Billing Specialist Medical
Resume:
Teri Lewis
**********@*****.***
PROFESSIONAL SUMMARY
Efficient billing specialist providing over 15 years of experience in handling a wide variety of medical billing tasks, including; billing primary, secondary, tertiary insurances with all different payers and specialties. Working follow up on aged claims and handling insurance denials in a timely manner, including filing appeals. Determined and hardworking with excellent communication skills and multitasking abilities. Coordinates with insurance companies and expedites claims processing.
WORK EXPERIENCE
Remote Medical Billing Specialist II
Premier Physicians Network, Moraine, OH (Dec 2023-Dec 2024)
Utilize clearinghouse Quadax and billing software Epic to review clean medical claim submissions.
Prepare and submit medical claims to Insurance Companies Electronically for different specialties.
Follow up with Insurance claims on unpaid, denied or rejected claims utilizing worqueues.
Analyze and address claim denials, rejections and underpayments, ensuring accurate resubmission or appeal processes.
Submit primary and secondary insurance claims electronically to ensure timely reimbursement.
Identify any payer specific issues and communicate to manager.
Remote Medical Claims Adjudicator
Caresource, Dayton OH (Aug 2016 – Dec 2022)
Evaluates and processes Medicaid claims in accordance with company policies and procedures, as well as to productivity and quality standards utilizing Facets.
Interprets and processes CMS 1500 and UB04 claims.
Reviews and analyzes data from system-generated reports for in-process claims in order to identify and resolve errors prior to final adjudication.
Track claims payment, claims refunds and claims recoups.
Ensure ongoing adjudication of claims within company standards, industry best practices, and all state and federal guidelines.
Consistently maintains production and quality standards based on quality control expectations.
Patient Account Specialist
Kettering Medical Center, Miamisburg, OH (Sept 2009- Aug 2016)
Responsible for all aspects of patient accounts hospital billing, collection processing in compliance with departmental policies and procedures.
Working and completion of older, problematic accounts and handles all special projects as required and works various payers including inpatient and outpatient billing utilizing Epic.
Provides guidance, feedback and training to staff as it pertains to billing, follow-up, denied/rejected claims payers and Epic.
Assisting with research of missing payments, updating polices/procedures and participates in payer operations meetings as needed.
Performs routine Audits and Quality Assurance for staff.
SKILLS
Attention to detail
Strong Communication Skills
Knowledge of Medical Terminology, ICD-10, CPT
Problem-Solving Abilities
Time Management Skills
Proficient computer and data entry skills
Posting Payments
Multitasking and time management
Accounts Receivable
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