Medical Billing Insurance

CAROL JOHANSON

Experienced Medical Coder and Biller Accounts Receivable

Eagleville, PA 19403 *****.********.**@*****.*** 484-***-**** Medical Billing Specialist with 11 years experience in a fast-paced, multiple client medical billing company. Researched and denied claims and submitted appeals. Familiar with medical billing and have advanced Knowledge of insurance processes. Authorized to work in the US for any employer

WORK EXPERIENCE

Medical Coder and Biller Midlantic Urology - Plymouth Meeting, PA May 2018 to Present

Submitted electronic and paper claims to insurance companies including Medicare and Medicaid to collect Medical payments. Reviewed patient records, identified the medical codes and created invoices for billing purposes. Complied with all HIPAA Privacy and Security Regulations to protect patients' medical records and information. Analyzed complex Explanation of Benefits forms to ensure insurance carriers were charged correctly. Communicated with insurance providers to ensure any denied claims were resolved and resubmitted. Maintained current accounts through aged revenue reporting. Reviewed patient diagnosis codes to ensure accuracy and completeness. Verified proper ICD-10 coding on claims. Posted charges, payments and write-ups for urology procedures.

Revenue Cycle Specialist McBee Associates Inc - Wayne, PA January 2018 to May 2018 Identified and resolved payment issues between patients and providers. Processed accounts receivable and accounts payable. Prepared documents in Word and Excel. Account billing and follow up with all payers. Prepared appeals as needed. Account research and look up on various client billing systems AR Representative Fresenius Vascular Care - Malvern, PA August 2014 to September 2017 Verified patients' eligibility and claims status with insurance agencies Managed account of monthly gross charges $2,189,261.17 .Reduced AR over 90 days from 28% to 7% within 4 months and have maintained AR over 90 less than 7%, AR over 120 days less than 5% and AR over 180 days less than 5% Diligently filed and followed up with third-party claims. Determined prior authorizations for outpatient procedures. Maintained strict patient and physician confidentiality. Submitted electronic/paper claims documentation for timely filing. Responded to correspondence from insurance companies. Posted and adjusted payments from insurance companies. Identified and resolved patient billing and payment issues. Confidently and adeptly handled claim denials and/or appeals. Reviewed and resolved claim issues captured in TES/CLAIMS edits and the clearinghouse. Examined patients' insurance coverage, deductibles, possible insurance carrier payments and remaining balances not covered under their policies when applicable. Successfully implemented new technologies and process automation to encourage continuous improvement. Consistently achieves 98%-100% on monthly audits. Billing Coordinator Quest Diagnostics - Norristown, PA March 2009 to May 2014 Accurately documented, researched and resolved customer service issues. Managed customer calls effectively and efficiently in a complex, fast-paced and challenging call center environment. Defused volatile customer situations calmly and courteously. Managed high call volume with tact and professionalism. After two years was promoted to Billing Specialist Diligently filed and followed up on third-party claims. Researched questions and concerns from providers and provided detailed responses. Reviewed, analyzed and managed coding of diagnostic and treatment procedures contained in outpatient medical records.

Submitted electronic/paper claims documentation for timely filing. Accurately posted and sent out all medical claims.

Server/Bartender Flying Pig Saloon - Malvern, PA January 2006 to January 2009 Attempted to limit problems and liability related to customers' excessive drinking Checked patrons' identification to ensure that they met minimum age requirements for consumption of alcoholic beverages Cleaned and maintained the beverage area, display cases, equipment, and order transaction area Increased customer attendance at weekly Bar Trivia night by providing fast and friendly service. Made and served drinks to guests and cocktail servers following established guidelines, procedures, and policies Skillfully anticipated and addressed guests' service needs.

EDUCATION

Bachelor of Arts Drexel University - Philadelphia, PA Associate of Arts Community College of Philadelphia - Philadelphia, PA Associate of Arts in Nursing Delaware County Community College SKILLS

• AR (10+ years)

• BILLING (10+ years)

• FILING (10+ years)

• CUSTOMER SERVICE

• FAXING

• claims

• Collection

• Accounts Receivable (10+ years)

• Accounts Payable (10+ years)

• Receptionist

• Medical Billing

• coding

• СРС

• Medical Coding

• Medical Insurance

CERTIFICATIONS AND LICENSES

CPC Currently enrolled in AAPC course for CPC certification ASSESSMENTS

Medical Terminology - Highly Proficient February 2020 Understanding and using medical terminology.

Full results: https://share.indeedassessments.com/share to profile/ 7eb590747e96010f4d73cb5bbe9abfabeed53dc074545cb7

Electronic Medical Records: Best Practices — Highly Proficient February 2020 Knowledge of EMR data, associated privacy regulations, and best practices for EMR use. Full results: https://share.indeedassessments.com/share to profile/ f73357acbdc7f2e355b58837507145a9eed53dc074545cb7

Indeed Assessments provides skills tests that are not indicative of a license or certification, or continued development in any professional field. ADDITIONAL INFORMATION

Skills

Familiar with commercial and private Office support (phones, faxing, filing) Composed and professional demeanor anatomy, AR, attention to detail, automation, insurance carriers Understands insurance benefits, Billing, call benefits center, continuous HCPCS Coding Guidelines Resourceful and improvement, customer service, reliable worker documentation, fast, faxing, filing, Insurance, Medical terminology expert Close attention to math, Medical terminology, Office, 98, Nursing, detail physiology, policies, Coding, psychology, Insurance and collections procedures Adept servers, phones multi-tasker

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