Customer Service Medical Biller

Pragna Shah LinkedIn Profile: https://bit.ly/*EvrHJd **************@*****.*** Cedar Park, TX 78613 248-***-****

Summary:

Experienced Medical Biller with a passion of working in hospital and professional billing. Strong skillset in AR/Billing, benefits, and relationship management.

Achievements:

Employee of the Month May 2014, Feb 2015, Feb 2016, Aug 2016 Recipient of Henry Ford Health System’s employee of the month award from CBO, Transaction Flow Manger for exceptional customer service and efficient claims processing. Experience:

Natera 2019 to 2020

Reimbursement Specialist II Austin, TX

• Responsible for submission and follow up for adjusted claims and payer specific appeal. • Provide superior customer service related to resolving patient and billing inquiries.

• Liaison to account staff team on special AR resolution projects such as: 1. Medicaid of Utha: HCFA billing incorrectly resulting in claims not received. Identified problem of billing address in box 33 must be a physical address. Implemented necessary solution, resulting in $500,000 in revenue.

2. Community Care: resolved 366 denied claims for CUA resulting in $1.6M in revenue. MAP Revenue Cycle Solutions 2017 to 2018

AR Follow Up & Denials Specialists Austin, TX

• Responsible for collection of unpaid third-party claims and appeals within the revenue cycle. • Processing over $4M in charges for the largest account (Farnum Center).

• Responsible for servicing $10M in monthly accounts receivables.

• Working on claims and follows up with all payers including Aetna, United HealthCare (UHC), Cigna, Veterans Health Choice, Veterans (VA), and various others.

• Resolving identified billing issues by insurance carriers. Actively researching and following up on claims using provider portals and medical software Health PAC and Zirmed. Following up with phones calls, when necessary. Henry Ford Health Systems 1999 to 2017

Medical Billing Specialist Troy, MI

• Understood correct procedures and edits necessary to submit third party compliance claim forms (UB92 or HFCA 1500) through in-house claim editing software.

• Initiated appropriate action while conducting refund requests, further inspected, and identified actions to justify the legitimacy of refund. Processed investigation includes credit balance, reviewed with due diligence over/under payments.

• Successfully completed end-to-end process, extended system knowledge & expertise with accounts receivables (AR). • Accurately posted all appropriate financial adjustments with contorted rates.

• Developed excellent relationships with various insurance carriers. Medical Biller

• Identified successful error files including working rejections and posted electronic payments from error file. • Processed third party rejections and followed up on open accounts receivables, refilled, and updated status and procedures in a timely manner.

Education:

Dorsey Business School, Certified Medical Billing Specialist May 1995 Madison Heights, MI

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