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Click here or scroll down to respond to this candidateCandidate's Name
Appeals and Claims SpecialistSaint Peters, MODetail-oriented Medical Billing Representative with 10 years of experience demonstrating strong background in healthcare revenue cycle management. Proficient in accurately coding and processing medial claims, resolving billing discrepancies, and optimizing reimbursement processes. Exceptional knowledge of medical billing software and compliance regulations. Adept at maintaining high levels of patient confidentiality and ensuring timely, error-free claim submissions.Work ExperienceMedical Billing RepresentativeMed-Tech - Ballwin, MOSeptember 2021 to PresentAchieve 98% claims acceptance rates by meticulously reviewing and accurately coding medical claims, resulting in 20% reduction in claim denialsReduce accounts receivable aging by 30% through diligent follow-up on outstanding claims, leading to an improvement in cash flow and financial stabilityMedical Billing representative who helped in resolving denials, wrote appeals, submitted claims, reviewed and sent medical records, fixed diagnosis codes and refilled claims. Also, resolved recoupment issues and set up account for EFT payments and online registration for provider web portals. I filed medical necessity, out of network, timely filing and many other appeals. Ive also provided end of month reports as well as many other needs from the docto r and staff.Appeals AnalystWashington University in St. Louis - Saint Louis County, MO August 2018 to June 2020 Appeals Coordinator for Neurological Surgeons and other Divisions to include Pediatric, Trama, Cardiothoracic, Plastic Surgery, Urology, Orthopaedics and more. Specialist in claims submission and editing, authorization, appeals management, negotiations, claim errors, small balance write off's, patient payments, systematic error correction, coordination of benefits, CCI edits, claim denials, patient and insurance verification.Laboratory Coding SpeacialstAIMS - Olivette, MONovember 2017 to May 2018 Coding for clinical and laboratory screenings, data entry, payment posting, charge correction, claim submission, denials and appeals. Insurance Follow Up ManagerConifer Health Solutions - Saint Ann, MOSeptember 2015 to May 2016 Performed insurance follow-up tasks on 3,000+ outstanding and denied insurance claims. Claim submission and resubmission using EDM Ace for Mercy Hospital and Saint Louis University. Corrected Denials, verified DX codes, submitted medical records, wrote and mailed appeals, insurance verification and posted payments. Approved patient refunds, verified and updated contracts, pulled reports and reformatted within excel. Once I find more than 3 claims with similar errors, I strive in using excel to help locate trends in hopes to bring more profitable income. Accounts Receivable ManagerNational Medical Billing Services - Chesterfield, MO February 2013 to September 2015 Ambulatory surgical centers and professional provider's claims submission/ denials follow- up. Experience using UB-04, UB-92 and CMS 1500 forms, negotiations and appeals. Updated patient demographics, posted and issued refunds for patients and insurance companies. Worked with insurance providers to include: Government, private, commercial carriers like Aetna, Humana, HealthNet, Healthcare USA, Molina, Medicaid, Medicare, Cigna, Blue Cross and Blue Shield, United Healthcare, VA, Workers Compensation, Auto Accidents and many smaller carriers. Negotiations made on OON claims for minimum of Medicare fee schedule to maximum of 100% of billed charges. Claims submissions, charge posting, payment posting, posting, corrections, added hospice diagnosis's and resubmitted corrected claims. Claim escalation, verified benefits and eligibility, contracts and fee schedules, CCI edits. Highly knowledgeable using EDM systems such as Medinformatix, ACE, E-clinical, SIS, Medtech, Med works, Nextgen, and clearinghouse Zirmed. "You get more bees with honey than you do with vinegar" EducationHigh school diploma in General Studies, Hancock High School Core CompetenciesMedical Billing, Claims Processing, Billing Software, Revenue Cycle Management, Billing Compliance, Claims Resolution, Accounts Receivable Management, Healthcare Regulations |
