Reimbursement Specialist Managed Care
Resume:
Nedia Morrison
Rego Park, NY *****
Phone: 347-***-****
Email: *************@*****.***
Professional Summary
Skilled Reimbursement Specialist with over 25 years of experience in medical billing and collections. Proven track record in managing claims, resolving billing issues, and optimizing reimbursement processes. Adept at handling complex billing systems and maintaining strong relationships with insurance carriers. Skilled in credentialing, claims adjudication, and financial reconciliation.
Professional Experience
Rapid Diagnostics
Medical Biller( May-2025- Present)
Processing and submitting claims for several clients, primary and secondary insurance.
Revenue Cycle (Patient Accounting) follow-up on denials, ensuring proper documentation is provided, and using insurance verification and authorization
Responsible for handling denials and performing appeals
Posting payments, collecting outstanding balances, and managing patient billing inquiries.
Village Physical Therapy Chiropractic, and Acupuncture Chiropractic and Acupuncture Billing Specialist (No-Fault Insurance) Sept 2024-Feb-2025)
Submit timely claims for chiropractic and acupuncture services to No-Fault Insurance companies.
Verify patient for No-Fault coverage and benefits prior to service, ensuring the policy is active and covers the required treatments.
Used appropriate CPT, ICD-10, and HCPCS codes for chiropractic and acupuncture services.
Track the status of submitted claims and follow up on denied, rejected, or outstanding claims, working with insurance companies to resolve any issues or discrepancies.
Communicate with patients regarding billing inquiries, outstanding balances, and No-Fault coverage..
Review and address claim denials by identifying reasons for rejection, appealing claims, and providing necessary documentation to ensure payment.
Elmcor Youth and Adult Services
Billing Specialist
July 2022 – October 2023
Credentialed and maintained managed care, Medicaid, and commercial carriers for Article 31 and 32.
Handled eligibility verification, prior authorization, and claims batching for multiple insurance providers.
Batched claims for several insurances, including Medicaid and Managed care,
Checked validations, worked on appeals for current billing and back billing with interest.
Maintain APG rate codes and methodology billing in Teneleven –Ecr
Processed and posted payments, and managed claim appeals and re-submissions to resolve billing issues.
Implemented strategies for effective follow-up on unpaid claims and invoices.
Dynamic Youth Community Inc.
Billing Specialist
September 2017 – February 2023
Credentialed and maintained managed care, Medicaid, and commercial carriers for Article 31 and 32.
Batched claims for several insurances, including Medicaid and Managed care,
Checked validations, worked on appeals for current billing and back billing with interest.
Maintain APG rate codes and methodology billing in Teneleven –Ecr.
Ensured accurate receivables and handled claims corrections and appeals.
Processed and post payments, arranged payment plans,
Trained staff on Teneleven-Ecr system and maintained APG rate codes.
Winston Medical Staffing / Recombine / Cooper Genomics
Medical Billing / Reimbursement Specialist
December 2015 – August 2017
Prepared and submitted insurance claims electronically, managed payment postings, and resolved billing issues.
Engaged in extensive follow-up on collectibles and advised management on problem accounts.
HRI Consulting Group / Darren Jay Epstein Esq
Medical Collector / Legal Assistant
December 2013 – May 2015
Conducted collections for out-of-network medical claims and worked with various stakeholders to resolve issues.
Prepped, scanned and uploaded original summons and complaint for index numbers
Prepared filled summons and complaint to be submitted for process service
Managed legal documentation, data entry, and court filings related to medical claims.
Millin and Associates
Senior Billing Analyst / Accounts Receivable Representative
December 2010 – August 2013
Batched claims for several clients for Medicaid utilizing Accumed 12 and Emedny exchange
Billed for article 16, O.p.w.d.d, F.q.h.c, 31, mental health service's and substance abuse
Utilized APG rate code's and methodology billing
Checked validations, worked on denials for current billing and back billing
Assisted managers regarding training for Accused 12 and MillinPro.0.1 for our new and current clients as well as new staff
NYU Langone Medical Center
Project Assistant Level III - Department of Dermatology
October 2007 – September 2009
Scheduled appointments,
Managed prior authorizations, and coordinated patient information for the dermatology department
Case studies for in the Pigmented Lesion Section
Education
High School Diploma
Queens Academy High School (1997)
Certified Medical Insurance Biller and Reimbursement Specialist
Caliber Training Institute (1999)
Skills
Medical Billing Systems: Teneleven 10e11, ECR, Therapy Bands, Recombine Billing, Simplicity, IDX, Anasazi, Accumed 12, MillinPro, Medical Manager, Cerner (Epass), EMR (Logician), SRS, Emdeon, Eagle, Omni-Pro, E-medny, Inovalon, Aclips, ADS, Availity, My Ability, Provider Express, Managed Care & Other Provider Portals.
Software: Microsoft Office (Word, Excel), Gmail, Outlook, Slack
Specialized Knowledge: Claims processing, credentialing, financial reconciliation, payment plans, appeals, for managed care, Medicaid, and commercial carriers for Article 31 and 32.
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