan Community CollegeOrlando, FLExpected in – –Bachelor of Science:Healthcare Administration Management Healthcare Administration Management Social Work - GPA:Healthcare Administration Management Healthcare Administration Management Social Work
, Expected in – –Associate of Science: - GPA:
Skill Highlights
Guest services
Inventory control procedures
Merchandising expertise
Loss prevention
Cash register operations
Product promotions
Professional Experience
Kaiser Permanente - Radiation Cancer AR Specialist Woodbridge, VA, 04/2014 - 05/2015
Contact insurance companies to check on status of Radiation Cancer claims payments and write appeal letters for denial on claims.
Sort and file correspondence, and perform miscellaneous clerical duties such as answering correspondence and writing reports.
Complete insurance or other claim forms.
Transmit correspondence or medical records by mail, e-mail, or fax.
University Of Pennsylvania Health System - Claims Examiner Moorestown, NJ, 04/2013 - 03/2014
Examined Humana and AIG supplemental Cancer claims based on policy provisions.
Process and review claims for any pre-existing conditions.
Process contestability reviews Process all incoming correspondence Assess patient calls Analyzed and interpreted patient medical and surgical records to determine payable services Demonstrated knowledge of HIPAA Privacy and Security Regulations by appropriately handling patient information.
Strictly followed all federal and state guidelines for release of information.
Johnson Controls, Inc. - AR Representative Lincoln, RI, 09/2011 - 02/2013
Strictly followed all federal and state guidelines for release of information.
Consistently ensured proper coding, sequencing of diagnoses and procedures.
Demonstrated knowledge of HIPAA Privacy and Security Regulations by appropriately handling patient information.
Analyzed and interpreted patient medical and surgical records to determine billable services.
Interpreted medical reports to apply appropriate ICD-9, CPT and HCPCS codes.
Thoroughly reviewed remittance codes from EOBS/AR's.
Confirmed patient information, collected copays and verified insurance.
Completed appeals and filed and submitted claims.
Posted charges, payments and adjustments.
Submitted refund requests for claims paid in error.
Meticulously tracked and resolved underpayments.
Consistently informed patients of their financial responsibilities prior to services being rendered.
Remained up-to-date with all insurance requirements, including the details of patient financial responsibilities, fee-for-service and managed care plans.
Efficiently performed insurance verification.
Universal Hospital Services, Inc. - Office Administrator West Allis, WI, 02/2011 - 09/2011
Responsible for the setup of a new practice that focuses its care on low vision rehabilitation.
Setup Office Electronic Medical Records System Set up Practice Management System Established and setup Office Merchant account Set up office Inventory Tracking System Over all did everything for the practice and addressed any area with precision and expedience, from assessing technical issues to office Maintenance.
University Of Pennsylvania Health System - Medical Insurance Collector Phoenixville, PA, 09/2009 - 07/2010
Following up on unpaid accounts or denying claims for their status Filed appeals for all denied claims Work special insurance reconciliation spread sheets for resolution of old unpaid claim issues.
Look up IDC-9 codes to verify if code has been changed.
Verify insurance payments were made based upon the provider's contracted fee schedule as well as confirm the insurance contractual adjustments are loaded correctly.
Physician Associates - AR Representative City, STATE, 06/2005 - 06/2009
Charge Entry for Hospitalist, Podiatry, and Sleep Study Verify procedure-diagnosis relationship Process claims for either electronic or paper billing Research and respond to patient inquiries regarding billing issues and insurance problems.
Maintained supporting documentation and patient insurance demographics and data collection systems.
Following up on unpaid accounts or denying claims for their status.
Monitor unpaid claims, initiate tracers.
File dispute and/or appeals to insurance companies for resolution of claims.
Resubmit claims as needed.
Balance daily batches and reports.
Ensure strict confidentiality of financial records.
Perform miscellaneous job-related duties as assigned.
Oversee physicians to make sure they are submitting charges timely for proper billing guidelines.
Professional Affiliations
Member of American College of Healthcare Executives (ACHE)
The Alliance of Professional Health Advocates (APHA)
Sep 2015
Skills
AR, Balance, billing, Cancer, Clerical, CPT, Critical Thinking, data
collection, Decision Making, diagnosis, documentation, Electronic Medical Records, Electronics, e-mail, fax, financial, forms, ICD-9, insurance, Inventory, letters, Medical billing, Medical coding, mail, Office, Personnel, coding, rehabilitation, Repairing, Research, spread sheets, Time Management, vision
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School Attended
University Of Phoenix Borough of Manhattan Community College
