A Medicare Billing Specialist is responsible for submitting medical claims to the insurance companies and Medicare and Medicaid. The job description entails taking responsibility for the timely submission of technical and professional medical claims. A well-drafted Medicare Billing Specialist Resume indicates the following duties and responsibilities – obtaining referrals and pre-authorizations as required, checking benefits and eligibility for treatment, and hospitalization; reviewing patient bills for accuracy and completeness, preparing and reviewing claims using billing software; checking insurance payment for accuracy and compliance with contract discounts; identifying and billing secondary insurances; researching and appealing denied claims; setting up patient payment plans and updating billing software with needed changes.
Apart from proven work experience, the following skills and abilities are expected – knowledge of insurance guidelines, familiarity with CPT and ICD coding; knowledge of accounting and bookkeeping procedures; proficiency of medical terminologies, and the ability to maintain the confidentiality of patients. While a high school diploma is mandatory, possessing knowledge of business and accounting process is preferred.
Objective : Detail-oriented Medicare Billing Specialist with two years of experience in processing claims and managing billing for Medicare and Medicaid. Proficient in analyzing accounts for accuracy and resolving denied claims. Committed to enhancing operational efficiency and ensuring compliance with healthcare regulations. Eager to contribute expertise in billing processes to support patient care and financial integrity.
Supervised Accounts Receivable Billing Collection Specialists responsible for Medicare and Medicaid billing issues.
Analyzed accounts receivable for accuracy and filed reconsiderations on denied claims.
Submitted, adjusted, and voided Medicare and Medicaid claims efficiently.
Negotiated contracts with insurance companies and performed month-end close activities.
Maintained a comprehensive chart of accounts, including general ledger and accounts receivable.
Worked on estate claims and filed reconsideration claims with medical records.
Processed and tracked Medicare billing inquiries and resolved discrepancies promptly.
Experience
0-2 Years
Level
Entry Level
Education
AAS
Senior Medicare Billing Specialist Resume
Headline : Accomplished Senior Medicare Billing Specialist with over 7 years of expertise in managing Medicare claims, ensuring compliance, and optimizing billing processes. Adept at resolving complex billing issues, enhancing operational efficiencies, and driving revenue growth. Passionate about delivering exceptional service and supporting healthcare providers in navigating the complexities of Medicare billing.
Maintained comprehensive knowledge of ICD-10 and CPT coding standards to ensure accurate billing.
Verified patient eligibility and claims status with various insurance providers.
Prepared and organized patient charts for efficient billing processes.
Responded to inquiries from providers, ensuring timely resolution of documentation requests for Medicare appeals.
Adhered to HIPAA regulations, ensuring patient confidentiality and data security.
Utilized coding manuals and online resources to stay updated on Medicare billing guidelines.
Managed collections for unpaid claims, improving recovery rates through effective follow-up strategies.
Experience
5-7 Years
Level
Senior
Education
B.S. in Health Admin.
Medicare Billing Specialist Resume
Objective : Dedicated Medicare Billing Specialist with two years of experience in claim processing and billing management for Medicare. Skilled in ensuring compliance and addressing billing discrepancies. Passionate about improving billing efficiency and enhancing patient service through effective communication with healthcare providers and insurance entities.
Processed Medicare claims accurately and efficiently to ensure timely reimbursement.
Reviewed patient records for completeness and accuracy before billing.
Reviewed cash receipts and reconciled accounts to maintain financial accuracy.
Managed insurance follow-ups and accounts receivable using Excel spreadsheets for tracking.
Calculated accurate billing amounts for various services provided.
Generated and submitted medical claims to appropriate payers.
Communicated with patients, facility office managers, and insurance carriers to resolve billing inquiries.
Experience
0-2 Years
Level
Junior
Education
AAS
Medicaid/Medicare Billing Specialist
Resume
Objective : Resourceful Medicaid/Medicare Billing Specialist with two years of experience in managing claims and optimizing billing workflows. Expertise in ensuring compliance with healthcare regulations and resolving billing discrepancies. Passionate about enhancing revenue cycle management and delivering excellent patient support through effective communication.
Provided exceptional customer service to Medicare patients, addressing inquiries and concerns promptly.
Maintained comprehensive knowledge of Medicare and Medicaid rules and regulations to ensure accurate billing.
Managed patient accounts, ensuring quality communication and support throughout the billing process.
Conducted audits of billing practices to ensure compliance with Medicare guidelines.
Processed 50 to 70 claims daily with a focus on accuracy and compliance.
Investigated and resolved patient inquiries and complaints with empathy and efficiency.
Participated in local Medicare meetings for ongoing education and cross-training in insurance billing.
Experience
0-2 Years
Level
Entry Level
Education
AAS
Medicare Billing Specialist Resume
Objective : Experienced Medicare Billing Specialist with 5 years in managing claims and optimizing billing processes. Proficient in ensuring compliance with Medicare regulations and resolving complex billing discrepancies. Committed to enhancing revenue cycle efficiency and providing exceptional service to patients and healthcare providers alike.
Monitored and resolved billing discrepancies for both active and terminated Medicare accounts, ensuring accurate payment processing.
Adjusted customer accounts by entering discretionary billing items, requesting rebills, and maintaining comprehensive records.
Conducted monthly analysis of Billing Aging reports, identifying and resolving outstanding invoices.
Reviewed Dunning Reports across all lines of business to ensure compliance with billing practices.
Compiled and generated detailed reports capturing key data for the billing process, enhancing operational efficiency.
Created pivot tables and modified spreadsheets to achieve analytical goals within the billing team.
Researched accounts and provided resolutions for complex customer complaints related to Medicare billing.
Experience
2-5 Years
Level
Management
Education
AAS
Certified Medicare Billing Specialist Resume
Headline : Detail-oriented Medicare Billing Specialist with over 5 years of experience in processing claims, ensuring compliance with regulations, and optimizing billing procedures. Proficient in using billing software and managing patient accounts, with a strong focus on accuracy and efficiency. Excellent communication skills to liaise with healthcare providers and patients, ensuring timely resolution of billing inquiries.
Ensure accurate coding of claims and timely submission to insurance carriers, focusing on Medicare.
Analyze various claim statuses, including clean, rejected, and denied claims using Cirius software.
Identify and rectify late charges and incorrect claims through DDE, ensuring compliance with billing guidelines.
Manage appeals for unpaid and denied claims, enhancing recovery rates for underpaid accounts.
Oversee facility accounts receivable reports, identifying trends and issues for proactive resolution.
Conduct audits on RAC accounts for appeals, ensuring thorough documentation and compliance.
Engage with insurance companies through calls to collect outstanding payments, maintaining strong relationships for effective resolution.
Experience
5-7 Years
Level
Senior
Education
AAS-HIM
Medicare Billing Specialist Resume
Objective : Proficient Medicare Billing Specialist with two years of experience in accurately processing Medicare claims and managing billing operations. Skilled in identifying discrepancies, ensuring compliance with regulations, and optimizing billing workflows. Driven to enhance revenue cycle performance and support healthcare providers in delivering quality patient care.
Ensured accuracy and compliance by reviewing Medicare claims and correcting errors.
Utilized billing software to manage patient accounts and track claim statuses.
Collaborated with healthcare providers to resolve billing discrepancies and improve workflows.
Maintained detailed records of billing activities and communications with patients.
Conducted data entry for payments and adjustments into the billing system.
Monitored production schedules to meet deadlines and maintain operational efficiency.
Analyzed financial reports to identify trends and opportunities for process improvements.
Experience
0-2 Years
Level
Entry Level
Education
AAS
Associate Medicare Billing Specialist Resume
Objective : Experienced Medicare Billing Specialist skilled in managing claims submissions and denials, with a proven track record of improving billing accuracy and reducing turnaround times. Adept at navigating complex Medicare regulations and maintaining up-to-date knowledge of policy changes. Strong analytical skills to identify trends and implement process improvements for enhanced revenue cycle management.
Skills : Payment Posting, Fast Typing Skills, Telephone Communication, Denial Management, Customer Service Skills, Billing Software
Description :
Monitored billing and collection processes to ensure compliance with financial policy standards.
Conducted accounts receivable and revenue analysis to identify discrepancies.
Trained front desk staff and providers on practice management system updates and acted as a resource for billing and coding education.
Reviewed monthly self-pay accounts, recommending bad debt write-offs to CFO.
Handled escalated issues within the practice management system effectively.
Audited data within the practice management system for accuracy, recommending process improvements based on results.
Discussed patient accounts and processed payments as required.
Experience
0-2 Years
Level
Junior
Education
AAS
Medicare Billing Specialist Resume
Summary : With a decade of specialized experience in Medicare billing, I excel in managing complex claims and ensuring compliance with regulations. My expertise includes optimizing billing workflows, resolving discrepancies, and enhancing operational efficiency. I am driven to support healthcare providers and improve patient financial experiences through meticulous account management and effective communication.
Skills : Revenue Cycle Management, Regulatory Compliance, Process Improvement, Training And Mentoring, Patient Privacy Practices, Insurance Policy Knowledge
Description :
Edit and maintain Medicare claims within Alpha split to ensure accuracy.
Utilize Meditech software to review patient accounts and identify discrepancies.
Enhance billing quality to maximize benefits for both patients and the hospital.
Analyze account balances to ensure timely follow-up and resolution.
Gather and verify patient history and insurance information for accurate claim processing.
Submit medical records to Medicare, Medicare Railroad, and Medigold as needed for documentation.
Ensure compliance with Medicare regulations during the claims submission process.
Experience
7-10 Years
Level
Management
Education
AAS
Medicare Billing Specialist Resume
Objective : Accomplished Medicare Billing Specialist with two years of experience in managing Medicare claims and ensuring compliance with industry standards. Expertise in processing claims accurately, resolving discrepancies, and optimizing billing operations to enhance revenue cycle efficiency. Dedicated to supporting healthcare providers and improving patient financial experiences through effective communication and meticulous account management.
Skills : Attention To Detail, Time Management, Problem-solving Skills, Communication Skills, Data Entry Accuracy
Description :
Generated weekly, monthly, and year-end reports to ensure compliance with state and federal regulations.
Processed Medicare claims for contract payers, ensuring accuracy and compliance.
Served as the primary liaison for new satellite offices, facilitating smooth billing transitions.
Provided detailed ad hoc reporting to management to support decision-making.
Monitored changes in billing regulations to maintain compliance and operational efficiency.
Ensured adherence to patient confidentiality and rights in all billing practices.
Followed all organizational policies and procedures to uphold quality standards.
Creating an account is free and takes five seconds.
You'll get access to the PDF version of this resume template.
Choose an option.
Sign up with Google
Sign up with Facebook
Sign up with Linkedin
This helps us make sure you're human and prevents spammers from abusing our services.
By continuing, you agree to our Privacy Policy and Terms.
Unlock the Power of Over 10,000 Resume Samples.
Take your job search to the next level with our extensive collection of 10,000+ resume samples. Find inspiration for your own resume and gain a competitive edge in your job search.
Get Hired Faster with Resume Assistant.
Make your resume shine with our Resume Assistant. You'll receive a real-time score as you edit, helping you to optimize your skills, experience, and achievements for the role you want.
Get Noticed with Resume Templates that Beat the ATS.
Get past the resume screeners with ease using our optimized templates. Our professional designs are tailored to beat the ATS and help you land your dream job.
