Medical Biller/ Health Claims examiner
Resume:
Pauline Mubiala Ntoya
Van Nuys, CA 91411
Phone: 818-***-****
Cell: 818-***-****
*********@***.***
CAREER OBJECTIVE:
To obtain a full time position as a Medical biller / Health Claims Examiner with a well-
established business where I could utilize my skills, as well as gaining new knowledge.
SKILLS:
-Microsoft office -10 Key by touch -CPT and ICD-9-CM coding
-Excel -Typing -Medical Terminology
-Medical Billing -Customer Services -Health Claims Examiner
EXPERIENCE:
2012-2014 Medical Biller/Health claims examiner: Cover Your Assets Services (CYA Services)
Irvine, CA.
Worked as a contractor.
Submitted credits and/or write-offs; provided documentation to the manager for
research and applications of adjustments needed to the A/R.
Identified and corrected claims prior and post submissions: Corrections made in the
system in documentation to ensure that the claims meet payer standards and
qualifications.
Reviewed daily EMC billing for acceptance or rejections.
Researched and re-submitted electronic claims unpaid or claims with errors within
the
established period.
Informed management of any problem accounts.
Called doctors’ offices and patients to get documentations pertaining to claims
billing.
Followed up on all open claims to ensure that outstanding balances were collected
from patients and insurance companies.
Followed up on Medicare claims; got detailed claims status on rejected or
outstanding claims.
Corrected and re-submitted electronic Medicare claims.
Responsible to obtain all documentation needed for Medicare claims appeals, and
completed appealed claims via telephone reopening, redetermination and
reconsideration.
Data entry: Responsible to obtain and to enter in the system all related information
needed to complete documents retrieved, which included but not limited to: correct
payer assignment, complete item billing, and insurance verification or doctor/referral
information relating to clean billing submissions.
2012-2012 Medical Biller/Health Claims Examiner: Advanced Sleep Medicine Services, Inc.
Los Angeles, CA.
Temporary job in the Collection Department from October 2012 to November 2012.
Assisted the collector in catching up on outstanding claims by calling private
insurances
companies to follow up on unpaid balances.
Researched unpaid claims, responsible to calling in doctors’ offices to obtain
documentation needed to complete claims processing.
Responsible for the mailing of all retrieved documentation needed to resolve
outstanding accounts with private insurance companies.
2005-2012 Medical Biller/Health Claims Examiner: Apguard Medical, Woodland Hills, CA.
Prepared accurate and complete claims for assigned claims or accounts.
Submitted claims in a timely manner to meet claims processing requirements.
Identified and corrected claims prior to submission: Corrections made in the system
In documentation to ensure that the claims meet payer standards and qualifications.
Submitted credits and/or write-offs; providing documentation to the collectors for
research and application of adjustments needed to the A/R.
Reviewed new claims and claims submitted electronically or via paper within 48 hours of
claims generation.
Responsible to obtain all related information needed to complete documents retrieved,
which included but was not limited to: correct payer assignment, complete item line
billing, and insurance verification or doctor/referral information relating to clean billing
submissions.
Requested authorizations from insurance companies for services provided.
Researched and re-submitted electronic claims unpaid or claims with errors within
established period.
Informed Management of any problem accounts.
Submitted claims via paper within 48 hours of invoicing/claims generation. Reviewed
daily EMC billing for acceptance or rejection. Rejected claims corrected and generated
via paper within 24 hours of notification.
Followed up on all open claims to ensure that outstanding balances were collected from
patients and insurance companies.
In some instances helped the Denial Department by working on denied claims, and
helped filing medical records in the filing room.
1999-2004 Homemaker: Van Nuys, CA
Used that time to devote to the care of my ailing mother, schedule appointments,
counseling, emergencies, raising a child, tutoring, mail sorting, and other responsibilities
associated with maintaining a household and all the responsibilities that comes with it.
1989-1998 Respiratory Therapist: Children Hospital of Los Angeles, CA
Evaluated patients in the emergency room as well as in the Hospital.
Administrated breathing treatments and oxygen treatment to patients.
Participated in the well-being of patients by suggesting and administering the best
course of treatment for their rapid recovery. Administered Chest physiotherapy to
patients and responded to emergency calls of cardiac arrest and also administered
Cardiac Pulmonary Resuscitation.
Attended to patients on artificial ventilation (respirators ).
Logged each procedure performed in the computer.
As a health care provider, I constantly worked with the public. I trained new therapists,
parents, and patients in the administration of breathing treatments and the use of
medical equipments for hospital and home care.
EDUCATION:
2004-2005 Medical Biller / Health Claims Examiner: Adelante Career Institute, Van Nuys, CA.
Certificate. Honor Roll.
1983-1984 Respiratory Therapist Technician: Valley College of Medical and Dental Careers,
North Hollywood, CA.
Licensed Respiratory Therapist Technician.
REFERENCES:
Sharon Evans: Manager at CYA Services. Irvine, CA.
Frances Henderson: Manager at Apguard Medical, Inc. Woodland Hills, CA.
Contact this candidate