Insurance Medical Billing

SHABIR MOHIUDDIN

#*** ****** ***. *******, ** ***66 201-***-**** *********@***.***

PROFESSIONAL ACCOMPLISHMENTS SUMMARY:

Over seven (7) years of experience in hospital and physicians’ medical billing, claims analyst, and supervising office staff

Analyzed claims data, prepared an claims adjustment and denial report on time

Ensured all submitted and paid claims are maintained correctly for audit purposes

Conducted special projects as assigned by the director of patient accounts

Experienced in Commercial, Medicaid, No-fault and Worker comp insurance claims processing

Hands on experience in reconciliation of paper claims, electronic claims and EMR

Interpreted insurance and network contracts for the hospitals

Interacted with insurance companies regarding billing and coding issues

Negotiated high dollar claims with insurance companies for prompt payments

Familiar with medical billing software such as SMS, EPIC, Medisoft, Meditech, & Navinet

Proficient in medical terminology, and online claim submission

Proficient in Microsoft Word, Microsoft Excel, and PowerPoint

Ability to work positively and productively in fast-paced environment

Excellent communication, written, verbal and strong follow-up skills

PROFESSIONAL EXPERIENCE:

DICKS SPORTING GOODS PARAMUS, NJ

Internet Fulfillment Specialist November 2016 – February 2017

Performed shipment receiving duties while ensuring the right item has been delivered

Ensured posting of outbound deliveries using pre-designated software

Organized packaging procedures to ensure safety of shipment

Prepared invoice & delivery orders online

Ensured all transactions are record in company database

PEDIATRIC SURGICAL ASSOCIATES PARAMUS, NJ

Billing & Collections (Contract Assignment-Uniforce Staffing) July 2016 – September 2016

Responsible daily for billing & collection activities on both new & denied claims

Negotiated dollar amount with major insurance plans for out-of-network claims

Posted insurance & self pay payment to the appropriate account

Monitored and rectified the credit balance accounts

HOLY NAME MEDICAL CENTER TEANECK, NJ

Authorization Specialist (Contract Assignment-Uniforce Staffing) November 2015 – January 2016

Obtained 20 pre-authorizations (daily) for PT, OT, ST & SN services in timely manner

Prioritized incoming prior authorization request from the director of nursing

Coordinated and accountable for the daily operations of the prior authorization

Adhered to the Plan’s HIPAA and Privacy law

LIFELINE MEDICAL ASSOCIATES PARSIPPANY, NJ

Denial Specialist (Physicians Billing – OB/GYN Specialty) September 2014 – October 2015

Evaluated and ensured all denied or underpaid claims identified, appealed and reversed; assist with appeals if payer ICD-10 application or logic is invalid

Audited claims to ensure payments are made according to the contract reimbursement rate

Organized responsibilities and priorities to ensure timely collection of account receivables

Performed special audit requests for denials and assisted in the writing of appeal letters

Self-motivated, detail-oriented, analytical and problem solving skills

LINCOLN HOSPITAL BRONX, NY

Patient Accounts Manager (Contract Assignment–Execu-Search) December 2012 – August 2014

Performed review and recommendations regarding the denied claims to the A/R department

Coordinated A/R follow-up activities, ensured denials are identified and addressed effectively

Promoted revenue integrity by evaluating accounts for accurate expected reimbursement

Trained and monitor staff to ensure proper steps are taken to overturn or appeal denial

Performed periodic analysis to ensure all regulatory billing requirements are met

Participated in departmental meetings, updated policies & procedures & billing performance

BON SECOURS HEALTH CARE SYSTEM WARWICK, NY

Financial Consultant (Contract Assignment) February 2012 – June 2012

Performed corrective action and appropriate steps on unpaid claims on daily basis

Posted necessary adjustments and payments to patient accounts as required

Contacted insurance and third party payers for claim status for commercial & Medicaid claims

Accurately resubmitted approximately 20-40 corrected claims to insurance companies

Reviewed all denials and makes recommendations for denial management and improvement

SAINT JOHN’S EPISCOPAL HOSPITAL FAR ROCKAWAY, NY

Managed Care Department - (Contract Assignment-Besler Consulting) June 2011 – November 2011

Obtained 25 authorizations (daily) for managed care cases in timely manner and timely billing

Monitored the nurses’ work queues to ensure turnaround compliance timeframes are met

Coordinated & accountable for the daily operations of the prior authorization team

Adhered to the Plan’s HIPAA and Privacy Standards Confidentiality Agreement & Guidelines

Provided direct clinical support to Physicians regarding utilization & authorization

Communicated with scheduling coordinators, clinical staff regarding inquiries/referrals

ENGLEWOOD HOSPITAL & MEDICAL CENTER ENGLEWOOD, NJ

Medical Claims Analyst (Contract Assignment – Besler Consulting) October 2007 – June 2008

Prepared correspondence and appeals regarding reimbursement claims

Working knowledge of Medicare, Medicaid and commercial health care billing & insurance

Corrected insurance denials & resubmitted to appropriate insurance companies

Applied working knowledge of preauthorization for special surgeries

EDUCATION:

Saint Peter’s University, Jersey City, NJ

Masters in Business Administration,(MBA) MIS/Finance, May 2013, Overall GPA: 3.5

Bachelor of Science, (BS) Health Care Management, May 1997

SHABIR MOHIUDDIN Page 2

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