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Click here or scroll down to respond to this candidateCandidate's Name
(Medical Biller - (18+ Years Experience)225 Sagebrush Trail Lexington, NC 27292-7319Email EMAIL AVAILABLECell Phone # PHONE NUMBER AVAILABLELinkedIn Profile https://LINKEDIN LINK AVAILABLE Detail oriented & meticulous Medical Biller, who undertakes complex assignments, able to meet tight deadlines & takes pride in delivering superior performance. Extremely knowledgeable with medical billing, insurance & coding regulations/guidelines. Applies strong planning & analytical skills to inform management/superiors of any/all updated billing "trends", to help reduce claim "write-offs". Operates with a strong sense of urgency & thrives in a fast-paced setting. Always willing to cross-train & learn any billing methodology not yet known to myself. Previous Work Experience:No-Fault & Workers' Compensation Claims Analyst(100% Remote Position)RTR Financial Services, Inc.July 2023 - PresentSoftware Used: Epic, OnBase, HealthLogic, Boomea, All Microsoft Office Programs/Software Responsibilities:Responsible for obtaining the status of hospital/physician's bills (claims) that are sent to Insurance Carriers.Made collection calls on a daily basisfor any overdue self-pay balances.Exprected to retrieve information from the Insurance company both via online portals & via direct calls to the carrier office(s).Responsible for understanding, based on that information, why claims have been denied & finding the best action to rectify the issue at hand.Attention to detail & trends are important, as is the ability to communicate said knowledge to upper management when requested.Expected to maintain a work quota of at least 30-45 accounts per day - Meaning: following up with carriers, adjusters, attorneys & more.Ability to notate clear & concise notes via Epic on each account.Responsible for submitting AOB (Assignment of Benefits) regarding all "No-Fault" accounts to either the patient or patient's attorney.Knowledge of WCB (Workers' Compensation Board) portal to submit HP-1/DOIs in cases when carriers do not respond to us within the required 45-day timeframe alotted.Adequate fluency via telephone communication with carrier representatives as well as attorneys & paralegals.Insurance & Patient Accounts SpecialistSalem Professional Anesthesia Services - Advance, NC August 2021 to July 2023Software Used: MacPractice, BB&T for self-pay & VCC payments Responsibilities: Posted VCC payments daily. Posted insurance payments in MacPractice to each patient's account and date-of-service -- Also includes posting large, bulk insurance payments.1 Filed appeals to insurance carriers as needed. Created orders for any EOBs that weren't paid in full and needed follow-up of any kind. Worked the rejected eClaims reports. Made collection calls on past due accounts. Transferred past due accounts to a third-party collection agency. Set patients up for payment arrangements when qualified. Interacted with patients to educate them the need of contacting non-contracted insurance carriers for reprocessing of claims for balance billing. Kept patients updated via phone or email when requested. Participated in conference calls with insurance carriers and patients when needed. Contacted third-party pricing vendors for negotiations. In charge of checking voicemails daily. Providing self-pay Anesthesia and Nerve Block estimates to patients. Entering demographics to MacPractice when needed. Scanned all EOBs, denial letters, appeal information from insurance carriers, etc. Office Receptionist Training Position OnlyFour Directions Treatment Center - Lexington, NCFebruary 2020 to July 2020Coronavirus/COVID-19 caused our offices to close, which led to having to let staff members go. Software Used: DMV systems that cannot be listed due to privacy laws. Responsibilities: Direct interaction with NC DMV. Obtained all required records from the state. Acquired all criminal and non-criminal background checks. Collected all payments either via cash or debit/credit card. A/R Representative IIMcKesson, Inc - Winston-Salem, NCJune 2015 to February 2020Software Used: AllScripts & TouchWorks Practice Management Responsibilities: Follow-up of all outstanding A/R with all payors - including self-pay and the resolution of denials. Responsible for handling all correspondence/EOBs related to patient accounts. Responsible for contacting insurance carriers, patients, & other facilities as needed to get maximum payment on accounts. Used Citrix telephone queue software - Received an estimate of 50 calls/day (minimum). Used BB&T credit card software to process any payments received via telephone from patients. Ran daily A/R reports to work on all outstanding accounts. Cash Posting SpecialistHigh Point Regional/UNC Healthcare - High Point, NC 2January 2014 to June 2015Software Used: STAR & BB&TResponsibilities: Keyed transactions & posted batches into hospital accounting system (STAR) to reconcile outstanding balances. Resolved Posting issues identified by other departments. Completed daily balancing for accurate accounting. Monitored & resolved unapplied payments monthly. Maintained productivity & quality standards at all times. Verified all incoming Explanation of Benefits.Authorizations AnalystCornerstone Healthcare - High Point, NCFebruary 2008 to December 2013Software Used: AllScripts, AllScripts PM, TouchWorks PM Responsibilities: Scheduled all procedures/testing (including diagnostic scans). Verified benefits/eligibility for all procedures/tests prior to services being rendered, to help ensure payments would be made by insurance companies. Verified medical necessity guidelines, prior-authorization requirements, & pre-determination requirements for every patient/service. Attended all insurance meetings to stay up-to-date with medical necessity guidelines. Spoke with patients via phone & face-to-face regarding their benefits before tests/procedures were rendered. Collected deductible payments, co-payments, out-of-pocket payments, & co-insurance payments upfront before services were rendered. Set patients up on payment arrangements/plans as needed & as the office/provider allowed. Assisted the office manager with keeping track of "no-shows", as well as sending dismissal letters via certified mail, on a daily basis. Stayed up-to-date with ICD-9 coding, ICD-10 coding, HCPCS, & CPT-4 coding. Obtained any/all necessary prior-authorizations from patient's insurance companies for prescription medications.Medical BillerBethany Medical Center - High Point, NCSeptember 2006 to February 2008Software Used: Medical Manager, AllScripts EMR, AllScripts Practice Management Responsibilities: Responsible for posting payments, office charges, nursing home charges, & hospital charges daily. Prepared & distributed all monies to the front desk staff. Analyzed, researched & resolved billing issues. Responsible for gathering month-end reports for monthly staff meetings. Worked Medicare, Medicaid, & commercial insurance EOBs/denials. 3 Responsible for staying up-to-date on all medical coding & insurance guidelines. No-Fault & Workers' Compensation Claims Follow-Up Analyst RTR Financial Services Remote PositionJuly 2023 to CurrentSoftware Used: Epic, OnBase, HealthLogic, MS Teams Responsibilities: Responsible for obtaining the status of hospital/physicians bills (claims) that are sent to Insurance Companies. Expected to retrieve information from the Insurance company both via online portals and via direct calls to the carrier office(s). Responsible for understanding, based on that information, why claims have been denied and finding the best action to rectify the issue at hand. Attention to detail and trends are important, as is the ability to communicate said knowledge to upper management when requested. Expected to maintain a work quota of at least 30-45 accounts per day Meaning following-up with carriers, adjusters, attorneys & more. Ability to notate clear and concise notes via Epic on each account. Responsible for submitting AOB (Assignment of Benefits) regarding all No-Fault accounts to either the patient or receiving from the patient's attorney. Knowledge of WCB (Workers' Compensation Provider Portal) to submit HP1/DOIs in cases when carriers do not respond to us within 45 calendar days via EOB/Payment/Denial Adequate fluency in telephone communication with carrier representatives. Education:Certification in Medical CodingAllied Health InstituteJuly 2009Certification in Medical Office AdministrationSan Joaquin Valley College - Visalia, CAJanuary 2005 to December 2006Clinical Medical AssistingSan Joaquin Valley College - Visalia, CAJanuary 2005 to December 2005Certified Professional Coder Online (in progress) AAPC Online Instructor LedFebruary 2024 to CurrentSkills:4 EMR (10+ years) MS Office (10+ years) Sleep Studies (6 years) PT (6 years) Pain Management (10+ years) EOBs (10+ years) Prior Authorizations (10+ years) CMA (2 years) Coding (10+ years) Medical Terminology (10+ years) Anatomy (10+ years) Billing (10+ years) Customer Service (10+ years) Patient Scheduling (10+ years) Medical Billing CPC Medical Coding Medical Insurance DME Scheduling Medical Records Insurance Verification Microsoft Office Filing Word ICD-10 CPT Coding ICD-9 Allscripts Physiology Knowledge Allscripts Epic ICD-9 Physiology Knowledge Laboratory Experience No-Fault Claim Follow-Up Workers' Compensation Claim Follow-Up Knowledge speaking with attorneys regarding No-Fault/Workers' Comp Claims Ability to write clear and concise notes Willingness to participate and to be flexible with changing priorities and projects Ability to read and understand previous notes on an account to take the accurate next step toward resolution Time management skills and a team player mentality Detailed understanding of medical billing terminology and processes Familiarity with payer portals and denials Fluency in telephone communication with carrier representatives Actively participates in team huddles via Microsoft Teams webcam meetings as needed 5 |
