Medical Billing Insurance

Galina Lukashevich

**** ***** **** #***, ******** MD 21044

Phone: 410-***-**** / E-Mail **************@*****.***

LinkedIn Profile: https://www.linkedin.com/in/galina-galina-lukashevich-b29a5363/

Professional Summary

Highly skilled claims/collections professional, experienced in all phases of medical billing and claims collections (Medicare, Medicaid, Champus, HMO’s, PPO’s) and private insurance carriers, including secondary insurance claims, outstanding record with Worker’s Compensation, auto, and personal injury claims.

Professional Experience

• Billing and A/R Follow-up Representative Ameritox, LLC 10/2009 - present

Columbia, MD

• Managed patients’ information in compliance with HIPAA

• Working on SP for Anthem BCBS-KY decrease denials by 81%,increase collection by 43%

• Liaise between medical facilities and insurance carriers (HMOs, PPOs, Medical, Medicare)

• Selected to participate in a high-visibility project, which resulted in refunds in the hundreds of thousands of dollars.

• Efficiently process claims with different Insurances

• Demonstrated ability to read and interpret EOBs, and face sheets from medical facilities

• Knowledge with insurance authorizations and denials

• Correct denial claims with correct information and re-submit claims

• Submit electronic claims and paper claims (primary insurance or secondary insurance)

• Follow up on unpaid claims as well as old claims

• Actively maintained current working knowledge of CPT and ICD-9 coding principles, government regulation, protocols and third party requirements regarding billing.

• Verified patients’ eligibility and claims status with insurance agencies.

• Responsible for all follow up on insurance claims to Medicare, Medicaid and commercial insurance

• Increased instances of insurance claims payment by 65% by efficiently creating and maintaining meaningful relationships with all insurance companies onboard.

• Monitored and performed on management of third party and governmental denials.

• Expert level knowledge of healthcare industry applications and processing, EDI 835 transaction sets and formats.

• Pharmacy Billing Specialist NEIGHBORCARE-OMNICARE 11/2003-10/2010

• Established and maintained patient profiles

• Prepared and processed medical insurance claims forms and record

• Contacted insurance companies on status of claims

• Bill pharmacy charges to both facilities and patient

• Effectively resolved insurance rejections and other billing issue

• Answer incoming call from client and patients regarding facility/patient billing

• Responsible for medical claims billing for Medicare, Medicaid, and other various insurances

• Handled all appeals/correspondence in a timely manner required by the company

• Improved revenue for most recent provider over 32% with same patient load

• Successfully obtained payments from 10 delinquent accounts by continually following up on them

• Insure office practices are in compliance with HIPAA regulations

Medical billing 02/2005- 06/2006

St Agnes Medical Center/Urologist Group Baltimore, MD

• Collections, medical billing CPT and ICD-9

• Perform insurance verifications following protocol

• Coordinator referral, and authorization for O/P and I/P procedures

• Responsible for complaints and audit

Billing & Collection Agent 02/2001-11/2003

GTR Medical Billing Service Metro Health Baltimore, MD

• Marketed services to local physicians/medical practices - preparing oral/written presentations.

• Implemented a successful system for intensive and comprehensive follow-up for all non-responsive insurance companies approaching the 30-day limit for payment.

• Improved practice’s collections/cash flow by 200.000

• Organized record keeping and aging reporting, and significantly reduced bad debt write-offs.

• Significantly reduced outstanding accounts receivable over 90 days by 77%

• Reduced returned claims from Medicare/Medicaid by nearly 95%

• Collected $49,000 of monies scheduled to be written off

• Maintained an above average billing ratio of 73/27.

• Create and main an efficient reporting system to provide the management with information on billing procedures and outcomes

• Insure office practices are in compliance with HIPAA regulations

EDUCATION

Bachelor of Science, Bachelor degree in electrical engineer Graduated: 1987

University Of Lithuania, VILNIUS

ACCOCIATE DEGREE Certificate Awarded: 2000

Insurance Billing for 3rd Party Billing

Baltimore County Community College, Baltimore, MD

QUALIFICATION

• Extremely detail oriented and organized

• Committed to complete a job on time

• Proven ability to overcome and solve problems

• Medical billing educated as well as terminology

• Friendly and dedicated

• Enthusiastic team member

• Able to meet dead lines

• Speak 5 languages English, Russian, Lithuanian, Polish, German

TECHNOLOGY SUMMARY

MS Office (Word, Excel, Outlook), QuickBooks, AltaPoint,MediSys,MediNotes, xifin,infusion

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