Mental health/ABA Billing Specialist

QUALIFICATIONS

Key Connections ABA Services **/2022 – present

Billing/Credentialing Specialist

Verifies patient-specific benefits and precisely documents specifics for various payer plans including patient coverage, cost-share, and access/provider options according to specific SOPs.

Submit insurance claims to clearinghouse electronically or via paper claim.

Ensure claim information is complete and accurate.

Prepare and submit secondary claims upon processing by primary carrier.

Knowledge of insurance websites

Follow up with insurance carriers on unpaid or rejected claims.

Receive and post payments from insurance and patient responsibility through Central Reach, PureSight, or Insurance websites, PaySpan, Zelis

Billing for all ABA Services via AcuPoint, Central Reach after 10/2022

Credentialing for all new BCBA’s (CAQH, Insurances)

Alliance Lifetime Mental Health 9/2024 – present

Assist with Best Practice set-up

Guidance through Claim denials via InSync

Training Admin. Staff with Billing questions

Light Mental Health, LLC – Kelly Hargett, PMHNP-BC 7/2024 – present

Assist with Best Practice set-up

Guidance through Claim denials

Post payments are needed

Counseling, Coaching & Consulting – Manjit Khalsa, EdD 7/2023 – present

Full cycle billing via Therapy Notes

Invoicing Clients on Monthly Basis and processing payments

Send & Upload Intake documents

Respond to all inquiries via phone or email

Katherine T. Lambert, LICSW 2015 - present

Full cycle billing and credentialing

Unemployment 01/2022 – 03/2022

April D Farley, Self-employed – Remote July 2018 to Present

Credentialing / Billing Consultant

Accounts Receivable Recovery, when necessary, call insurance companies regarding any discrepancies in payments

Monitor denied claims and work to resolve any issues to obtain payment

Insurance carrier enrollment and re-enrollment for group and clinical staff, the maintenance of these providers in in CAQH,

Acquire a CAQH ID for the provider, complete CAQH information, and maintain the CAQH ID information for the provider.

Full-cycle Insurance credentialing & Insurance billing and Insurance Verification

Maintain knowledge of multiple Billing Platforms

Comprehensive Health Services, LLC February 2020 to November 2021

Billing/credentialing Specialist

Accounts Receivable Recovery, when necessary, call insurance companies regarding any discrepancies in payments

Insurance carrier enrollment and re-enrollment for group and clinical staff, the maintenance of these providers in in CAQH,

Notify all staff of any upcoming billing protocol changes

Implemented the bring back all Billing Functions in-house

Monitor denied claims and work to resolve any issues to obtain payment

Monitor patient statement prior to mailing for accuracy

Managed all aspect of the Implementation of a New EMR/billing software (IACANotes to InSync)

Ally Integrated Healthcare - Part-time (remote position) February 2020 to January 2021

Billing/credentialing Specialist

Full cycle Behavioral Health Billing, Practice/Provider Credentialing.

Review and submit claims 3-4 times a week, post all payment via ERA, health insurance websites, using AdvancedMD. Assign Pt balances. Submit Month End reports and other reports requested

Waltham Behavioral Health, LLC - January 2015 to February 2020

Credentialing / Billing Consultant

Accounts Receivable Recovery, when necessary, call insurance companies regarding any discrepancies in payments

Review and submitted claims 3-4 times a week, post all payment via ERA, health insurance websites, using AdvancedMD

Insurance carrier enrollment and re-enrollment for group and clinical staff, the maintenance of these providers in in CAQH,

Acquire a CAQH ID for the provider, complete CAQH information, and update the

CAQH ID information for the provider.

Knowledge of insurance websites

Train front end and Intake staff on the importance of information obtained for claim and treatment

Submit Month End reports for Payroll and other reports requested

EDUCATION

Greater Lowell Regional High School 1985

Graduated (H.S. Diploma) – Major- Marketing and Distributive Education

SKILLS

Experience with several billing software, Word, Excel, Payroll platforms, CAQH, Google Docs, Teams, Zoom, Electronic Data Interchange/3rd party clearinghouse environment, eligibility platforms, MCO portals, Medicare, and Medicaid.

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