Billing Specialist Senior Claims
Resume:
SUMMARY
Versatile, seasoned finance professional with 15 years of experience in the healthcare and telecommunications sectors. Roles have spanned the finance spectrum, from revenue and receivables management, to billing/credit/contract analysis and payroll administration, with extensive billing and claims experience. Deep systems expertise in EMR, MIS, spreadsheet, database, operations management, and CRM applications.
PROFESSIONAL EXPERIENCE
Evergreen Treatment Services 2016 – PRESENT:
Billing Specialist
●Provide broad support to revenue cycle management
●Support budget formulation based on charge master changes
●Perform broad auditing, contracts, and collection procurement functions
●Conduct contract renewal through supporting executives with billing and payment information
●Ensure full charge capture, aligned with Medicare/Medicaid/carrier guideline
●Conduct Collections procurement - aged receivables – B2B
●Evaluate programming adjustments to increase clean claim percentage rate
●Post and update client profile data, utilizing Indicia software for utilization and level of care assessments
Northwest Eye Surgeons 2014*:
Senior Billing Specialist
●Performed all levels of billing support, including billing chart research, audits, and related patient and carrier communications
●Processed patient credit balances with related audits
Swedish Medical Group 2011 – 2014
Credit Analyst
●Provided broad oversight of the revenue cycle aligned with internal and regulatory guidelines
●Verified posted payments met contractual guidelines and reported department revenue variances
●Conducted annual documentation reviews and audits, including charge masters, medical records, and related instruments, ensuring all billable services were captured
●Analyzed, designed, and implemented information reporting systems to monitor, detect, and correct variations in revenue cycle performance
Group Health Cooperative 2008 – 2009
Sr. Billing Specialist
●Performed high-level billing administrative functions
●Served as liaison between financial and operational managers, clinicians, and staff
●Responded to ad hoc inquiries and researched complex billing issues
●Recommended improvements to billing and charge capture instruments and systems, for updates to ICD9/ICD10/CPT4 code sets
●Monitored and audited revenue and usage reports, charge, billing, and medical records in ensure full charge capture and comprehensive supporting documentation
AETNA 2004 – 2007
Senior Claims Benefits Specialist
●Performed broad claims functions for Alaska region
●Prepared financial reports and statements
●Supervised and trained new staff members
●Ensured CPT coding compliance Medicare/Medicaid /internal guidelines (ICD9/ICD10)
●Submitted claim determinations, coordinating balance resolution
UW Harborview Medical Center 2002 – 2004
Fiscal Specialist
●Provided broad accounting support to laboratory operations, including time keeping, budget formulation/variance review, risk account identification, and related mitigating action
Davita, Inc. 1999 – 2002
Revenue Accountant
●Managed revenue for 12 clinics assigned to my portfolio
●Researched and reported profitability and revenue variances, aggregate and clinic site level
●Researched financial resources for patients in need in order to resolve balances
●Managed variances in revenue from the administration of ancillary drugs, reporting sources of revenue fluctuation, generating monthly profit and loss statements, performance evaluation of each clinic, and accessing areas of growth and improvement
Providence Health- 2015*:
Billing Specialist
●Managed Medicare and Medicaid billing for skilled nursing facilities unit, operating to Medicare/Medicaid guidelines
●Posted payments, reconciled statements, updating Medicare/Medicaid offices with changes to patient status
Sprint Telecom - 1996 - 1999
Business Account Executive
●Briefed clients on new products to expand revenues
●Managed a portfolio of 145 mid-market business clients totaling $465,000 in revenue
●Served as a principal contact for account management and support
●Created new client contracts aligned with internal and industry guidelines
●Performed contract reviews to ensure full compliance
●Provided broad account management and business development functions, leveraging dynamic communication skills and innovative problem-solving expertise
●Cultivated new sales opportunities and closed new business, achieving or exceeding monthly revenue objectives
EDUCATION
Master’s in Business Administration
Seattle Pacific University, Seattle, Washington (year)
Bachelor of Science, Business Administration
Central Washington University, Ellensburg, Washington (year_
Bachelor of Science, Accounting
University of Liberia, Monrovia, Liberia (year)
Professional Affiliations
Washington Society of CPAs
Associate Member (year)
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