Medical Billing Specialist

HELEN S. PILEY

*** ******** ****** ********, ** *6046

Email *******@*****.***

Cell/Home 785-***-****

FINANCE/OPERATIONS

Dynamic Medical Finance career that has combined innovative new ideas that have lead to the reduction of outstanding accounts receivables.

SELECTED ACHIEVEMENTS Finance:

•Improved the internal process of determining the correct payment structure between the third party insurance and the patient.

•Developed a model for the determination of payments for duplicate bills.

PROFESSIONAL EXPERIENCE

Medical Reimbursement Technician, Department of VA 01/17 – 12/04/2020

Conducting payer analysis: managing retractions/offsets and suspense payments. Process refunds, following up on accounts receivable, completing prescription claims submissions using ECME (Electronic Claims Management Engine) and enter/editing billing information in VISTA for prescription encounters patients receive from active third party pharmacy coverage.

Full time. GS-0503-07-04. Salary $49,597.00 per annum.

Medical Reimbursement Technician, Department of VA 05/12 – 01/17

VistA, entering and authorizing outpatient and inpatient claims. Researching inpatient stays to verify if patient information is correct and inpatient stay if billable.

Work claim status awaiting and Medicare remittance advice reports in VistA. Authorizing claims through Quadramed. Correcting/cancelling claims in Huron through the CPAC

Portal. Providing assistance in training new employees to enter/authorize claims, including training in working claim status awaiting, Medicare remittance advice reports, and Huron. Full time. GS-0503-06-03. Salary $37,983.00 per annum.

Medical Billing Specialist, Lincare Regional Billing Center 11/ 05 – 05/12

Processed claims for billing either by electronic media or paper UB to Medicare and CMS 1500 paper claims to third party payers. Identified duplicate payments and overpayments and initiated requests for refunds. Processed verification of insurance coverage to determine the potential for revenue collection. Reviewed reports for correct information and corrected any errors prior to sending to supervisors.

Account management. Posted payments received from patients and third party payers. Created and sent refunds when necessary for overpayments.

Full time.

EDUCATION

Shawnee Mission East High School Graduated 1987

REFERENCES FURNISHED UPON REQUEST

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