PROFESSIONAL PROFILE

**+ years successfully inputting and validating medical claims data and overseeing the use of proper documentation and coding on patients’ accounts. Skilled at preparing and submitting clean claims to various insurance companies and performing regular follow-up. Oversee staff of five. Balance daily receivables and run daily/monthly A/R reports. Coordinate referrals and pre-authorizations. Very positive and proactive approach to getting things done.

PROFESSIONAL SKILLS

Claims denial follow-up

Delinquency management

Insurance liaison

Bad debt reporting

Patient data coding

Benefits Interpretation

Patient statement review

Reimbursement processes

TECHNICAL SKILLS

ICD-10, CPT Coding

Electronic Remittance Advice

Electronic Medical Billing

HCFA 1500 forms

KEY ACHIEVMENTS

Implementation of EMR

Monitoring and reporting for Meaningful Use

Initiate PQRS reporting

Maintaining Insurance aging at 90-95% current

PROFESSIONAL EXPERIENCE

Elgin Internal Medical Associates SC, Billing Supervisor, March, 2007-Present: Supervise staff of five for Special Procedures, Billing and Referrals department. Review daily encounter documentation for claim submission. Submit appeals. Balance daily receivables, and run daily/monthly A/R reports.

Children and Teens Medical Center, Site Manager October, 2001-April, 2002 and Billing Manager April 2002-March, 2007: Managed staff of three. Balanced daily/monthly receivables for three clinics and review daily charge tickets for electronic claims submission. Refunds and appeals

Highland Managed Care Group, Utilization Review April, 2000-October, 2000, and Claims Adjudication April 2000-October, 2001: Review and enter incoming referrals for authorization. Review and pay monthly EOB’s for three physician groups.

Additional experience includes working as an LPN staff nurse at Friendship Village, Schaumburg, IL, November 1992-November 1994. Health Aid at School District #20 in Hanover Park, IL, May 1993-November 1995, and office nurse at Bloomingdale General Pediatrics, Bloomingdale, IL, November 1995-September 1999.

Education

Chicago Public School’s LPN Program

Pharmacology for LPN’s, Mayfair College, Chicago

Nursing Refresher, Elgin Community College, 1991

Certificate in Physician Office Coding and Billing, College of DuPage, December, 2000

Certified Coding Associate, Certified and Credentialed with AHIMA since 2009

References

Beth Wendt 847-***-****

Debbie Smith 847-***-****

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