Medical Customer Service

Sophia Marie Miller, CBCS

*** ***** ******** **. *** B Philadelphia, PA 19139 267-***-**** ***************@*****.***

Professional Summary

Certified Medical Billing & Coding Specialist

Ensures health providers are paid for medical services rendered. Responsible for the accurate flow of medical information and patient data between physicians, patients and third-party payers. Familiar with numeric codes to define diagnostics, treatments and procedures for both ICD-9 and ICD-10. Allocates information into a facility’s database using medical coding protocol to produce a statement or claim. Liaison between the facility and payment parties. If the claim is denied by the third-party payer, specializes in medical claims investigations, and verifying its information, and updating the databases.

Education &Licenses

Full Circle, Philadelphia, Pennsylvania 04/2016 to 07/2016

NRCET

CBCS

Harcum Collage, Bryn Mawr PA

Associates Degree in psychology 09/2002 to 05/2004

Professional Experience

NNMC, National Naval Medical Center, Bethesda, Maryland 08/2015 to 06/ 2016

Patient Access Rep/Coding and Billing Specialist

Perform daily billing department functions, including medical coding,chargeentry,claims,payment posting, and reimbursement management

Verify diagnosis codes into billing software to generate invoices

Use electronic charge capture practices such as billing and account receivables(BAR) system and medical billing clearinghouse accounts to submit codes and invoices on time

Follow up om past due invoices and delinquent accounts to reduce number of unpaid and outstanding balances

Document patient data and medical records, and perform routine medical record audits to comply with insurance company requirements

Uphold and reinforce compliance with hospital polices and federal regulations such as HIPAA

Independence Blue Cross Philadelphia, PA

Account Payable 10/2014 to 08/2015

Collaborated in dynamic team approach to resolve inquiries

Built and nurtured business rapport with customers

Investigated and provided accurate resolution to electronic and telephonic inquiries

Complete and process cross functional transactions to reduce end to end handle times

Reported trends in procedural and administrative errors; Processed all corporate reimbursement claims

Professional Experience cont.

American Association for Cancer Research Philadelphia, PA

Membership Services 03/2014 to 08/2015

Provided overall Administration for all functions related to IMIS, the AACR database system of record

Managed content in IMIS to provide integrity over the database and ensure that the information is captured accurately

Assisted in developing, implementing and maintaining a training program for staff

Assessed all vendor upgrades to recommend enhancements to vendor software

Responsible for assessing the qualifications of member applications as well as individuals currently on the membership rolls to ensure their eligibility

Independence Blue Cross (IBC) Philadelphia, PA

Data Entry Support 11/2013 to 01/2014

Completed all assigned administrative operational tasks in an accurate manner

Provided administrative support to sales representatives and associates account in completion of all external customer service issues such as billing, enrollment, and claims

Prepared reports and maintains files and records of group accounts

Entered and sorted numeric data into excel based program

Northeast Treatment Center Philadelphia, PA

Administrative Assistant (Temp) 08/2013 to 10/2013

Processed foster care and DHS claims for children; Responsible for all Foster care And DHS Files

Scheduled appointment setting for all families and children into placement homes

Answered phone calls, made case files for foster children and their families; faxed claims to N.E.T community resources.

Scanned all replacement files into N.E.T Computer program as well as all Medical records

Data entered of all foster child medical records from DHS Programs

Escorted all clients to assigned case worker

OKI Data Mount Laurel, NJ

Database Coordinator 06/2010 to 03/2011

Management managed four employees in the technician department

Responsible for all office technology operations including faxing, data entry, copying of documents

Responsible for all employee timecard entries; Prepared and processed for all timesheets

Assisted with preparing reports based on the information recorded in databases

Audited daily and hourly timesheets submitted for correct budget assignments and data

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