Medical Billing Customer Service

Amy Gaines

**** ******* ** ***** *********, NJ **902 732-***-**** *************@*****.***

Professional Profile

Dedicated and versatile professional with management experience in leading teams who consistently meet organizational expectations seeking to transition professional experience and medical education to a healthcare career.

Proficiencies: MS Excel; MS Word; MS PowerPoint; JDE, Access, ACT, AS400, Printers Plus, Sales Logix, Simple Practice, Therapy Notes, Office Ally, Availity; Typing Speed: 41 WPM

Skills: Written and verbal communication (letters, emails, presentations, face-to-face communications); Time management skills; Attention to detail; Reviewing, evaluating, and improving processes; Customer Service oriented

Honors/Awards: Ultimate Medical Academy Dean's List - May, August and November 2022

Key Qualifications

Medical Terminology Anatomy & Physiology HIPAA Compliance Medical Coding (ICD-9-CM ICD-10-CM HCPCS CPT) Medical Billing Accounts Receivable Collections Co-Pay Deductibles Co-Insurance EOBs Revenue Cycle Management Posting Payments Government (Medicare & Medicaid) Third Party Payers Electronic Health Records (EHR) Electronic Medical Records (EMR) Managed Care (HMO PPO and POS) Workers Compensation Insurance Verification Insurance Claim Processing CMS 1500 CMS 1450 (UB-04) Front Office Operations Medical Office Procedures Scheduling

Certifications

Ultimate Medical Academy – Tampa, FL

Dean's List

4.0 Grade Point Average

Ultimate Medical Academy – Tampa, FL

Dean's List

4.0 Grade Point Average

Ultimate Medical Academy – Tampa, FL

Dean's List

4.0 Grade Point Average

Education

Ultimate Medical Academy Associate of Science Degree – Medical Billing and Coding, 2023

Fully accredited, accelerated program providing instruction in medical billing and ICD-10, CPT and HCPCS coding for diseases, surgeries and medical procedures. Program content includes electronic health record (EHR) systems, accounting methods, and processes for preparing and submitting healthcare claims. Research, professional writing, critical thinking and communications skills are emphasized throughout the program.

Keller Graduate School Masters in Project Management, 2006

Help you learn relevant skills that are critical in a business setting including professional communication, corporate team building and business analysis competencies. In addition to the management theory practices taught in our online MBA program, our experienced faculty teach industry-specific skills like human resource management, risk management and business processes.

University of Phoenix Online MBA, 2002

Integrate decision-making skills to deliver organizational value in dynamic environments. Create strategies for sustainable organizational success that integrates the organization’s mission and vision with societal values. Synthesize leadership skills to foster innovation and facilitate change in a dynamic business environment. Evaluate the global environment to sustain an organization’s competitive advantage. Integrate managerial skills to support strategic execution in a rapidly changing business environment.

Marywood University Bachelors in Marketing, 1998

Provide a background in areas such as sales, advertising, and retailing. Along with the other business requirements, the marketing major is introduced to concepts including marketing research, marketing management, and international marketing.

Experience

Hopscotch – Remote 1/8/2024-3/13/2024

Mental Health Billing Specialist

Verify insurance benefits via eligibility tools online and over the phone

If needed, correct clients’ credit card payment and insurance data

Ensure compliance with our payor guidelines

Claim rejection/denial follow-up as needed before the deadlines occur

Ownership of the unpaid claim ticket from start to end within the required deadline

Ownership of denied claims

Dream Consulting – Remote 07/2023-11/2023

Insurance Collections & Insurance Biller Mental Health

Claim scrubbing/understanding denials

Resubmitting denied claims

Daily Insurance collection calls

Submitting to secondary claims

Daily Insurance verifications (verifying insurance benefits for potential clients)

Organizes and monitors work emails throughout the entire work day

Maximizes office productivity through proficient use of appropriate EHR software applications.

Researches and develops resources that create timely and efficient workflow by limiting the amount of insurance call backs.

Establishes uniform correspondence practices and procedures.

Formulates procedures for systematic retention, protection, retrieval, transfer, and disposal of records while being HIPAA compliant.

Reviews & updates the spreadsheets weekly to ensure completeness, accuracy, and timeliness.

Coordinates claims calls throughout the week while updating notes in EHR software’s.

Maintains constant contact with Manager.

Uses the Following EHR systems – Office Ally, Simple Practice, Therapy Notes, Therapy Appointment, Therapist Availity & Insurance Portals

Globe Footwear– Roselle Park, NJ

08/2013-07/2014

Customer Service Representative

In charge of Receiving and Processing Containers

Entered Sales Orders for Manufacturers

Answered Phone Calls from Customers, Sales Reps

Answered Emails from Customers and Sales Reps

Checked to ensure that appropriate changes were made to resolve customers' problems

Contacted customers to respond to inquiries or to notify them of claim investigation results or any planned adjustments

Determined charges for services requested, collect deposits or payments, or arrange for billing

Kept records of customer interactions or transactions, recording details of inquiries, complaints, or comments, as well as actions taken

Resolved customers' service or billing complaints by performing activities such as exchanging merchandise, refunding money, or adjusting bills

Solicited sales of new or additional services or products

United Legwear– Edison, NJ

02/2013-07/2013

Logistics Coordinator

Did Shipping and Invoicing for Orders

Emailed sales reps and warehouse about Orders

Was in charge of Canada orders.

Processed credit card orders

Main Tape– Cranbury, NJ

01/2012-09/2012

Customer Service Representative

Checked to ensure that appropriate changes were made to resolve customers' problems

Completed contract forms, prepare change of address records, or issue service discontinuance orders, using computers

Conferred with customers by telephone or in person to provide information about products or services, take or enter orders, cancel accounts, or obtain details of complaints

Contacted customers to respond to inquiries or to notify them of claim investigation results or any planned adjustments

Determined charges for services requested, collect deposits or payments, or arrange for billing

Kept records of customer interactions or transactions, recording details of inquiries, complaints, or comments, as well as actions taken

Ordered tests that could determine the causes of product malfunctions

Referred unresolved customer grievances to designated departments for further investigation

Resolved customers' service or billing complaints by performing activities such as exchanging merchandise, refunding money, or adjusting bills

Solicited sales of new or additional services or products

Print Tech– Mountainside, NJ

08/2007-02/2009

Project Manager/Customer Service Rep

Data Entry of job specifications to generate quotes and manufacturers work orders.

Work as liaison between the sales and production teams

Contact vendors for supplies and in outsourcing situations

Manage Work in Process and other reports to maximize efficiency.

Understanding of the organization’s strengths and limitations

Ensure Quality Control with every job

Job Scheduling for temps, Attending Daily Production Meetings

Sales Reports for Sales Reps and CSRSand worked with buyers, Monthly reports for Sales Manager/Owner

Reports for Prepress Work and Monthly Work Up for Pre-Press Work for Production Manager

Follow up with every job to make sure the progressthroughout the company with every department.

Dr. Krantz Dental Office– Somerset, NJ

06/1991-01/1999

DentaL assistant - administrative assistant - marketing

Assisted Dentist with patients during treatment.

Did Marketing Advertisement in Church Bulletin

Assisted with Administrative Tasks at Front Desk

Set Appts for Patients

Cleaned Equipment after Use

Developed X-Rays

Volunteer Experience

N/A– Somerset, NJ

N/A– Queens Village, NY

03/2022-01/2023

Took Care of Father In Law

Cooked Food

Gave Medicine In Morning andEvening

Cleaned Up After Him

N/A– Queens Village, NY

08/2021-03/2022

Caring for Mother In Law While In Hospice At Home

Changed Her and Bathed Her in the Morning and Evening

Stayed in Hospital while getting Blood Transfusion

Fed Her

01/2022-12/2022

Tutor

Helped with Reading

Helped with Math

Helped with Writing

Helped with any homework

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