Billing Specialist Data Analyst

PEARL M. ROLLE

Lauderhill, FL ***** 786-***-**** ********@*****.***

PROFESSIONAL SUMMARY

Results-driven Healthcare Billing Recovery Specialist with extensive experience, adept at claims processing and problem-solving. Proven track record in resolving discrepancies and ensuring compliance, while maintaining confidentiality and quality control. Skilled in medical billing and customer service, consistently delivering accurate documentation and enhancing operational efficiency.

SKILLS

Medical billing

Confidential records maintenance

Quality control

Posting and balancing

Insurance contracts

Appeals

EOBs

Ability to multitask

Claims processing

Customer service

Payment processing

Attention to detail

Problem-solving

PROFESSIONAL EXPERIENCE

09/2018 to Current

Healthcare Billing Recovery Specialist

PERFORMANT Sunrise, FL

Review the account claim and other documentation to verify payment liability for claims that may have been paid by Medicare in error.

Updates client and/or company systems with clear and accurate information, such as contact and updated demographic information, notes from contact dialog and attempts, payment commitment, as well as account status updates, as applicable.

Initiates claim activities, follows up, and follows through accordingly to ensure documentation is accurate in accordance with policies and procedures.

07/2018 to 08/2018

Billing Clerk

PATH MEDICAL Plantation, FL

Retained knowledge of organizational policies and procedures.

Performed audits on ICD-10, CPT, HCPCS coding, medical terminology, HIPAA compliance, and emergency medical response.

Researched and resolved discrepancies in payment processing.

Reviewed customer files to make sure all documentation was complete and accurate.

Prepared periodic reports detailing accounts receivable status.

11/2013 to 04/2018

Authorization Data Analyst

HUMANA-AMERICAN ELDER CARE Boca Raton, FL

Act as a liaison between care coaches and the claims function for proper processing and authorizations.

Identified and resolved non-compliant authorizations.

Consistently documented clear communications for proper invoicing criteria to providers and the claims department.

Assess policy details to determine accurate coverage interpretation.

04/2001 to 04/2013

CLAIMS EXAMINER III

Emblem Health HOLLYWOOD, FL

Collaborated with internal departments such as Underwriting, Provider Relations, Medical Management, and Quality Assurance, as needed.

Demonstrate a thorough knowledge of the plans, claims processing procedures, as provided in training materials.

Complete a highly detailed investigation on each claim in a timely manner, and fully document the file with pertinent information.

Familiar with information in the forms of UB04 and CMS 1500.

Experience with Medicaid, coordination of benefits, and third-party liability.

EDUCATION

01/1989

Computer Business Application

Miami Technical College Miami, FL

REFERENCES

References available upon request.

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