Skills:

•Over ** years of experience in physician office and hospital settings; skilled in all insurance types, regulations and guidelines for Medicare, Medi-Cal, CHDP, PPO, HMO and private pay

•Knowledge of medical terminology and familiarity with CPT, ICD-10 and HCPCS codes

•Experience EMR/EHR computing management software such as ePCR, Paper Clip, EMA and computerized medical billing systems; AdvancedMD, Cener, NextGen, Office Ally, Navicure and RightCAD

Experience:

Choc Children’s Hospital Orange, CA Patient Account Representative for Pediatric Primary Care Service January 2017-Septemter 2018

•Reviewed electronic and paper claims and determined eligibility for payment

•Identified reasons for claim denials and corrected denials and appealed claims

•Researched and followed up on unpaid, underpaid claims and audited payments

•Re-submitted electronic rejected claims, ensuring the timely filing limits and collection were current

•Analyzed, maintained current and accurate follow- up on patient account balances

Office Works & Ultimate Staffing Services, Staffing Agencies Downey, CA & Los Alamitos, CA

Medical Billing Specialist for three medical specialties practices November 2015-August 2016

Dermatologist/ Otolaryngologist (Ear, Nose and Throat) / Orthopedic Surgery

•Verified and secured accurate patient demographic and insurance eligibility coverage information

•Determined co-payments, deductibles, co-insurance or any charges prior to patient's arrival

•Performed insurance verification, authorizations and pre-certification as needed

•Processed posting payments from insurance companies with Explanation of Benefits (EOB)

Care Ambulance Service Orange, CA Medical Insurance Verifier and Claim Processor February 2005- June 2015

•Identified and verified insurance eligibility coverage for all patients using online resources

•Verified, reviewed and corrected patient billing information

•Obtained all authorization and medical necessity required for transportation

•Completed and submitted all claims to responsible payers with right diagnosis and appropriate level of services

Eagle Medical Billing Anaheim, CA Medical Insurance Billing and Coding Specialist December 2003-January 2005

•Processed and reviewed electronic, manual claims submissions and rejections

•Checked claims status and followed up on unpaid claims

•Resolved and appealed claims posted payments, adjustments, audited payments until account paid in full

Education:

Alexandria University Alexandria, Egypt

Bachelors of Science, Agricultural Sciences Dairy Technology

ROP North Orange County Anaheim, CA

Certificate of Achievement, Medical Insurance Billing and Coding