Montgomery Street, San Francisco, CA94105609 Johnson Ave., 49204, Tulsa, OK
H: (555) 432-1000
C:
resumesample@example.com
Date of Birth:
India:
:
single:
Professional Summary
To fulfill all job descriptions as a Medical Biller / Medical Collector Supervisor where I can apply my billing experience and skills towards achieving the goals of the company.
Skills
Medical Billing, Medical Coding, Medical Terminology, Team player with positive attitude, Work well under pressure, Ability to analyze solutions and identify problems, Experience in managing Medi-Cal and Medicare HMO Departments, Experience in managing Private Pay Department, Knowledgeable with health care billing procedures, Keyboarding, Microsoft Office, Bilingual, ICD-9, CPT, HCPCS
Professional Experience
Team Lead, 01/2010 - Current Topgolf â Albuquerque, NM,
Answer and resolve patient billing inquires.
Assist with any patient complaints received via email, over the phone or from the Better Business Bureau
Train employees to ensure that policies and procedures are implemented in the Insurance/Self-Pay Department
Handle and resolve billing issues with patients and insurance companies
Ensure that updates are made to our billing system of any address/phone number changes of Health Plans or Medical Groups
Ensure that employees are provided with updated billing instructions when billing Health Plans or Medical Groups to ensure correct billing so claims are paid accordingly
Provide outside sources such as Law Offices with any balances and invoice request
Request cancellation of accounts from the collection agencies after careful review of accounts is made and a determination is made that the accounts does not belong in collections
Communicate with insurance companies and provide them with a report of trips when necessary for issues with payments delays or denials in errors to expedite payment from the payors
Assist the company with the migration from one billing system to another
Communicate with the System Administrators for any issues or updates needed on claim forms to ensure claims are submitted correctly
Process credit card payments received from Operations and communicate with the Cash Department to make sure the payments are posted to the correct trips. Also, communicate with the Initial Billing Department to ensure the trips are placed on hold once entered since a payment was received at the time of service, so the patients are not billed
Review Medical Records for discrepancies of information entered into the system and that recorded on the patients medical records. Will communicate with the Initial Billing Department for any necessary updates to a trip
Provide customer service to patients with billing issues or those in connection with their account balances which have gone to collections.
Direct staff during management absence
Train staff on specific duties such as mail return, insurance billing, appeals, collections and when necessary on any enhancements perform in the company's billing system
Evaluate/asses employees on their strengths and weakness of their job duties (reps doing initial billing, follow-up and those reviewing denials and submitting appeals to an insurance) to be able to assist and determine if additional training is needed for the employee
Report to management of any conflicts that arise whether it is with an insurance carrier, the billing system or with employees. A report is given to Management even when an issue is resolved
Give a report of any updates to management
Assist with approval of adjustments/write offs
Run reports of employees production
Review Audits of employees and provide our QA Department with feedback on any discrepancies on their review. Also, provide employees with the results of their audits to ensure they agree, and so additional training or training material is provided if necessary
Work on special projects. Previously assisted and trained on a project for issuing refunds to insurances and patients
Communicate with Operations on any billing disagreement from patients to ensure customer satisfaction
Maintain communication with staff and management
Communicate with the Cash Department to locate any misapplied payments and transfer requests
Submitted HMO, PPO, Medicare, Medical and Worker compensation claims to both commercial Insurances as well as private via paper and electronic
Submitted an aging of accounts to different payors when issues where encountered such as underpayments for expediting of payment
Familiar with websites of insurances and have agility to check status for claims or eligibility. Negotiate collection claims that are unpaid with both insurance companies and patients
Reviewed EOB and denials from insurance providers. Submit appeals to insurances.
Billed patients once insurance pays their portion of claim or if entire claim is denied. Send EOB to secondary insurance.
Make calls to the Health Plan to check on status of claims and eligibility. Provide insurance representatives with any additional information requested. Assist them with the best of my knowledge on submission of claims to ensure request gets resolved.
Requested retro-authorizations for services provided in order to receive payment from Medical Groups, and forward claims to IPA.
Resolve incorrect payments and submit correct write downs or write offs for accounts paid correctly or with underpayments, overpayment's or paid at Contract rates.
Calculated Medicare allowable for accounts in which patients have a supplemental plan with Medicare and submit write down request.
Provided follow-up to ensure proper payment was made, and no overpayment or underpayment is done on accounts.
Check medical record charts in computer system and provide medical records of patients when requested by insurance. Maintain and organize charts for accounts with underpayments, overpayment's, EOB and for accounts requesting follow-up calls to insurances.
Provided customer service to patients with billing issues or those in connection with their account balances which have gone to collections. Take phone payments from patients and adjust accounts accordingly.
Researched in system for payments received and not posted to correct accounts. Provide reports to management on aging accounts
Adhered to company policies and procedures
Received payment information from patients made by either credit card or by check
Released trips for billing
Assisted patients with any questions regarding payments or balances on their accounts. Forwarded any customer grievances to management when necessary
Assisted with mail return
Assisted management with locating unapplied payments
Answered incoming calls from insurance carriers, patients or law firms
Teacher Assistance, 08/2005 - 05/2006 Los Angeles Unified School District â City, STATE,
Clerical support for teacher, and meeting special needs of
parents.
Supervising children and assisting with reading and writing.
Operating office equipment, translating, assisting in event and program preparations.
Office Assistant/ Instructor Assistant, 02/2003 - 05/2005 Los Angeles Harbor College â City, STATE,
Answer multiple phone lines.
Usage of computer, fax, copier and typewriter.
Wrote memos for instructors and was in charge of distributing memos to professors
Assisted disable students in Adaptive Physical Gym by transferring them from station to station and to their classes.
Demonstrated proper usage of equipment.
Assisted students with selecting courses from the Physical Education and Health Department
Assisted with communication between the Physical Education Chairman and staff
Certified Nursing Assistance, 08/2000 - 05/2001 C.N.A San Pedro Pavilion â City, STATE,
Assist disable patients perform daily task such as personal grooming.
Provide personal care by giving patients bed bath and assisting.
patients getting up from bed.
Took the time to motivate and encourage patients to have a more active lifestyle.
Education and Training
CPC Certificate: Medical Coder, Expected in 2007 - American Academy of Professional Coders - Redondo Beach, CA GPA:
Medical Biller Certificate: Medical Biller, Expected in 2007 - Southern CA Regional Occupational Center - Torrance, CA GPA:
Associate of Arts: Liberal Arts, Expected in 2005 - Los Angeles Harbor College - Wilmington, CA GPA:
High School Diploma: , Expected in 2002 - San Pedro High School - San Pedro, CA GPA:
C.N.A. Certificate: Certified Nursing Assistance, Expected in 2001 - San Pedro High School - San Pedro, CA GPA:
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