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Click here or scroll down to respond to this candidateCandidate's Name
Street Address SE Stark Street, #1Portland, OR Street Address
PHONE NUMBER AVAILABLEEMAIL AVAILABLEI am a highly experienced and licensed Medical Claims and Billing Specialist with over 30 years in the field. As the owner of Sunnybrook Billing Services, LLC, I manage all aspects of medical billing, collections, and financial reporting. My expertise includes accounts receivable, denial claim management, and appeals, along with proficiency in EPIC Hospital Billing and various software systems. My background also encompasses administrative roles, nursing services, and legal support, making me a versatile professional. With a Bachelor's degree in Social Sciences and multiple certifications, I ensure compliance with regulations while delivering exceptional customer service.Skills & Qualifications:Licensed Medical Claims and Billing Specialist, Collections, Credentialing, Contracting, Consulting, Accounts Receivable, Accounts Payable, Inventory Management, Month-end Financial Preparation, Reports and Analysis, Bank Reconciliations, Re-configuring Fee Schedules to appropriate Medicare/Medicaid allotted amounts, EMR, EHR, ADP, DMEADMINISTRATIVE NURSINGMedical claims and billing service CMA/CNAPre-certification, Insurance Verification Unit SecretaryCollections and Appeals, Revenue CycleEPIC Hospital BillingRegistration, SchedulingDenial claim managementReferral Follow-upMedicare/Medicaid/VA/WCCPT and ICD-9/ICD-10 CodingHCFA-1500 & UB-04 Electronic BillingAccounts Payable/Accounts Receivable ManagementProviding Credentialing and Contracting Needs for Individuals and Group PracticesWorking with Paralegals and AttorneysProfessional Experience:SUNNYBROOK BILLING SERVICES, LLC (http://sunnybrookbillingservices.com/) -- Portland, OR 1996 to present Owner Perform all Administrative and Nursing skills and requirements as given. Collection Specialist on $Million Account Receivables to Decrease Outstanding Balances. Generate monthly/yearly end client financial statements. Reconcile bank accounts, improved cash collection and control. Create organizational, departmental and client budgets emphasizing client billing, financial reporting, including invoices and receipts. Obtain referrals and pre-authorization as required Verify benefits and eligibility Scrub claims for completeness Transmit claims using billing software, including electronic and paper claim processing Follow up on unpaid claims within standard billing cycle time frame Reconcile claim remittances Post payments Manage claim discrepancies and denied claims Answer all patient billing and insurance inquiries Set up patient payment plans and work collection accounts Maintain current insurance rates within billing program Run, manage and report on claim and invoice status reportsACCLARA Portland, OR2021 to 2024 - Revenue Cycle RepresentativeOptimize cash flow and minimize bad debt by managing accounts receivable billing, collections, and follow-up activities.Resolve payer rejections and denials through the appeals process as per payer requirements.Follow up with insurance companies to track outstanding claims and facilitate resolution.Review and respond to insurance correspondence to ensure accurate reimbursement for medical claims.Achieve or surpass productivity and quality benchmarks.Handle payer correspondence, edits, and aged accounts receivable, rectifying billing errors as needed.Stay updated on payer rules and regulations to maintain knowledge.Prepare various correspondence such as claim forms, appeals, and notifications.Engage with patients and guarantors to address outstanding insurance balances while delivering exceptional customer service.Ensure compliance with HIPAA and other regulatory requirements to safeguard patient confidentiality.Strive for continuous improvement in performance metrics like touches to resolution, appeal resolution rate, and average work time per claim.Effectively utilize various computer applications and accurately document all actions taken.Perform other duties as assigned.- 30+ years high-volume insurance, denials, and appeals.- Demonstrate ability to maintain high productivity and quality standards.- Strong written and verbal communication skills.- Proficiency in Microsoft Office Suite; experience with EPIC and SharePoint.- Capacity to work independently, multitask, and problem-solve effectively.Education:UNIVERSITY OF MARYLAND @ COLLEGE PARK -- College Park, MarylandBachelor of Arts and Social Sciences (Sociology) (Pre-Nursing)Certificates & Licenses:LICENSED AS A MEDICAL CLAIMS AND BILLING SPECIALIST -- February 1998CERTIFIED AS A NURSING ASSISTANT (CNA) -- March 1996/2005CERTIFIED AS A MEDICAL ASSISTANT (CMA) -- June 2005CERTIFIED BASIC FIRST AID/CPR/AED -- June 2005/2007/2009EKG INTERPRETATION & MANAGEMENT CERTIFIED -- June 2007Software:EPIC, MEDITECH, Microsoft Office, Availity, JaneApp, Dentrix, Centricity, TX-ACE, Oracle, HIPPA billing systems,Windows apps, QuickBooks, NextGen, Infinity, Medi-Soft, Office Ally, OCHIN |
