John Michael Sullivan

San Antonio, TX

210-***-****

CAREER OBJECTIVE

To obtain full-time employment that will allow me to utilize my skills to help my employer meet their goals while providing a fulfilling work environment and sense of accomplishment.

PROFESSIONAL EXPERIENCE

Licensed Texas Realtor July 2013-Present

ReimbursementXperts, San Antonio, Texas Nov. 2002 - Present

Owner-Self-Employed

Demonstrate knowledge of HIPAA Privacy and Security Regulations by appropriately handling patient information.

Receive, organize and maintain all coding and reimbursement periodicals and updates.

Appropriately and correctly identify errors and re-file denied/rejected claims as they are received.

Add modifiers as appropriate.

Code narrative diagnoses and verify diagnoses.

Analyze and interpret medical and surgical records to determine billable services.

Thoroughly review remittance codes from EOBs/ARs.

Evaluate the accuracy of provider charges,

including dates of service, procedures, level of care, locations, diagnoses, patient identification and provider

signature.

Complete appeals, file, and submitted claims.

Post payments, charges and adjustments.

Carefully prepare, review, and submit patient statements.

Ensure timely and accurate claim submission through paper and electronic clearinghouse.

Research CPT and ICD-9 coding for compliance and reimbursement accuracy.

Maintain strict patient and provider confidentiality.

Resourcefully use various coding books, procedure manuals and on-line encoders.

Alamo Heights Surgery Center, San Antonio, TX Jul. 2001 – Nov. 2002

Billing and Collections Representative

Responsible for all billing for Ambulatory Surgery Center; responsibilities included dealing with contracted and non-contracted insurance companies including all Commercial, Government, and Workers' Compensation plans, patient billing and collections placement, physician support and administrative reporting to accounting office as required.

Demonstrate knowledge of HIPAA Privacy and Security Regulations by appropriately handling patient information.

Receive, organize, and maintain all coding and reimbursement periodicals and updates.

Appropriately and correctly identify errors and re-file denied/rejected claims as they were received.

Added modifiers as appropriate, coded narrative diagnoses, and verified diagnoses.

Analyze and interpret patient medical and surgical records to determine billable services.

Evaluate accuracy of provider charges, including dates of service, procedures, level of care, locations, diagnoses, patient identification, and provider signature.

Complete appeals, file, and submit claims and patient statements.

Post charges, payments and adjustments.

Ensure timely and accurate charge submission through paper and electronic clearinghouse.

Research CPT and ICD-9 coding discrepancies for compliance and reimbursement accuracy.

Maintain strict patient and physician confidentiality.

Tower Life Insurance Company, San Antonio, TX Jun. 2000 – Jul. 2001

Eligibility and Benefits Representative

Maintain eligibility of records for several employer group health plans including additions and deletions of new and terminated employees.

Effectively communicate with various HR personnel, customer support, COBRA enrollment, and reporting to underwriting department.

South Texas Radiology, San Antonio, TX Jul. 1999 – May 2000

Billing Department Manager

Effectively supervise 30+ billing and collections clerks for busy X-ray provider.

Consistently met collection goals and expectations.

Report weekly to President and other managerial staff of new hire placement and employee termination, incentive planning, training, and managing placement of collection accounts and ensuring timely submission of required correspondence to ensure prompt claims payment.

COMPUTER SKILLS

Various medical billing software.

Software procurement and installation/maintenance.

Data verification and backup.

Office automation.

Microsoft Office.

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