Medical Office

JAMIE SCHAFER

**** ****** ******, **** ******, FL 34683 ● 727-***-**** ● **********@*****.***

MEDICAL CODING & BILLING ANALYSIS

Accomplished, Office Manager with 12+ years, experience in medical billing. Continuous operational improvements to insure reimbursement with minimal insurance denials. Insurance carrier engagement and implementing solutions that improve efficiency, increase profits, and position providers/facilities for sustainable success. Dedicated management skills and problem solving that enhance productivity and clinical reimbursement.

KEY STRENGTHS

●eClincal Works and EMR systems ● Medical terminology, anatomy and physiology ● ICD-9, ICD-10, J-Codes and CPT coding ●Coding, Reimbursement and Claim denial Analysis ● Medicare Fee Schedule ● Medicare, Medicaid, Commercial and third party Reimbursement ● Medical Subrogation ● Liability Claims and Personal Injury analysis of claims and billing ● Patient Communication/Engagement ● Utilizing and submission of UB92 and HCFA 1500 claims electronic and paper ● MS Word, Excel, Outlook● HIPPA, OSHA and ACHA compliance ●Growth Strategy Development ● Proactive professional who can identify collection trends and solve unpaid claims in a timely manner.

PROFESSIONAL EXPERIENCE

Law Office of Paul B. Genet & Genetics Health, palm harbor, FL (October 2012-Present)

Office administrator, paralegal and medical claims analysis for liability claims

Reviewing medical claims and records to ensure accident related injuries.

Billing personal injury claims for providers, review of billing for providers.

Negotiating claim settlements with Insurance Adjusters, providers and Third party medical liens and ERISA liens.

Preparing injury demands for Bodily Injury, Uninsured Motorist and Medical Malpractice claims.

Florida E-Filing of court documents.

Analyzing provider and facility claims for insurance billing with highest coding for reimbursement.

Resubmission of denied claims for Physicians for reimbursement in a timely manner.

Vetting cases for liability. Review of insurance policies for highest liability allowance.

Review of purchased LOP’s from surgery facilities to ensure proper reimbursement for liability claims.

Office policy and procedure with HIPPA, OSHA and ACHA compliance for medical facilities and law office employees. And all other daily office manager duties.

Active Orthopedics, Tampa, FL, 2012 (Closed)

Office manager and medical biller

ICD-9-CM diagnosis coding, CPT procedure coding for orthopedic office procedure and hospital surgeries with specific modifiers for Insurance and Attorney billing. Submitted posted and handled Accounts Receivable and Accounts Payable.

Submitted request for approval of HMO patient Insurance Authorization for office visits and hospital procedures to ensure payment. Submitted documentation for emergency authorization and back dated authorizations from HMO Insurance carriers.

Responsible for daily posting and reconciliation to ensure accurate AR reporting.

Monthly statements to patients.

Denied claim resubmission for timely payment, including letters for resubmission and proof of timely filing.

Review of EMR system to review accurate patient accounts and physician notes.

Office policy and procedure to follow OSHA, ACHA and HIPPA guidelines.

Cristobal r. Rosario m.d., P.A., Internal Medicine, PALM harbor, FL April 2007- May 2012

office manager and medical biller

Managed daily billing and A/R for 2 office locations, including posting of Insurance payments, copayments, cash patient billing and monthly statements to patients.

ICD-9 and CPT billing for office visits and procedures to Medicare, Medicaid and Commercial Insurance Companies.

eClinical Work certified set up and built EMR system to physician’s preference.

Trained office staff on EMR system as the office changed from Paper charts to Electronic Records.

Analyzing and resubmission of denied medical claims for timely reimbursement.

Medicare Advantage HEDIS review and analyzing of medication and referrals for patients to ensure proper medical diagnosis and preparing for review for Medicare Advantage carriers monthly and quarterly reports.

ICD-9 HEDIS billing for Medicare Advantage plans to assist with monthly insurance bonuses.

Review of insurance contracts and Applying, updating Hospital applications and privileges. Updating all provider required applications including HIPPA, OSHA, HEDIS and ACHA for doctors and staff.

Payroll for employees including Payroll taxes and working with Quick Books.

Accounts payable for the physician’s office and personal bills, daily bank deposit and balancing of personal and office banking accounts.

Senior Home Care, Clearwater, FL (February 2006- April 2007)

Medicare and Commercial corporate BILLER May 2006-April 2007

Home Health, HMO-Commercial billing for 12 districts in the state of Florida.

Home Health. Medicare billing for 6 districts including submission, posting and resubmitting denied claims for payment.

Review of Pre-Authorizations to approve Home Health visits to ensure full reimbursement for services provided.

Developed long-term profitable relationships with Districts, weekly meetings to build solid teams in multiple counties across Florida to ensure proper and timely patient care and billing.

ASSISTANT DISTRICT ANALYZER, FEB 2006- MAY 2006

• Review of Skilled Nursing, Physical Therapy, Occupational Therapy and Speech Therapy notes to prepare billing for corporate office as patient are discharged or Re-certified for additional care.

• Relaying doctor’s orders and change in medications of patients to Home Health nurses as orders are sent to the district branch.

• New Referrals and verification of patient insurance and approval for home health services. Knowledge/use of the Medicare MECCA system to ensure proper billing, obtaining Insurance pre authorization for care and treatment.

CRISTOBAL R. ROSARIO M.D., P.A., INTERNAL MEDICINE, PALM HARBOR, FL July 2003- February 2006

Front Desk Coordinator

Answered multi-phone lines, making patient appointments and answering insurance questions.

Check-out counter duties which included, making follow up appointments, Referrals to specialist.

Input and submission of ICD-9 and procedure codes for patient billing, posting patient co-payments and cash patient payments using Visionary Medical System.

Researched modifiers and proper billing for Internal Medicine for proper reimbursement.

Review of denied claims, correct and resubmitted for payment.

Verification of patient active insurance policy and patient monetary responsibility’s, reviewed and explained health plans to patients to help them understand their policies.

Coping and mailing/faxing patient medical records to specialist or new physician.

Setting up Home Health, DME and patient assistance for patients, including submission of proper paper work with medical records showing medical necessity and requesting insurance pre authorization.

Assisted physician in exam rooms with patients when Medical Assistants was unavailable or helping another physician.

Organized and worked with 5 office associates to ensure a smooth schedule, review of patient demographics.

Robert Dean M.D., P.A., INTERNAL MEDICINE, PALM HARBOR, FL November 2002- July 2003

Front Desk and back Office Assistant

As a Medical Assistants, I assisted with office procedures and patient education of new diagnosis and medications.

Answered multi-phone lines, making patient appointments and answering insurance questions.

Check-out counter duties which included, making follow up appointments, Referrals to specialist, research and input of ICD-9 and procedure codes for patient billing, posting patient co-payments and cash patient payments.

Verification of patient active insurance policy and patient monetary responsibility’s, reviewed and explained health plans to patients to help them understand their policies.

Coping and mailing/faxing patient medical records to specialist or new physician.

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