Medical Billing Specialist
Resume:
Mayra Rivera
848-***-**** ********.*********@*****.*** 415 South Glenwood Avenue, Russellville, AR 72801
EXECUTIVE SUMMARY
Drawing on extensive experience in medical billing and insurance follow-up, handled patient accounts and insurance verifications effectively at BC Services and MMC Group. Successfully processed a high volume of claims, consistently reducing processing times and improving patient satisfaction. Demonstrated proficiency in electronic health record systems including Epic, Athena, and Intergy, and maintained meticulous attention to detail in all aspects of revenue cycle management.
- Expert in insurance follow-up and claims processing, ensuring accurate and timely resolutions of billing discrepancies.
- Skilled in patient account management and insurance verification, with a strong ability to handle inquiries and establish patient satisfaction.
- Proficient in medical billing software and familiar with Medicare, Medicaid, and third-party payer systems, enhancing efficiency in reimbursement processing.
CORE COMPETENCIES
Claims Processing Insurance Verification Patient Account Management Medical Billing Inquiries Revenue Cycle Optimization Reimbursement Strategies Patient Satisfaction Enhancement Insurance Discrepancy Resolution Policy and Procedure Adherence Electronic Medical Records Management
Technical Skills: Epic Athena Intergy Microsoft Word Microsoft Excel Microsoft Outlook Microsoft PowerPoint Zoom Skype MS Teams
PROFESSIONAL WORK EXPERIENCE
Medical Claims and Billing Representative BC Services Russellville, AR 10/2024 – 04/2025
- Ensured accurate billing and maintained patient satisfaction by processing patient accounts efficiently, addressing any challenges with data accuracy.
- Verified insurance coverage and processed patient insurance claims, effectively following up on unpaid claims to enhance revenue flow.
- Resolved patient billing inquiries and discrepancies by ensuring clear communication with patients, healthcare professionals, and insurance providers, resulting in reduced dispute rates.
Patient Account Service and Claims Specialist MMC Group Russellville, AR 07/2024 – 10/2024
- Explained medication usage, dosage, and potential side effects to patients, improving adherence and reducing errors.
- Provided clear instructions and answered patient questions, enhancing patient understanding and satisfaction.
- Guided patients through enrollment forms and procedures, simplifying the process to ensure timely completion.
- Verified patient information and scheduled appointments efficiently, optimizing clinic operations.
- Confirmed patient insurance coverage and obtained pre-authorizations, ensuring compliance and preventing billing delays.
- Explained insurance benefits and resolved discrepancies, successfully enhancing patient trust and resolving queries effectively.
- Effectively submitted and worked medical claims and the appropriate follow up.
Full Time Student Ultimate Medical Academy Russellville, AR 11/2023 – 09/2024
- Remained self-directed, motivated, and accountable for personal actions during a full-time study.
- Maintained preparedness for class and consistently completed assignments on time, demonstrating strong organizational skills.
- Navigated new technology and utilized available resources to facilitate learning, setting realistic expectations.
Medical Billing Sunshine Medical Billing Port Lucy, FL 06/2022 – 02/2024
- Managed accounts receivables duties, ensuring timely and accurate collections.
- Submitted appeals and managed medical records effectively, resulting in increased claim approvals.
- Created weekly and monthly accounts receivable reports, providing management with precise financial insights.
Medical Billing and Claims Management Specialist Medi-Centrix Neptune, NJ 03/2018 – 11/2021
- Answered inbound calls and addressed billing questions, improving customer service satisfaction.
- Submitted claims electronically and by mail, efficiently increasing processing speed.
- Interviewed potential candidates and trained new employees on policies, procedures, regulations, systems, and workflow, ensuring operational consistency.
- Prepared patient statements and closing balances after payments, enhancing financial accuracy.
- Communicated effectively with supervisors and employees, fostering a collaborative team environment.
Front Desk Representative Fair Haven Internal Medicine Fair Haven, NJ 07/2017 – 11/2017
- Managed high volume inbound calls, scheduled appointments, and verified insurance coverage, improving patient registration efficiency.
- Scanned documentation and records into patients' electronic charts, maintaining accurate and up-to-date records.
- Supported billing processes, posted charges, and coordinated prescription and procedure requests, ensuring smooth office operations.
- Processed pre-authorizations and pre-certifications for medications and procedures, meeting insurance requirements promptly.
Account Representative Acclaimed Healthcare, Inc Lakewood, NJ 03/2016 – 02/2017
- Handled initial intake, scheduled assessments, repairs, and deliveries, and managed billing, enhancing service efficacy.
- Verified insurance coverage prior to servicing, ensuring pre-certification for durable medical equipment coverage, preventing billing issues.
- Entered new patients into the system and processed intakes for new power wheelchairs and mobility equipment, streamlining operations.
- Forwarded completed assessments to designated Medicare, Medicaid, and Third Party departments, improving inter-departmental efficiency.
- Ensured delivery of trial equipment to homes and facilities, managed private pay cases, and ensured monthly payment compliance.
- Obtained equipment quotes for patients and converted quotes into orders upon approval, enhancing sales efficiency.
- Set up technical worksheets for power chairs in the warehouse for assembly and delivery, ensuring quality and accuracy.
Medical Billing and Reimbursement Representative Back and Neck Center of Brick, LLC Brick, NJ 02/2015 – 02/2016
- Verified patient eligibility and coverage prior to visits and pre-certified treatments as needed, reducing claim denials.
- Checked claim status and appeals, completing claims reconsideration processes when denied, improving reimbursement rates.
- Reviewed and posted ERA’s, EFT’s, EOB’s, and payments, maintaining financial accuracy and transparency.
- Filed and followed up on third-party claims, managed collections and unpaid balances effectively, ensuring revenue recovery.
- Tracked and followed up on unpaid claims, contacted patients for payment options, and offered payment plans, improving collections.
- Managed accounts for patients issued insurance checks, contacting patients for payments to maintain account stability.
EDUCATION
Diploma – Medical Office and Billing Specialist Ultimate Medical Academy 2024
Business Management Diploma Penn Foster College 2024
Bachelor’s Degree Purdue University Global 2022
Diploma – Administrative Assistant Penn Foster College Not Provided
Diploma – Accounting Stratford Career Institute 2022
Associates Degree in Medical Billing and Coding Lincoln Technical Institute 2012
Additional Certifications:
HIPAA Essentials for Healthcare Professionals Certificate Ultimate Medical Academy Not Provided
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