MIBC (Medical Insurance Billing/Coding) Eligibility Verification Expert

Senior Collections Representative Senior Appeals Specialist

More than 15 years of experience with collections, eligibility verification, medical billing/coding, customer service, front/back office, medical records, and quality assurance. Experience Lead, Trainer and Project Manager with a focus in collections, Claims Analyst with timely and appropriate follow up operations. Proven analytical and strategic thinker who thrives in a high-paced environment.

Core Competencies

Eligibility/Insurance Verification for all In and Out of Network Benefits, Clinical and Outpatient Services.

Claim/Eligibility of Benefits/Accounts Receivable Reviews

Maximize-Collection Dollars

Workers Compensation Specialist

First Call Resolutions/Settlements

Strategic Planning

Organization/Prioritization

Business Products and Filings

Relationship Building

Training

Intergy/Laserfische

Microsoft Word and Excel

Professional Experience

Hospital Business Services, Inc – Ontario, CA 2017-Current

Financial Recovery Analyst

Perform medical billing/collection for various health insurance carriers. Specializing in workers compensation and billing/collections. Manage ICD/CPT codes, denials, collections and refunds of over-payments and secondary insurance billing and collection. Maintain good awareness for verifications and eligibility, and co-pay collections.

Responsible for medical billing/coding on all claims.

Timely follow up on all claims and retrieval of medical records.

Maximize collection dollars for all claims aged and current.

Communicate on a regular basis insurance carriers, adjusters, and legal firms to ensure proper handling of claims.

Handled all Eligibility Insurance verification to ensure timely claim processing.

Managed all incoming mail.

APEX Cardiology Consultants – Los Angeles, CA 2007-2017

Senior Billing/Appeals and Collections/Claims Specialist (5 Providers)

Evaluate medical claims and verify ICD-10 and CPT codes. Corroborate insurance and account registration for patients and physicians. Lead medical appeals and correspondence for multiple collections and settlements. Perform payment posting and bank deposits for patients. Communicate directly with patients and physicians regarding accounts.

Eligibility/Insurance Verification for all In/Out of Network Benefits, Clinical, Outpatient Services.

Review all claims (facility/professional/workers compensation) for resolutions/settlements.

Follow up on zero and payments (EOB/AR), appeal of denied claims, retrieval of medical records.

Maximize collection dollars for all claims aged and current.

Address any patient concerns/issues to educate them on medical insurance processing times for Commercial/HMO/County or Federal agencies.

Assist Front Desk with scheduling appointments, procedures, answering multiple phone lines, check in/out patients, and other duties related to administration and human resources.

Collaborate with referring physician and legal offices to ensure the proper handling of cases.

Interface with an external collection agency to obtain patient payments.

The Michaelson Medical Group – Los Angeles, CA 1994-2007

Billing/Senior Workers Compensation Specialist (3 Providers)

Manage all billing and coding for workers compensation claims. Research high-profile issues including potential litigations and arbitrations. Communicate on a regular basis with workers compensation insurance adjusters and law offices to ensure proper handling of workers compensation cases.

Eligibility Insurance Verification to validate workers compensation coverage.

Scheduled all diagnostic testing and inpatient/outpatient surgeries.

Negotiated a settlement on all workers compensation liens.

Organized all Qualified Medical Exams and Agreed Medical Evaluations for Physicians.

Education

West Los Angeles College

Los Angeles, CA

Santa Monica College

Santa Monica, CA

References

Available upon request

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