Medical Billing Specialist Resume Samples

Description :

1. Screening all self-pays for determination of possible 3rd party assistance and/or charity care.
2. Completing 3rd party assistance applications with patient and/or family while in-house.
3. Accurately predicting and assisting the patient in obtaining all necessary documents to complete the application.
4. Updating the patient's file and appropriate computer systems each time the account is worked.
5. Acting as the liaison between patient, hospital, and agency during the application determination process.
6. Assistance with the completion of daily, weekly and monthly reports (both internal and external).
7. Additional job responsibilities include processing return mail, filing, scanning, faxing, mass mail-outs, ordering supplies, and any additional duties as assigned.
8. Utilizing verbal and written communication skills effectively in interactions with patients, third-party payers, and any and all hospital personnel.
9. Constantly providing outstanding service to all patients, hospital staff, co-workers and guests.
10. Reviewing and researches insurance claims to determine possible payment sources.

Experience

10+ Years

Level

Senior

Education

MI

Description :

1. Interpreting medical terminology in order to create numerical codes for insurance and medical statistics purposes.
2. Posting customer payments by recording cash, checks, and credit card transactions.
3. Posting revenues by verifying and entering transactions form lock box and local deposits.
4. Verifying the validity of account discrepancies by obtaining and investigating information from customer service departments, and from customers.
5. Reviewing charge tickets and resolve problems concerning the recording or provision of services rendered which impact on the ability to collect charges.
6. Working on AR daily - review accounts. , fix problems, answer insurance company questions and/or file appeals.
7. Preparing and submitting clean claims to various insurance companies either electronically or on paper.
8. Verifying the validity of account discrepancies by obtaining and investigating information from insurance companies and customers.
9. Monitoring patient account details for non-payments delayed payments and other irregularities.
10. Identifying and resolving patient billing complaints communicate with patients via phone, mail or personally.

Experience

5-7 Years

Level

Executive

Education

BA

Description :

1. Performing analytical duties to ensure timely processing of insurance claims in order to maximize reimbursement.
2. Participating in cross-training to provide coverage and training to new employees.
3. Verifying insurance eligibility by accessing online websites for various carriers.
4. Constant contact with clinical departments for information to complete the claims process.
5. Writing letters to patients appeals to insurance companies along with multitasking by performing a wide variety of duties to ensure claims get paid.
6. Recruiting, scheduling and communicating with volunteer groups and individuals from the community for the (CLP) - christie leadership program.
7. Assisting with fundraising related activities such as customer service calls to donors, sent out pledge letters to receive donations.
8. Introducing new ideas by sharing information obtained from other sources.
9. Providing supervision in order to ensure organizational policies and procedures are maintained.
10. Implementing billing procedures which resulted in an increase in revenue for the company.

Experience

10+ Years

Level

Management

Education

BA

Description :

1. Preparing and submitting clean claims to various insurance companies either electronically or by paper.
2. Answering questions from patients, clerical staff and insurance companies.
3. Evaluating the patient's financial status and establishes budget payment plans.
4. Reviewing e-accounts for possible assignment and makes recommendations to the billing supervisor, also prepares information for the collection agency.
5. Performing various collection actions including contacting patients by phone, correcting and resubmitting claims to third-party payers.
6. Processing payments from insurance companies and prepares a daily deposit.
7. Participating in educational activities and attends monthly staff meetings.
8. Maintaining the strictest confidentiality; adheres to all HIPAA guidelines/regulations.
9. Contacting insurance companies to check the status of claims payments and write appeal letters for denial on claims.
10. Performing bookkeeping duties such as credits or collections, preparing and sending financial statements or invoices and keeping financial records.

Experience

5-7 Years

Level

Executive

Education

Cosmetology

Description :

1. Precisely completed appropriate claims paperwork, documentation and system entry.
2. Professionally and courteously verified appointment times with patients.
3. Adeptly managed a multi-line phone system and pleasantly greeted all patients.
4. Verified patients' eligibility and claims status with insurance agencies.
5. Determined prior authorizations for medication and outpatient procedures.
6. Researched CPT and ICD-9 coding discrepancies for compliance and reimbursement accuracy.
7. Managed collections claims for unpaid bills against the estates of debtors.
8. Interacted with providers and other medical professionals regarding billing and documentation policies, procedures and regulations.
9. Follow up on correspondence, unprocessed, rejected, and claims not paid in a timely manner.
10. Keep records of collections and disbursements, ensure accounts are balanced.

Experience

5-7 Years

Level

Executive

Education

ED

Description :

1. Reviewing reports and transactions prior to generating invoices to ensure accuracy.
2. Researches and documenting customer disputes, responding to all inquiries within the expected timeframe.
3. Communicating with business office managers, pharmacy/branch managers and/or administrators at the long-term care facilities.
4. Meeting all billing deadlines designated by customer expectations and contractual agreements.
5. Maintaining accurate and complete records concerning patient billing activity/communication on all accounts.
6. Working and partners with other internal and external departments to resolve issues.
7. Reviewing unsent cms 1500 claims with an explanation of benefits (EOB) and electronic remittance network documents daily before sending it through electronic and printing claims, EOB and ERN to mail it to the secondary and tertiary payers/commercials.
8. Scanning and indexing medical records/documents and submit to ECM (enterprise content management) system.
9. Identifying and resolving patient billing complaints, address inquiries from patients, clerical staff and insurance companies.
10. Preparing and submitting clean claims to various insurance companies either electronically or by paper.

Experience

10+ Years

Level

Management

Education

MPA

Description :

1. Fixed claims edits, provided timely follow-up of the regulated payer, and maintained current knowledge of federal and state regulations to ensure compliance (HIPPA training).
2. Submitted secondary claims with EOBs in a timely manner to ensure payment.
3. Provided follow-up for all insurance carriers, including Medicare, commercial, and workers' compensation.
4. Pulled remit for SSI and other payor websites fixing edits/errors on the claim before submitting to insurance for prompt payment.
5. Sending a request to coder or nurse auditor for claim review and necessary corrections on charges/coding for HIPPA compliance.
6. Reviewing claims that crossed Cerner/SSI system for missing incorrect patient or billing information and resolution of nonpayment accounts.
7. Reviewing claims for appropriate uses for the procedure, modifiers, diagnostic codes, calculating Medicaid outliers and removing duplicate charges to ensure maximum reimbursement.
8. Working closely in a team environment to meet daily, monthly and quarterly billing metrics.

Experience

10+ Years

Level

Senior

Education

GS

Description :

1. Reviewing patients medical records and assign numeric codes for each diagnosis and procedures.
2. Possessing expertise in the ICD-10-cm and CPT coding systems, knowledgeable about medical terminology, disease processes, and global and standard modifiers.
3. Knowledge of New Jersey, Florida, South Carolina, and New York billing standards; as well as the interpretation of those states EOBs.
4. Sending HCFA's to insurance policies and send claims to secondary insurances when required.
5. Excelling in identifying the incorrect claims address for every insurance, specific policy, and front desk input of the patients' member id.
6. Asking proper questions when trying to identify if the patient is in or out of network.
7. Sending medical records to insurance companies if a claim needs further review.
8. Answering and resolving patient billing inquiries follow up on insurance and patient aging.
9. Research and resolving incorrect payments, EOB rejections, and other issues with outstanding accounts.

Experience

5-7 Years

Level

Executive

Education

Associate

Description :

1. Maintained the confidentiality of all the patient data and ensured database security.
2. Worked with computer software to organize data, maintain databases, prepare charts and reports.
3. Handled and organized the information about all additional procedures and follow-up treatments that patients get.
4. Followed up with insurance companies on claims, especially if there were denials.
5. Figured out why a claim was rejected and resubmitted with correct information to ensure payment.
6. Made sure that the medical facility received the payments for all of the procedures performed.
7. Processed the payments received from insurance companies and maintained records about those.
8. Perform various collection actions including correcting and resubmitting claims to third-party payers.
9. Read and interpret insurance explanation of benefits basic knowledge of medical coding/ third-party operating procedures and practices.
10. Prepare and submit clean claims to various insurance companies either electronically or by paper.

Experience

0-2 Years

Level

Entry Level

Education

Diploma

Description :

1. Daily communication with Medicare, blue cross, and numerous other commercial insurers to address claim resolution and rejections.
2. Verifies all resident billing information upon admitting/discharge for accuracy.
3. Responsible for communicating accounting corrections and inquire on patient account status with bookkeepers located at multiple skilled nursing facilities.
4. Recording and balancing daily census totals and bank deposits for monthly billing.
5. Making recommendations to physicians and prepares information for reimbursement changes.
6. Evaluating patient financial status and establishes budget payment plans.
7. Reviewing accounts in system, reports and other information sources, such as credit bureaus, performs collection actions including contacting the patient by telephone and resubmitting claims to third-party payers.

Experience

10+ Years

Level

Management

Education

BBA