Patient-focused Revenue Cycle Specialist for Freestanding ER Facility Familiar with commercial and private insurance carriers, skilled at medical billing, coding and office management. Reliable multi-tasker
Conducted an investigation outside of assigned job duties and initiated a mass appeal to Aetna to address claims that were not being paid correctly for the 2yrs prior to my hire, which led to Aetna being found liable. Prepared legal correspondence for attorney Thoroughly investigated past due invoices and minimized number of unpaid accounts.Recorded and filed patient data and medical records.Demonstrated analytical and problem-solving ability by addressing barriers to receiving and validating accurate HCC information.Assigned additional diagnosis codes based on specific clinical findings (laboratory, radiology and, pathology reports as well as clinical studies) in support of existing diagnoses.Strictly followed all federal and state guidelines for release of information.Accurately entered procedure codes, diagnosis codes and patient information into billing software.Reviewed diagnostic and procedural terminology for consistency with acceptable medical nomenclature.Consistently ensured proper coding, sequencing of diagnoses and procedures.Quickly responded to staff and client inquiries regarding CPT codes.Demonstrated knowledge of HIPAA Privacy and Security Regulations by appropriately handling patient information.Confirmed patient information, collected copays and verified insurance.Thoroughly reviewed remittance codes from EOBS/AR's.Performed full-cycle medical billing in a fast-paced medical billing company.Efficiently performed insurance verification and pre-certification and pre-authorization functions.Prepared and attached all required claims documentation including referrals, treatment plans or other required correspondence to reduce incidence of denials.Ensured timely and accurate charge submission through electronic charge capture, including the billing and account receivables (BAR) system and clearing house.Carefully prepared, reviewed and submitted patient statements.Submitted refund requests for claims paid in error.Thoroughly reviewed remittance codes from EOBS/AR's.Interpreted medical reports to apply appropriate ICD-9, CPT-4 and HCPCS codes.Added modifiers as appropriate, coded narrative diagnoses and verified diagnoses.Appropriately and correctly identified errors and re-filed denied/rejected claims as they were received from the Patient Account Representative.Demonstrated knowledge of HIPAA Privacy and Security Regulations by appropriately handling patient information.Acted as a liaison between the business department, billers and third party payers in resolving billing and reimbursement accuracy..Thus resulting in a payment to Employer of $192,000.00. Provided Successfully led key
HIPAA compliance, Patient relations,Accounts receivables, Electronic billing, Cash flow reports, Customer service, Data entry, Documentation, Clali, frame, hiring, ICD-9, CPT Codes, inventory control, coding, recruitment, scanning, scheduling, Word Processing, Staff training/motivation/development, HMO, indemnity, and commercial insurance, Hospital business administration, Non contracted/contracted billing,Creative Problem Solving, Critical Thinking, Customer Needs Assessment, Customer Service, Data Collection, Data Entry, Documentation, Email, Microsoft Excel, Microsoft Office
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