Medical Billing claims specialist

Latrice Littles

Lithonia, GA / ad5to0@r.postjobfree.com / 404-***-****

Summary

Experienced medical billing specialist with a proven track record in collections, leveraging a deep understanding of medical coding, billing procedures, and insurance claims to optimize revenue cycle management.

Experience

Medix Health Staffing

Claims Support Specialist – Remote – USA

05/2023-Present

Review EOBs, superbills, and invoices from medical professionals for services rendered. Review coding charges, verify insurance policies and eligibility.

Follow up on claims, appeals, and inquiries to ensure timely resolution and/or payment.

Assist healthcare providers and patients with claims inquiries status, coverage details, and claims processing status.

Humana Government Business / Humana Military

Referral Claims Coordinator, Louisville, Georgia

01/2018 - 12/2022

Recognizes sensitive diagnoses and/or referrals requiring Case Management and pend to the appropriate point of contact for review.

Understands TRICARE benefits/limitations and Humana Military referral processes, MOUs with MTFs, and referral and UM policies.

Answers questions or contacts MTFs and/or civilian providers to obtain additional information that may be required to complete referral etc.

Requires assigning appropriate ICD10 code to referral as well as appropriate CPT Code. Decisions are typically focus on interpretation of area/department policy and methods for completing assignments.

Works within defined parameters to identify work expectations and quality standards, but has some latitude over prioritization/timing, and works under minimal direction.

Follows standard policies/practices that allow for some opportunity for interpretation/deviation and/or independent discretion

Gwinnett Medical Center

Unit Secretary, Lawrenceville, Ga

06/2015 - 04/2017

1.Administrative Support: As the unit secretary in a hospital I was responsible for providing administrative support to the nursing and medical staff. This may include managing phone calls, scheduling appointments and procedures, coordinating patient transfers, maintaining patient records, and managing electronic and paper documentation.

2.Patient Care Coordination: I act as a liaison between patients, families, and healthcare providers, assisting in coordinating patient care activities.

3.Clerical Duties: As the unit secretary I was responsible for performing various clerical tasks, such as organizing and maintaining patient charts, transcribing physician orders, preparing and distributing reports, managing supplies and inventory, and ensuring accuracy and completeness of patient information.

4.Communication and Collaboration: Effective communication via phone, email, in-person, or through electronic medical record (EMR) systems. Collaborating with interdisciplinary teams, maintaining patient confidentiality, and providing excellent customer service are key responsibilities.

5.Emergency Response: In emergency situations, I may be responsible for initiating emergency protocols, contacting appropriate personnel, and maintaining communication and coordination among hospital staff during critical situations, such as codes, disasters, or emergencies.

Skills

Medical Terminology, Medical Billing, Medical Coding, Medical Records, Microsoft Office, EHR Systems, Insurance

Verification, Communication skills, Customer service, Revenue Cycle Management, Collections, Secretarial

Education

Medical Billing and Coding

Ultimate Medical Academy, Clearwater, FL

04/2018

EHR systems, payment posting, scheduling, insurance verification, claims processing, EOBs, deductibles, co-payments, managed care, third-party payers, workers' compensation, ICD 9/ICD 10, CPT, HCPCS, Medicare/Medicaid

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