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Click here or scroll down to respond to this candidateCandidate's Name
E-mail: EMAIL AVAILABLEPhone Number: PHONE NUMBER AVAILABLEPROFESSIONAL SUMMARYHighly organized, efficient, and experienced medical billing specialist with comprehensive expertise in inpatient, outpatient, and physical medical billing. Demonstrates a deep understanding of HIPAA regulations, electronic health records (HER) systems, and insurance terminologies. Excels in accurately filling claims, resolving rejected claims, and navigating insurance appeal processes. Possesses strong problem-solving skills and effectively handles customer complaints with a friendly and positive demeanor. Proficient in various Microsoft applications, including MS Office (Word, Excel, PowerPoint, Outlook), with a strong understanding of their functionalities. Well-versed in patient/client relations and possesses excellent problem-solving abilities. Adheres to HIPAA compliance guidelines and regulations. Demonstrates outstanding interpersonal skills and excels in providing exceptional customer service. Proficient in working with EMR software and adept at utilizing Practice Management Software Applications such as Epic, Cerner, Dr. Chrono, Kareo Billing, Medpointe, Jira Service Desk, and Zendesk.EDUCATIONBSc. Business Administration, Abubakar Tafawa Balewa University.PROFESSIONAL EXPERIENCEAR Follow-up SpecialistGreen Staff Medical Feb 2022 - CurrentFollow up with insurance payers on rejected, denied, and unpaid claims.Utilize Epic software to analyze, monitor, and manage the revenue cycle process, ensuring accurate and timely claim resolution.Manage account reconciliations related to missing remittance, refunds required, and any transfer or adjustments needed.Post all insurance payments, contractual and non-contractual adjustments for assigned carriers by CPT code and transfer outstanding balances to secondary insurance or patient responsibility per EOB protocol.Review claims denied in my work queue to determine a denial trend in claims from different payers to determine quick resolution for multiple claims.Call payers to investigate incorrect denials and get claims reprocessed correctly.Identify and correct billing errors.Monitor prior authorization, accuracy of information, and identify inefficiencies.Adhere to HIPAA law regulations, medical law, and ethics regarding billing.Efficiently work on special projects as assigned by the supervisor.Identify and bill secondary insurances.AR follow up RepresentativeAHS Nursestat Oct 2020 -Jan 2022Ensure accurate billing and timely submission of electronic and paper claims.Investigate and coordinate insurance benefits for insurance claims across multiple service lines.Monitor claim status, research rejections, denials, and document related account activities.Resolve accounts as quickly and accurately as possible, obtaining maximum reimbursement, and perform investigative activities in fast-paced environments.Post adjustments and collections of Medicare, Medicaid, Medicaid Managed Care, and commercial insurance payers.Perform follow-up with Medicare, Medicaid, Medicaid Managed Care, and Commercial insurancecompanies on unpaid insurance accounts identified through aging reports.Collect past-due balances and post payments from patients and insurance, also mail patient statements.Obtain preauthorization and referrals and verify eligibility and benefits for treatments.Reach out to patients to discuss payment and develop reasonable payment plans, entering patient data into administrative systems and recording information about outstanding claims.Responsible for tracking all claims filed, work on denied claims, and appeal claims until resolved.Maintain patient confidentiality based on HIPAA guidelines.Payment PosterLiquid Agent Healthcare July 2019 Sept 2020Prepare and send patient statements.Perform electronic and manual payment posting of insurance and personal payments.Resubmit corrected claims when applicable.Multitask and navigate through multiple systems.Transfer balances to self-pay or secondary insurances.Work closely with AR teams to resolve payment posting errors.Retrieve explanation of benefits (EOBs) from a variety of sources.Communicate with insurance companies regarding missing or incomplete EOBs.Maintain a daily production log.Use basic knowledge of computer programs such as PC, Microsoft Office, Excel, and Power BI.Advantis MedicalCustomer Service Representative Jan 2017 June 2019Identify, research, resolve, and respond to customer inquiries via telephone and written correspondence.Clarify to customers a variety of specifics pertinent to the organization's healthcare services.Explain plan policies, procedures, programs, and guidelines to customers.Answer a diverse and high volume of health insurance-related customer calls and correspondence daily.Consult and coordinate with various internal departments, external plans, providers, businesses, and government agencies to obtain information and ensure the resolution of customer inquiries.Document and record facts related to inquiries and correspondence.Verify various insurance plans and eligibility.Ensure member satisfaction and provide professional member support.Keep proper documentation of each member interaction in our computer system.COMPETENCIESCoreMedical billing (inpatient, outpatient, physical), Claims filing and resolution., Insurance appeal processes, HIPAA regulations and compliance, Electronic health records (HER) systems, Microsoft Office Suite (Word, Excel, PowerPoint, Outlook), Customer service and patient/client relations, Problem-solving and complaint resolution, Data entry and management, Efficient patient statement processing, EMR software proficiency, Practice Management Software Applications (Epic, Cerner, Dr. Chrono, Kareo Billing, Medpointe, Jira Service Desk,Zendesk), Strong interpersonal skills. |
