Medical Billing Specialist

Megan Smith

Grass Lake, MI ***** *****.*********@*****.*** 734-***-****

Professional Summary

Efficient and detail-oriented professional with 13 years of experience in medical billing and revenue cycle management. Expertise in auditing claims, managing third-party payor requests, and resolving billing discrepancies to ensure compliance and accuracy across commercial insurance, Medicare, Medicaid, auto, and life insurance providers in the U.S., Canada, and Europe (Travelers). Proficient in utilizing advanced medical billing software, including Epic and Cobius, to optimize operational efficiency. Demonstrated leadership in training staff on audit procedures and enhancing billing practices across healthcare settings. Experienced in developing and implementing standard operating procedures (SOPs) to improve departmental efficiency and streamline hospital operations. Authorized to work in the US for any employer

Work Experience

Sr. Billing Clerk/Representative

Michigan Medicine-Ann Arbor, MI February 2024 to May 2025

• Processed and submitted medical claims to insurance companies, ensuring accuracy and adherence to billing guidelines

• Verified patient information, including demographics and insurance coverage, to ensure proper billing procedures

• Reviewed medical documentation and coding to identify any discrepancies or errors that could impact reimbursement

• Followed up on unpaid or denied claims, working with insurance companies to resolve issues and secure payment

• Utilized electronic health record (EHR) systems and specialized software for accurate data entry and claim processing

• Assisted in the development of standardized billing procedures for improved efficiency and accuracy

• Managed accounts receivable by tracking outstanding balances, following up on overdue payments, and resolving discrepancies

Medical Billing Specialist

Nuvasive, Inc.-Columbia, MD May 2023 to January 2024

• Provided billing and payment posting support for Remote therapeutic Monitoring professional services, ensuring accuracy and efficiency.

• Managed payment posting activities, maintaining financial records and reconciliations.

• Utilized Carevoyant, Medical Record Management system, and Waystar for follow-ups and tracking payment processes.

• Delivered excellent customer service, assisting clients with billing inquiries and resolving concerns.

• Managed claim denials, coordinating with workers' compensation companies, auto insurance providers, and Medicaid nationwide.

• Drafted appeals to establish medical necessity for denied claims, improving reimbursement rates.

• Processed and posted payments, ensuring timely financial transactions Medical Billing Specialist

ProMed Billing, LLC-Midland, MI March 2022 to September 2022

• Processed payments from insurance companies and patients, ensuring accurate financial postings.

• Generated and distributed patient statements in a timely manner.

• Updated and maintained patient and insurance information for billing accuracy.

• Provided customer service support for patients, clinics, and insurance companies, resolving inquiries efficiently.

• Reconciled and corrected rejected claims, ensuring proper reimbursement.

• Managed aging follow-up reports to track outstanding claims and payments.

• Investigated claim denials and drafted appeals when necessary to establish medical necessity.

• Conducted audits and trained clinics on proper audit handling procedures.

• Collaborated with Behavioral Health, Cardiology, Family Medicine, and Podiatry clinics to optimize billing processes. Senior Payor Charge Audit Coordinator

Allegiance Health-Jackson, MI April 2016 to March 2022

• Supported third-party audit activities, including tracking audits from payors and system charge audits for Homecare, DME, Inpatient/Outpatient Hospital, professional Inpatient/Outpatient hospital

• Monitored audit and appeal deadlines, ensuring timely follow-ups with payors to maintain accuracy and efficiency.

• Managed third-party payor requests using Cobius software, Epic, and Legacy systems, tracking response and appeal deadlines.

• Processed itemized bill requests and utilized payor websites to track and reconcile audit/appeal tasks.

• Coordinated audit follow-ups with third-party payors to facilitate timely resolution.

• Assisted with interdepartmental communication and hand-offs to ensure compliance with payor audit requirements.

• Prepared invoices for audit requests when applicable.

• Monitored and followed up on 835 activity in Cobius for accurate financial posting and resolution.

• Acted as a liaison between the billing office and audit teams to resolve financial discrepancies.

• Analyzed audit data in Cobius for accuracy, providing feedback and process improvements.

• Developed standard operating procedures (SOPs) to enhance department efficiency.

• Conducted training on audit processes and Cobius software for HFAH users, corporate payor audit teams, and CBO teams.

Medical Billing & follow up specialist

Allegiance Health-Jackson, MI June 2011 to April 2016

• Managed billing and collections in a fast-paced environment, ensuring timeliness, accuracy, and efficiency.

• Assisted the Medicare team in tracking billing and payment processes to maintain compliance.

• Reviewed accounts for accurate payments, identifying and correcting errors as needed.

• Monitored receivables to ensure timely filing and prevent claim expiration.

• Communicated with insurance representatives and patients via phone and email to resolve billing discrepancies.

• Conducted weekly reviews of batch counts, including correspondence, appeals, and billing queues, to optimize efficiency.

• Audited claim submissions to verify proper receipt and processing by payors.

• Managed billing processes for commercial insurance, Medicare, and Medicare Advantage plans. Medical Records

Michigan Heart & Vascular Institute-Ypsilanti, MI August 2004 to February 2006

• Prepared patient charts for upcoming appointments, ensuring accuracy and completeness.

• Played a key role in implementing the NextGen system, transitioning the office from paper-based to electronic records.

• Collaborated extensively with St. Joseph Mercy Medical Records, including system access and coordination for patient documentation.

Education

Associates in Applied Science

Baker College of Jackson - Jackson, MI August 2008 to June 2011 Skills/Software

Epic

Medicare systems (C-snap and FSSO systems) (10+ years) Insurance verification

Audit/Denial appeal writing and coordinating inpatient/outpatient Audit/denial appeal writing private practice professional Audit/denial appeal writing HME

Audit/denial appeal writing Homecare

Audit/denial Behavioral Health Inpatient/Outpatient hospital & private practice Audit/denial appeal writing for professional hospital inpatient/outpatient Inpatient/outpatient hospital Billing

Professional inpatient/outpatient hospital billing Private practice billing

HME billing

Psychiatry

OB/GYN

E/M

Anesthesiology

Muscular

Respitory

Cardiology

Digestive

Renal

M/Gen

F/Gen

Nervous

Radiology

PA/Lab

Vaccine

Dialysis

Gastro Intestinal

Ophthalmology

Allergies

Neurology

Telehealth

Revenue cycle management

Payment Posting

Remote therapeutic Monitoring Services billing, follow-up & denials Brighttree

NextGen

Skills/Software (Continued)

Sfax

Power Point

Waystar

Series (SysA Legacy System (10+ years)

Microsoft Word

Claims Administrator

Behavioral Health Billing

Cobius (Audit tracking software)

Availity Payor Portal (10+ years)

Reading Denials/Decision Letters (8 years)

Commercial Insurance plans

Medicare & Medicare Advantage Insurance plans

Medicaid Insurance plans

Tricare/Champs Insurance plans

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