Insurance

Patient Insurance Billing Follow up

Qualifications Profile

Highly competent, detail-oriented, and hands-on professional, offering extensive experience in processing and administering medical charges as well as payment posting. Demonstrate expertise in evaluating insurance payments; complemented with comprehensive knowledge of International Classification of Disease (ICD) and Current Procedural Terminology (CPT) codes in verifying insurance coverage and eligibility requirements for processing operations. Thrive at multitasking, maintaining positive attitude to get things done even under pressure, within deadlines, and minimal supervision. Leverage strong communication, interpersonal, and problem-solving skills to contribute to organizational growth and efficiency. Bilingual in English and Spanish

Areas of Expertise

Clinical Administration and Operations

Medical and Healthcare System

Regulatory Compliance and Standards

Process Improvements

Medical Recordkeeping

Data Collection and Analysis

Medical Terminology and Billing Services

Workflow Planning and Scheduling

Patient Needs Assessment

Leadership and Teambuilding

Professional Experience

Watson Clinic LLP § Location

Special Accounts Representative Jun 2012–Present

Conduct follow-up on open claims and evaluate claims for completeness and compliance with established Medicare billing guidelines.

Determine and assess denials for inappropriate payments; dispute unpaid and underpaid charges with the carrier.

Demonstrate comprehensive knowledge of clinic contracts, carrier specific, state/federal governmental, Health Care Financing Administration (HCFA), or Current Procedural Terminology (CPT) billing and reimbursement guidelines.

Secure and properly maintain electronic file of signed medical necessity forms for accuracy and required procedures.

Patient Services Specialist Jan 2011–Jun 2012

Organized and coordinated patients appointments for laboratory and x-rays examination with doctors.

Carried out key tasks including setting up of medical test, evaluation of authorization, and handling of other multi-specialty desks functions.

Medical Eye Associates § Kissimmee, FL

Billing Specialist Aug 2008–Aug 2010

Took full charge of posting and recording all office and facility charges including insurance and patients payments into database.

Rendered assistance to patients by answering their queries on accounts over the phone.

Keenly identified and examined all Explanation of Benefits (EOB) denials; reconciled payments; recorded review as necessary.

Dealt with the collection and preparation of all accounts for monthly statement, while disseminating all electronic claims and statements.

Cataract and Laser Eye Institute § Davenport, FL

Billing Specialist Sep 2007–Jul 2008

-Posted and compiled all office and surgery charges for medical documentation.

-Reconciled patient accounts and resolved claim discrepancies including adjustments and corrective entries in the account in accordance with established procedures.

-Performed patient monitoring and coordinated patients surgery schedules and appointment with doctors.

-Administered the verification of insurance for surgeries authorization.

Heartland Healthcare Inc. § Haines City, FL

Medical Assistant/Office Assistant Dec 2006–Sep 2007

Carried out medical assessments including vital sign, electrocardiography (EKGs), as well as pro-time laboratory tests.

Interpreted all prescription to pharmacies and insurance companies.

Gathered and organized all referrals, pre-certifications, and prior authorizations for testing and surgical procedures.

Coordinated telephone calls to appropriate person for resolution, while maintaining confidentiality of patient medical records.

Handled the procurement of medical and office supplies and conducted inventory monitoring.

Retina Group of Florida § Ft. Lauderdale, FL

Billing and Office Specialist Nov 2000–Jul 2006

Compiled and analyzed all office and surgery charges as well as insurance and patient’s payments for posting.

Ensured proper procedures in reviewing all charges for accurate and timely submission of all electronic submitted claims.

Assumed accountability in the reconciliation of all account receivable, FOB’s appeals and denials for approval of third-party agency.

Education

[Specific Degree and Program] United States Army, Location

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