Billing Specialist Resume Samples

Description :

1. Posted payments from EOB's by insurance carriers including but not limited to Medicare, Medicaid, BCBS, Aetna, Cigna, and Humana.
2. Confirmed and corrected any patient demographic and insurance data entry errors to ensure clean claims.
3. Developed financial report for the head doctor that reflected the potential impact on the practice's insurance receivables when payment rules changed on a diagnostic test performed regularly successfully filed appeals directly online to the Texas Medicaid website.
4. Provided follow-up to insurance companies and patients when needed to expedite payment on receivables; received payment of over $4000 of $5000 billed surgery owed for one year.
5. Designed and delivered power point presentation about ABN form at practice's annual company meeting to three physicians and seventy employees.
6. Updated practice's advance beneficiary notice form to bring practice into compliance with current Medicare guidelines.
7. Created first medicare LCD injections allowed diagnosis sheet used throughout the practice by both the billing department and technicians in all exam rooms.
8. Designed and implemented the first banking reconciliation spreadsheet for practice to more effectively and accurately reflect out the daily deposit.

Experience

0-2 Years

Level

Entry Level

Education

Associates

Description :

1. Billing all primary and secondary insurance claims in a timely and accurate manner, demonstrating the working knowledge of all appropriate billing forms, ub04, 1500 or state specified forms, utilizing the electronic billing systems.
2. Demonstrating a working knowledge of federal, state, local and intermediary specific billing requirements to ensure appropriate authorizations are completed and/or notifies appropriate person of missing or incomplete billing requirements and following up in a timely manner.
3. Auditing each bill for charges, duplications and overlapped accounts before billing, making any necessary adjustments and documenting appropriately.
4. Maintaining and securing medical documentation to support claims or appeals as necessary.
5. Resolving the claim errors on the billing system in a timely manner by reviewing claim error reports and taking appropriate action.
6. Responsible for documenting billing activity including but not limited to the following: bill dates, notes, and electronic note posting.
7. Responsible for system balancing ensuring all downloaded/translated claims are submitted along with completing the daily billing balancing form.
8. Identifying additional billing edits required to submit clean and compliant billing to various payers.

Experience

5-7 Years

Level

Executive

Education

BS

Description :

1. Preparing journal entries to post to the general ledger on a monthly basis.
2. Reviewing and approving the daily balancing and closing reports of encounters processed.
3. Analyzing the designated accounts to ensure the accuracy of coding and account balances.
4. Serving as back-up for accounts payable front line of the financial office where responsibilities include insurance but are not limited to fraud investigations, patient billing, and liaison for both internal and external clients.
5. Experience handling multi-line phones with an exceptional work ethic that permits multiple hats to be worn in the finance department.
6. Communicating and performing follow up with insurance companies and vendors on patient accounts in a timely manner in compliance with HIPAA regulations.
7. Analyzing monthly account receivable reports to ensure timely filing, third-party payments, and consistent cash flow.
8. Examining patient discrepancies, reconcile patient disputes and satisfying attorney inquiries are examples of one of many the day to day tasks completed.
9. Skillfully monitoring and maintaining the assigned accounts to include but not limited to account adjustments, small balance write-offs, customer reconciliations and /or processing credit memos.

Experience

5-7 Years

Level

Executive

Education

College

Description :

1. Followed-up on all unpaid insurance claims answered patients questions regarding their bills, processed all refunds, performed insurance and patient collections.
2. Entered financial data into the company accounting database to be verified and reconciled.
3. Generated invoices upon receipt of billing information and tracked collection progress.
4. Tracked financial progress by creating quarterly and yearly balance sheets.
5. Streamlined daily reporting information entry for efficient record keeping purposes.
6. Communicated with customers to identify and resolve outstanding payments.
7. Routinely collaborated with department managers to correct problems and improve services.
8. Worked with the electronic claims filing system to ensure it is working properly.
9. Answered questions from patients regarding their bill and also met with them in person.
10. Worked with both medical and dental claims and following the FQHC guidelines.
11. Contacted the patient's doctor for a referral for non-emergency services.

Experience

10+ Years

Level

Consultant

Education

BS

Description :

1. Billing department functions, medical billing, charge entry, claims, payment posting, requisite patient information into billing software to streamline invoicing and account management, added modifiers, verified diagnosis, and coded narrative diagnosis.
2. Responded to staff and client inquiries regarding CPT and diagnosis codes.
3. Examine patients' encounter forms to verify diagnosis codes, and reconcile codes against services rendered.
4. Accurately input procedure and diagnosis codes into billing software to generate invoices.
5. Used electronic charge Capture Practices such as billing and account receivables (Clinix) system and medical billing clearinghouse accounts to submit codes and invoices on time.
6. Followed-up on the past-due invoices and delinquent accounts to reduce the number of unpaid and outstanding balances.
7. Documented patient data and medical records, and performed routine medical record audit to comply with insurance company requirements.
8. Researched and resolved billing and invoice problems entered the appropriate medical code into the billing system followed up on unpaid claims and denials.

Experience

5-7 Years

Level

Executive

Education

BS

Description :

1. Posting all payments by both patient and payor. Completing all month end processes, batch balances, and reporting.
2. Ensuring all payors are processing according to contracts, negotiating all non-par agreements and working with the collection agency on past due accounts.
3. Carrying the sole responsibility for the two largest aged accounts, Medicare and Anthem Blue Cross Blue Shield as well as assisting the department with the remaining commercial par and non-par accounts.
4. Working on insurance projects when needed and do all electronic fund transfer downloads for Medicare, Anthem, Aetna, and Medicaid.
5. Working closely with the billing supervisor to ensure claims are correct to secure prompt payment.
6. Maintaining monthly goals based on the percentage of charges and previous years statistics.
7. Working on educating our patients regarding their individual policy and plans with an effort for the patient's involvement to resolve unpaid claims and to encourage understanding of the billing process.
8. Verifying insurance for patients and verified referrals and pre-certification as needed.
9. Assisting patients with billing problems or in making initial financial arrangements.

Experience

10+ Years

Level

Consultant

Education

Associates

Description :

1. Providing billing support for client companies through temporary work assignments.
2. Establishing strong relationships with Medicare partners and commercial insurance carriers.
3. Partnering with outside skilled nursing facilities to resolve denied charges.
4. Efficiently resolving the payment gaps and billing disputes for patients' medical bills, advising clients on the best solutions for solving outstanding balances.
5. Key accomplishment: Decreased cash posting backlogs by processing refunds and account adjustments.
6. Significantly reduced denials for skilled nursing facility charges by over 65%.
7. Improved the acceptance rate of commercial claims through well-researched appeals proving medical necessities.
8. Communicating with utilities and clients to maintain accuracy in the billing process.
9. Receiving and assembling the charge forms and performs charge entry into the system.
10. Follow-up on exception rates and discounts along with research of payments and client charges.

Experience

5-7 Years

Level

Executive

Education

Diploma

Description :

1. Answering all incoming calls: calls from patients, answering all billing questions to the best of my knowledge.
2. Helping patients understand their bill and let them know what they're being billed for, copayment, co-insurance, deductible amount, no show, insurance company needing additional information from the patient, and a procedure not being covered under patient's policy.
3. Collecting the correct insurance information in order for the claim to be submitted to the patient's current insurance carrier and update the patient's insurance information in the system.
4. Confirming if a person is a current patient at the medical office, confirming if a patient was seen by a primary care physician on a particular date, when a secondary insurance company calls about a primary EOB that is not legible or missing, provide the correct EOB information for the claim to be processed correctly.
5. Printing the patient statements appealing all unpaid claims with insurance companies.
6. Dealing solely with funded accounts to ensure payment was accurately submitted by pharmaceutical companies.
7. Utilizing computer programs, spreadsheets and other systems, such as Microsoft Office systems.
8. Verifying that billed medical services, diagnostic tests and medications were supported by the patients' diagnoses before sending claims to carriers.

Experience

2-5 Years

Level

Junior

Education

College

Description :

1. Running commercial, Medicaid, no-fault, worker's compensation insurance reports twice a month.
2. Communicating with insurance companies to check the status of medical claims and to ensure timely reimbursement.
3. Communicating and negotiating with insurance companies and third party administrators for higher reimbursement on claims.
4. Reviewing the explanation of benefits and making necessary corrections on the claims and resubmit for processing.
5. Preparing and submitting appeal letters requesting higher reimbursement, as well as, preparing appeal letters for denied claims.
6. Following-up with insurance companies to ascertain the appeal letters have been received, as well as, checking the status of the appeal letters.
7. Posting insurance payments, as well as, patient payments for their outstanding balances.
8. Arranging and prepare payment plans for patients. Handling incoming calls from patients who have billing inquiries.
9. Monitoring gateway clearinghouse to ensure timely filing for electronic claims, and to make any corrections on the claims if needed.

Experience

7-10 Years

Level

Senior

Education

BS

Description :

1. Performed all aspects of a medical biller including correct coding for HCPCS codes and ICD-10 codes, entering charges into system, ensured all claims are submitted and printed in a timely manner, reviewed, submitted, and follow-up on all Medicare audits, insurance, and patient payment posting, printing of patient statements on a monthly basis, timely follow up for all outstanding accounts receivable.
2. Provided help in training all new employees on correct claim submission and using of software systems.
3. Prepared and submitted clean DME claims to medicare either by paper or electronically.
4. Follow-up with Medicare and other insurance companies regarding payment and denials.
5. Performed various collection actions including contacting patients by phone, correcting and updating payment information and resubmitting to third-party payers.
6. Updated patient profile information to ensure claims are billed correctly.
7. Calculated billing and reimbursement audits and accounts payable and receivables.
8. Maintained the strictest confidentiality, adhered to all HIPAA guidelines/regulations.

Experience

5-7 Years

Level

Executive

Education

Associates