Specialist Collections Medical Billing

Objective: Looking for a full time, part time or remote administrative billing position within a medical billing or medical practice. Certified Medical Billing Specialist familiar with most insurers including Medicaid, Medicare, No fault and Workmen’s Compensation.

Medical Practice Software Skills:

Change Healthcare (Eprimus); Mpower; E Clinical, IDX, IBAX Hospital Systems; Medics Premier Practice Management Software, E-Chart Software, Facets Claims Software; Altruista Software, Guiding Care Software; Aprima Practice Management Software; MD Everywhere Practice Management Software, Athena Practice Management Software; Therapist Helper Practice Manager Software; Lytec Medical Software, Spring Charts EHR, Claims Connect Software, Microsoft Office Suite, Microsoft Access Database.

Medical Billing Experience:

Prosearch Network (Med-Metrix -Third party biller) Accounts Receivable Specialist Collections (Temporary Assignment) 12/27/21-3/3/11/22.

Daily Responsibilities

Hospital Accounts Receivable - Claim underpayments - reviewed underpayments against payor contracts, possible secondary coverage. COB scheduled where needed. Underpayments greater than 15% of contract reviewed for claims errors and billing oversights.

Resulting claim reconsideration implemented via payor portal, phone or corrected E claim, paper claim.

Claim adjustments – Posted patient responsibility. Under payments less than 15% of contract reviewed for claims billing errors before recommending posting adjustments.

Medix Team (RTR Financial – Third party biller) – Revenue Cycle Specialist (Consulting Assignment) 5/22/18 – 11/13/18.

Daily responsibilities included:

Reviewed monthly aged hospital and outpatient reports.

Identified reasons for all open patient balances.

Followed up with internal billing teams and insurance accounts payable teams to insure patient account balances are properly reprocessed where applicable.

Reviewed EOP posted payments against contracted insurance rates.

Processed EOB denial reports. Reviewed patient charts for coding and billing errors.

Identified corrected claims information for appeals teams.

Healthcare Associates In Medicine - Neurology, Neurosurgery, Orthopedics, Orthopedic Surgery, Pain Management, PT, and OT Practice- 7/20/2015 – 5/18/2018.

Daily responsibilities included:

Reviewed assigned monthly insurance accounts receivable reports (HIP, Healthfirst, Careconnect, HMO Medicare, Medicaid, Champ Va, and Geico No-Fault).

Posted and scheduled corrected E- claims or HCFA’s.

Maintained patient accounts receivable open ledger.

Verified all EOBs, EOPs, Denial Notices and EDIs

Reviewed medical narratives for claims pending payment.

Wrote appeal letters as needed.

Posting payment updates to patient A/R ledger (updated claims payments, insurance reimbursements and disallowances).

Provided patient support for all related billing inquiries.

Initiated promissory notes and collections process for outstanding patient balances.

Secondary billing support to workmen’s compensation billing supervisor.

Access Staffing –VNS Choice MLTC (NYC) Grievance & Appeals Department -July 2014 –July 10, 2015– Provider & Patient Administrative Coordinator (Certified Medical Billing Specialist)

Daily responsibilities included:

Initial contact for provider and patient calls requesting status of outstanding claims.

Conducted initial review of provider and patient billing claims submitted during the grievance & appeals process.

Identified providers, or members billing and system coding and processing errors. Final results were forwarded to TMG billing specialist, insurance product specialist’ or nurse management for accounts payable assessment and determination.

Cambridge Management Services – University Physicians Group (Staten Island) Primary Care, Internal Medicine, Allergy, Dermatology, Endocrinology, Podiatry (including diabetic foot) Rheumatology, Pediatrics and Pulmonary Critical Care - September 2013 –June 2014 (Certified Medical Billing Specialist)

Daily responsibilities included:

Posted CPT and ICD9 codes to patient’s account for claims processing.

Provided quality control review for all ICD9 and CPT postings prior to release of insurance claims.

Updated patient’s registration and insurance coverage information .

Collected and posted patient copayments.

Balanced nightly ledger for copayment deposits.

Reviewed patients A/R aged report. Followed up with insurance provider representatives or patients regarding balances.

Silver Lake Psychotherapy Associates – Staten Island, NY – July 2013 –March 2014 – Part (Front Desk Receptionist and Billing Clerk)

Daily responsibilities included:

Provided new patient registration, patient appointment scheduling, insurance authorizations, benefits confirms.

Prepared patient super bills, statements and patient audit reports.

Posted patient co-payments, and insurance payments. Generated and uploaded electronic claims for insurance processing.

Reviewed EOB’s and Aged Reports. Followed up with insurance provider representatives or patients regarding balances.

Provided administrative secretarial support to senior therapists.

Dr.Russell, OB/GYN Medical Practice –Staten Island, NY – July 2012-March 2013 - Part Time (Front Desk Receptionist and Billing Clerk)

Daily responsibilities included:

Provided patient appointment scheduling, new patient registration, insurance authorizations, benefits confirms.

Posted patient co-payments.

Maintained patient electronic health records.

Eger Healthcare Rehabilitation & Health – Staten Island, NY – June 2011 – January 2012

(Medical Records Clerk Intern Volunteer)

Daily responsibilities included:

Provided administrative support within the medical records department.

Daily phone coverage, pulling medical records, filing lab tests results.

Reviewed insurance claims and patient record audits.

Supported all nurse management medical record inquiries

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