Experience

Shernaz Irani

***** **** ******* ***

Potomac MD 20854

301-***-****

Financial Health Dec. 2011 – June 2014

Medical & Dental Billing/AR Specialist

• Use web-portals and/or phone to check eligibility

• Add insurance to provider systems and queue the claims

• Prepare and submit electronic and paper insurance claims in a timely manner

• Prepare and attach all required documentation including referrals, treatment plans, or other required correspondence to reduce denial

• Responsible for bill and follow-up for physician claims submitted to Medicaid and HMOs

• Fix errors and validate electronic claims

• Follow-up on claims status and resubmit denied claims

• Write off non-covered charges

Orthopedic Associates of Frederick Nov. 2008 – June 2011 Medical Billing/AR Specialist

• Follow up on outstanding A/R for sel-pay and various insurance companies including resolution of denials

• Responsible for handling all workers compensation claim correspondence related to insurance bills or patient ac- counts

• Contacting insurance carriers, patients, and other facilities as needed to get maximum payment on accounts and identify issues or changes

• Reconciling carrier submissions, edits and rejection reports and making appropriate decisions on accounts to maximize reimbursements

Carolyn Gaynor Podiatry Jan. 2008 – Sept. 2008

Medical billing/AR Specialist (Contracted position)

• Medsoft Professional in Medical Billing

• Entering patient information in the system

• Correcting electronic claims

• File and edit reports

• Post payments and balancing

• Full understanding of Medicare billing regulations

• Understanding insurance rejections and how to correct the claims and re-file or appeal to get them paid

• Knowledge of electronic follow-up and resubmit claims Kaiser Permanente (Patient Financial Service Self-Pay Unit) Feb. 2007 – May 2007 PFS Follow-Up and Collections Specialist (Contracted position)

• Analyze, investigate, and resolve the daily error workload according to department policy

• Edit, correct and adjust copayment if member is charged incorrectly

• Check eligibility to confirm that the member is covered

• Check which services are charged to the member’s deductible Steven M. Shimoura, M.D., P.A.

Medical Billing Account Receivable Specialist: March 2003 – August 2006

• Electronic claims filing

• Paper claim filing

• Posting charges and payments

• Insurance follow-up

• Claim rejection adjustment

• Handle all outstanding A/R for self-pay and various Insurance companies Ajit Shah, M.D., D.L.O.E.N.T. Head and Neck Surgeon Nov. 2001 – July 2000 Medical Billing Specialist

• MEDISOFT Patient Accounting System Data set up

• Transaction payment and deposit

• Claim entry and management

• Electronic media claims

• Insurance payment adjustments

• Day sheet reporting

Union Labor Life Insurance Co. Nov. 2000 – Sept. 2001 Stop Loss Insurance Specialist and Auditor (Contracted position)

• Evaluated loss claims for release of large payments to various union health and welfare trust funds

• Duties include creating excel spreadsheets that could be utilized as funds

• Analyze/calculate information to determine re-insurance deductibles’ and Stop Loss attachment point

• Interpreting Access Loss Policies, addendum’s and update information to determine how changes in contracts determine Access Loss payments

American Psch Systems Aug. 1998 – Nov. 2000

Claims Analysts

• Process mental health and substance abuse claims

• Process claims entered direct from HCFA 1500 and UB92 forms

• Enter data in the Paradigm System for adjudication

• Document claims with error for reconsideration request

• Claim adjustments to those that were previously processed with incorrect data and adjust to reflect the correct information and issue additional payment or recoup over payments.

• Review claims to determine if they were paid correctly and if any non-payment errors were made in processing

• Coordinating of benefits to limit benefits from two or more carriers to 100% of the claimant’s covered expense

Claims Administration Corp. Nov. 1985 – June 1998

Medical Claims Analyst

• Analyze medical, dental, and prescription drug claims processing in a timely fashion for payment according to the Mail Handlers Benefit Plan

• Processing claims needing coordination of benefits from patients with Medicare, Medicaid or other insurance companies as the primary payer

• Maintained over 98% payment and procedural accuracy

• Process 160% of daily expected goals

• Demonstrated excellent knowledge of CPT and HCPCS codes

• Received three promotions within a two-year period

• Dental claims examiner

• Researched and resolved problems when necessary

• Demonstrated knowledge of dental terminology

• Handled routine telephone inquiries.

Skills

• Proficient with Medsoft and Paradigm System

• Knowledge of CPT & DMS IV codes

• Maintained 95-98% payment accuracy

• Microsoft Word, Excel

Education

• Bachelor of Arts, Sophia College, Bombay, India

• Word Processing, Montgomery College, Gaithersburg, MD

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