Medical Billing Specialist
Resume:
Ebony Jackson
Professional Summary:
● Healthcare professional with 6 years of medical billing, coding, and data
● Handled up to 100 claims daily
● Experience working with Medicare and Medicaid claims
● Knowledge of ICD-10, CPT, HCPC’s, revenue codes, and medical terminology
● Experience working with Softaid and Patman, Excel Professional Experience:
Geo Soluctions, Carol Harris Staffing, Pittsburgh, PA 08/2024 - present Data Entry Assistant
Pantherx Rare Pharmacy, Pittsburgh, PA 02/2022 - 05/2024 Claims Analyst
● Verifies patient pharmacy and medical coverage & processing info.
● Abilities to process pharmacy claims on the patient’s behalf through a pharmacy benefit system.
● Abilities to verify medical benefits accurately on patient’s behalf.
● Obtains authorizations & overrides as needed.
● Applies patients for copay cards and/or assistance programs.
● Discusses with patient to review patient financial responsibility, obtain patient consent and payment.
● Ensures proper shipment set up.
● Works special projects.
● Report to building once a month for in office work; attend meetings for updates.
● Other tasks as assigned.
Zoll Lifevest, Pittsburgh, PA 11/2014 – 02/2021
Billing Specialist
● Submits electronic claim batches to various clearinghouse entities. Prints and submits claims and supporting documentation via mail.
● Coding bills and maintaining clear records
● Reviews and enters claim information into various online insurance portals
● Operates computer terminal to input and retrieve data
● Records daily volume of incoming and outgoing claim information
● Responsible for reviewing and processing End of Use accounts
● Responsible for quality checks on daily claim reports to prevent incorrect claim submission CVS Caremark, Pittsburgh, PA 03/2013 - 10/2014
Rep II, Medicare Clinical Operations
● Work closely with providers to process prior authorization (PA), and drug benefit exception request in accordance with Medicare Part D regulations.
● Research and conduct outreach via phone or fax to obtain additional information to process coverage requests and complete all necessary actions to close cases.
● Additionally, the Rep II will be responsible for research and correction of any issues found in the overall process.
● Phone assistance is required to initiate and/or resolve coverage requests. Contact: Ashley Desalvo Email: ********@*****************.*** Tel: 321-***-**** Cell: 727-***-****
● Escalate issues to coverage determination clinical pharmacists and management team as needed. Education:
Career Training Academy, New Kensington, PA Associate of Applied Business in Medical Billing and Coding, 06/2012 Contact: Ashley Desalvo Email: ********@*****************.*** Tel: 321-***-**** Cell: 727-***-****
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