Jamie Porter

** * ***** ****** *** ** Bronx, NY *0452 • Phone: 646-***-****

Email: addx7a@r.postjobfree.com

CAREER SUMMARY

An experienced professional with over 15 years of combined quality services as a customer service and medical billing specialist. Naturally accommodating and versatile with the enthusiasm, dedication, and strong work ethic to manage and execute all responsibilities excellently. I have Strong analytical and problem solving skills. Proactive, self-motivated with strong organizational, interpersonal and communication skills.

PROFESSIONAL EXPERIENCE

Senior Billing Specialist

Radiology Department 10/2014 - 01/2020

NYU Langone Medical Center NY, NY

Responsible for ensuring unpaid and partially paid claims are resolved in an efficient and timely manner. Resolves EOB discrepancies and researches refunds. Monitors and ensures that collections, net, gross and days in accounts receivable targets are met.

Follows up on submitted claims, monitors unpaid claims and resubmits claims with appropriate corrections and documentation

Works declines and processes appeals based upon third party payor guidelines

Responds to patient and third party inquires; researches and resolves simple to moderately complex issues; correct errors and refers complex issues to supervisor

Reviews correspondence and rejection data from insurance carriers; posts rejections and perform reconciliations

Collect and analyze data to determine denial and underpayment trends

Reviews, works, and clears electronic and claims edits daily; summarizes and forwards non workable edits to supervisor for resolution

Review claims for billing, coding accuracy and completeness

Check reimbursement against the contract database utilizing governmental and commercial payment reimbursement methodologies.

Re billed corrected claims are needed to resolve incorrectly denied claims.

Worked with patients and insurance carriers to resolve and update coordination of benefit discrepancies.

Billing Representative 02/2013-09/2014

Jewish Home Life Care New York, NY

Submit Home Health Care medical claims electronically and via paper to governmental, private payors and commercial insurance carriers.

Identify and resolve any claim delay issues that impact billing and collections.

Contact patients as needed to establish payment for services and to reinforce financial agreements and patients financial responsibilities.

Verify member eligibility through Third Party Websites

Intake Specialist 01/2011-01/2013

Care to Care New York, NY

Answers incoming calls for the intake authorization department.

Process outpatient high tech radiology authorizations.

Works collaboratively with the Clinical department to ensure proper and timely approval of services.

Responsible for verifying patient’s demographic data, and coverage eligibility.

Observes client’s rights and confidentiality in accordance with HIPAA.

Maintains accurate record keeping in a confidential manner, as per agency policies and procedures.

Claims Specialist 03/2003-06/ 2010

Health net Tricare Federal Services Hampton, VA

Reviewed, investigated, and adjudicated claims for medical and non medical services that involve the application of contractual provisions in accordance with provider contracts and authorizations

Analyze patient medical information to identify COB, Worker’s Compensation or No-Fault conditions.

Reviewed description of services provided on claim forms to determine validity of charges

Generate letters requesting additional information required to support proper claim determinations as well as denial letters to providers and members.

Reviewed patient medical records to ensure all relevant information was recorded.

EDUCATION

1996 Bayside High School- High School Diploma

PROFICIENT SKILLS

Medical Software: Epic, Facets, Availity, Encoder Pro, Super coder, Optum, E paces, Craneware, Navinet and Centricity

Operating Systems: Microsoft Word Office

Billing: HMO, Private, Commercial, and third party insurance billing, Proficient with CCI – Edits, CPT 4, ID -10 codes, and CMS 1500 Claim Forms. Familiarity with UB04, DRG, and Carve outs.

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