Medical Billing Customer Service

Karen A. Raney

** **** **, *** **, Bloomfield, NJ 07003 973-***-**** **********@*****.***

SUMMARY OF QUALIFICATIONS:

A responsible and detail oriented team player. Excellent communicator with great organizational, customer service and managerial skills. I am seeking a position with a growing organization.

EXPERIENCE:

CarePoint Health Medical Group

Managed Care & Contracting Credentialing Specialist (February, 2014 – Present)

Maintain regular cooperation and compliance with all regulatory, accrediting, and membership-based organizations

Create and carry out various credentialing processes in relation to physicians, medical assistants, and various other healthcare professionals

Ensure that all personnel and services adhere to facility and staff policies, department guidelines, regulations, and government laws

Compile and maintain current and accurate data for all providers

Maintain copies of current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all providers

Maintain knowledge of current health plan and agency requirements for credentialing providers

Track license and certification expirations for all providers to ensure timely renewals

Ensure practice addresses are current with health plans, agencies and other entities

CarePoint Health Medical Group (Medix Temp Agency)

Medical Biller and Coder (April, 2014 – February 2015)

Reviewed patient medical records and assigned codes to diagnoses and procedures performed so that the facility can bill insurance and other third-party payers

Used coded data to produce and submit claims to insurance companies

Worked directly with the insurance companies, health care providers, and patients to get claim processed and paid

Reviewed and appealed unpaid and denied claims

Verified patients’ insurance coverage

Answered patients billing questions

Handled collections on unpaid accounts

Managed the facilities Account Receivable reports

Alves & Johnson, MD

Medical Billing Manager (2009 – 2014)

Was fully in charge of all medical billing for medical/ surgical practice including following-up with

insurance companies on submitted claim status.

Handled physician credentialing including Licensing, National Provider Identification..

Communicated with patients regarding test results (blood work, X-rays, CT scans, MMR, etc).

Assisted gastric bypass patients in completing follow-up requirements, and completed disability forms for patients returning to work.

Answered phones, scheduled appointments for patients, booked surgeries with hospitals and called insurance companies for surgery authorizations.

Handled accounts payable/ receivable, filed patients’ charts, EOB’s and test results; ordered office supplies.

Distinctive Marketing, Inc.

Marketing Associate (2000 – 2009)

Handled a diversified list of projects for medical marketing research company.

Developed and implemented programs targeted to men, women and multicultural health.

Assisted with proofing and finalizing medical marketing research statistical data reports.

Conducted internet research in support of marketing projects and provided information to management.

Assisted VP of Business Development in generating business from new and existing accounts.

Consulted with clients both over the phone and in person.

Attended and participated in the company’ annual conference in New York City

Roche Pharmaceutical Company

Contract Administrator (1999 – 2000)

Entered daily information regarding rebates, bids, charge backs and contracts.

Responded to incoming customer service calls and resolved problems to customer satisfaction.

SKILLS:

Medisoft Network Professional, Version v17, Practice Fusion electronic Health Records, Kareo – version 1.674585.30279, PC ACE Pro 32 (Medicare) version 2.36.0.100, Gateway (revenue manager advanced capabilities (EDI) for electronic billing, Capario (revenue manager advanced capabilities (EDI) for electronic billing, NaviNet Insurer Connect, MS Work, Excel, Access, PowerPoint, Cactus Credentialing Database, Type 60 wpm, NJMMIS (Medicaid Claims), Meditech, eClinical

EDUCATION: Seton Hall University, Major- Business Administration

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