Precise, efficient medical billing professional with over 20+ years of experience in inpatient, outpatient, and physician medical billing. Specialize in filing accurate claims, adjusting rejected claims, and understanding insurance contracts, appeals and EOBs. Additional expertise in quality control, reimbursements, and implementing improved processes to enhance accuracy of business, billing.

SKILLS

Billing and Collection, ICD-10 and CPT coding, Familiar with Commercial and Private Insurance, HCPCS Coding Guidelines, Medical Terminology, HIPAA Trained, Excellent Problem Solver, Close Attention to Detail.

PROFESSIONAL EXPERIENCE

Medical Biller, TrueCare – Brooklyn, NY 6/2019 - Present

Research and resolve denials, incorrect payments and claim rejections.

Submit billing data and medical claims weekly totaling $700,000.00 to $750,00.00.

Verify accuracy of insurance claims payments.

Improve revenue for providers by working aggressively on their aging report

Analyze, research and resolve patient billing issues.

Observed the HHAeXchange dashboard to ensure the accuracy of records involving visits and pre-billing updates.

Posted insurance payments.

Accounts Receivable Specialist, Special Touch Home Care Services – Brooklyn, NY 6/2016-11/2019

Ensured accurate and timely billing of all outstanding account balances to the appropriate third-party payers and patient guarantors.

Utilized specialized knowledge of contracts, regulatory or contractual billing guidelines to determine an account’s ability to pay after initial rejection from payer.

Resolved inappropriate payments with insurance carriers that are not in compliance with payer contracts or government agency rates.

Identified trends in payer non-compliance and informed management if not able to resolve with payers.

Coordinated collection activity for past due accounts, denials/appeals and reconciled EOB.

Successfully maintained a low rejection rate, led claims transmission through various clearinghouses.

Insurance Recovery Specialist, Phytest – Atlanta, GA 4/2007-8/2012

Processed all correspondence and EOBs from third party clients and file appeals when deemed necessary by the firm.

Appeals and rebills of denied charges, rejected claims or any issues that affect reimbursement.

Received up to 75 inbound calls from patients inquiring about their accounts.

Analyzed outstanding balances to determine appropriate course of action.

Keeping a daily claims log with details and actions taken on every claim worked.

Medical Biller Supervisor, FPS- NEW YORK, NY 1/2001-3/2007

Oversaw the billing functions, including the initiation of goals and procedures, overseeing daily operations, and coordinating office efforts to expedite payment of accounts.

Supervised employees in performance of tasks associated with billing and collection from third party payers. Monitor’s billing processes of billing staff to assure that billing is correct and timely.

Reviewed and resolved issues related to claim generations, clean claim ratios, rejected, denied billings. Determines the accuracy of charge capture, missing charges, late charges, covered and non-covered charges.

Served as a resource to staff by answering questions, assisting with problems, and providing training as necessary.

Implemented quality and performance improvement measures for the business office.

Participated in the development of unit policies and procedures

Ensured timely submission and acceptance of claims to all payers.

Communicated with management on day-to-day issues

Lead team to improve office collections, communicate issues, and implement ideas

Performed daily activities of billing and auditing of assigned claims

EDUCATION

Master of Business Administration, American Intercontinental University November 2014

Bachelor of Science in Business Administration & Management, Columbia College October 2013

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