Medical Billing Claims
Resume:
GEORGINA BAMFO
Hagerstown, MD 21742
Phone: 240-***-****
****@***********.***
SUMMARY
Detail oriented, quality focused professional Medical Claims & Billing Manager. Successful track record handling complicated assignments. Proficient in a variety of practice management software applications. Dedicated to maintaining strict patient confidentiality.
TECHNICAL SKILLS
Eclinical works 10e/11e NextGen PM Glenwood Systems
Office Ally AdvancedMD PM Medical Mastermind
EDUCATION
Walden University Minneapolis, Minnesota
B.S in Healthcare Management
Kaplan University, Hagerstown, MD
A.A.S. in Health Information Management
Wright Medical Billing, Greenbelt, MD
Certificate in Medical Billing & Coding Specialist
SUMMARY OF QUALIFICATIONS
Experienced with Medicare, Medicaid and Commercial insurance billing and workers compensation.
Ability to read EOB and assigned patient liability including secondary/tertiary assignments.
Experienced in Credentialing/Contracting and managing CAQH for providers.
Experienced in collections of overdue/delinquent accounts.
Experienced in processing claims, posting payment, claim denials, follow-up, and appeals.
Experienced with ICD-10 and CPT coding.
Experienced with insurance verification via online or IVR, obtaining pre-authorization and referrals.
Experienced in patient billing collections.
Excellent attention to detail and time management experience.
Increased accounts receivable and reimbursement amounts.
Developed and implemented mechanisms to ensure appropriate billing and payment cycles.
Increased Medicaid patients flow by registering them under uninsured for continuing of care.
Knowledge of medical terminology and HIPAA regulations.
Remarkable experience with management of diverse healthcare settings.
Managed actions relating to delinquent accounts, adjustments, and/or write-offs.
Created reports on billing and collection activities.
Excellent knowledge of healthcare billing procedures and standards.
Proficient with Windows 10 applications & multiple software for billing.
PROFESSIONAL EXPERIENCE
Medical Claim Adjuster (Personal Injury Protection-PIP)
ERIE Insurance, Hagerstown, MD September 2023 – Present
Handles first party medical benefit claims, including fatalities and wage loss claims.
Evaluates and makes decisions regarding coverage.
Conducts investigations, determines total value of claims, sets, and maintains adequate reserves, and manages cases.
Prepares related correspondence and reports, obtains medical and employment related records, calculates wage loss claims per applicable state laws and brings claims to conclusion.
Investigates, evaluates, and resolves coverage questions in compliance with applicable state laws.
Revenue Cycle Manager
Direct Medical Billing & Consulting Ser., LLC, Hagerstown, MD October 2017 – August 2023
Worked with multiple providers in different Specialty.
Worked claims and claim denials to ensure maximum reimbursement for services provided.
Worked directly with insurance companies to get claims processed and paid.
Responsible for credentialing and CAQH updates.
Made outbound phone calls to resolve denial issues.
Negotiated new insurance contract and increasing fee schedule for providers.
Medical Claims & Billing Specialist Manager
Psychiatry Center of Frederick, Frederick, MD June 2009 - June 2017
Responsible for processing claims, posting payment, follow-up on claims for denial and appeals.
Negotiated with various insurance companies as pertains to reimbursement.
Solely responsible for managing billing and claim processing.
Provide insurance companies with additional documentation or records (if requested) to expedite payments and resolve denials.
Submitted electronic and paper insurance claims within 24 hours of patient appointment.
Maintained and operated the electronic health records and billing system.
Scheduled and rescheduled appointments to meet the needs of our patients daily.
Managed office procedures related to insurance and billing.
Claims Resolution Specialist
Concentra Preferred Systems; Frederick, MD February 2002 – April 2009
Reviewed medical claims, verified accuracy of medical services and charges including accurate coding.
Followed up with healthcare providers; ensure contracts are received signed and returned.
Performed negotiations and contracts with providers using medical analysis.
Prepared selected types of reprising on concurrent cases agreements to healthcare providers.
HONORS AND ACHIEVEMENTS
Member of AHIMA
Professional Negotiation Service Percent Reduction Award- October 2005, December 2005 and July 2007
Overall Sustained Performance Award – July 2006
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