Medical Billing Account Management

Judy Belliard

Guttenberg, NJ 201-***-**** ********@*****.***

Certified Billing and Coding Specialist with several years of experience in billing administration & coding, medical billing, bank reconciliation, and account management across various sectors in the healthcare industry. Highly skilled in optimizing revenue cycles, streamlining administrative processes, and ensuring compliance with healthcare regulations. Adept at streamlining administrative procedures, improving efficiency, and collaborating with cross-functional teams to deliver exceptional healthcare services while minimizing financial risks.

CORE COMPETENCIES

Practice Management

Medical Billing

Account Management

Revenue Cycle Optimization

Regulatory Compliance

Operational Excellence

Healthcare Provider Relations

Patient Satisfaction Enhancement

Administrative Process

Improvement

PROFESSIONAL EXPERIENCE

Upper East Orthopaedics-New York Billing Specialist December 2023-Present : Managing two insurance carriers, Emblem Health plans, & Cigna multiple commercial plans, secondaries plans including Medicare & Medicaid. Posting payments,claim adjustment, patient responsibilities, including deductible, coinsurance & copays. Analyzing ERA daily denials, following compliance & adhering with reimbursement with payers guidelines. Identifying trending denials, credentialing denials, also coordination of benefits. Verified claims rejections from the clearing house

(WayStar). Reviewed medical documentation and coding to identify any discrepancies or errors that could impact reimbursement. Followed up on unpaid claims, working on denials efficiently with ERA working with insurance companies to resolve issues and secure payment.

Maintained updated knowledge of medical coding systems (e.g., ICD-10, CPT) and insurance regulations Collaborated with healthcare providers to obtain necessary documentation to obtain the insurance participation with the provider insurance plans.

Utilized electronic health record (EHR) systems and specialized software for accurate data entry and claim processing. Managed accounts receivable by tracking outstanding balances, following up on overdue payments, and resolving discrepancies. Reviewed medical documentation and coding to identify any discrepancies or errors that could impact reimbursement. Maintained confidentiality of patient information in accordance with HIPAA regulations. Identified opportunities for process improvement within the billing department. Provided guidance to colleagues regarding complex billing scenarios or coding questions. Proficiently utilized multiple platforms, including EMR software such as ECW, insurance EmblemHealth, Cigna portal & other as needed.

Park Medical Billing Englewood, NJ Account Manager-Billing Specialist June 2022 – September 2023 Coordinated activities with physician offices, service sites, and 5 other departments to ensure smooth operations. Ensured the collection and verification of all required insurance, referrals, authorizations, and clinical data. Prepared and submitted insurance claims to payers promptly and accurately, averaging 30+ claims per week. Proactively worked payer scrubber and denial reports to address issues swiftly. Championed and administered the resolution of outstanding insurance claims, maximizing revenue recovery. Identified and analyzed trends, denials, and issues impacting account resolution, and implementing strategic solutions. Successfully managed 3 client facilities specializing in chiropractic care, physical therapy, acupuncture, and sports performance. Prioritized client satisfaction through exceptional written and verbal communication. Proficiently utilized multiple platforms, including EMR software such as WebPT, Kareo, Advancedmd, PMB site, and more.

Navigated up to 10 payer portals, including UHC, Availity, and NaviNet, with expertise. Focused on professional claims management, consistently submitting reconsiderations, appeals, and corrected claims. Efficiently managed and supervised two team members responsible for daily denial and no-response claim processes. Columbia Doctors (Medix) Fort Lee, NJ Account Receivable Specialist November 2021–March2022 Diligently followed protocols within assigned work queues to determine an effective course of action for receivables follow-up. Applied a strong working knowledge of all aspects of billing and collections, including billing policies. Conducted thorough reviews of 100+ accounts' history, consistently pursuing continuous follow-up to resolve outstanding issues. Detected denials and leveraged payer policies to initiate the proper appeal process or take corrective actions for reimbursement.

Performed charge corrections based on payer policies, maintaining precise billing records. Communicated with insurance payers, patients, and over 100 guarantors through various means, including phone calls, correspondence, online portals, and approved channels, to track the status of outstanding claims. Managed multiple specialties, handling denials and appeals according to their specific requirements. Appealed prior authorizations for professional claims denials, maximizing reimbursement opportunities. Guaranteed the eligibility of all accounts by regularly updating active policies and adjusting term policies as needed. Addressed Coordination of Benefits (COB) denials by submitting correspondence to members (patients) to update their benefits.

Notified the practice of the need to obtain retro authorizations when necessary to facilitate claims processing. Proficiently managed multiple platforms, including payers' portals and Epic EMR, to streamline operations. Lexington Plastic Surgeon NewYork, NY Billing Coordinator December 2020 – November 2021 Analyzed complex Explanation of Benefits (EOB) correspondence to identify denials and non-payable codes, conducting thorough research and follow-up on both professional and facility claims denials.

Piloted in-depth analysis of medical records to ensure compliance with insurance company mandates and guidelines. Demonstrated a commitment to following payer policies and procedures to maximize proper reimbursements for claims.Reviewed medical records, identifying medical and ICD-10 CPT procedure codes in accordance with 1500 CMS guidelines. Skillfully managed 12 payer portals and actively updated the Electronic Medical Record (EMR) system (NexTech). Provided comprehensive training on payment posting to 20+ team members, ensuring accurate and efficient financial transactions. Handled payment posting for multiple payers received through the clearing house Tri-Zeto. Submitted claims electronically and through correspondence, adhering to payer-specific submission requirements. Pinpointed trending denials, specializing in credentials denials, Coordination of Benefits (COB) issues, proper coding denials, medical necessity discrepancies, and eligibility concerns for both professional and facility claims. Successfully appealed denials related to low payments, prior authorizations, coding discrepancies, and non-participating providers. Maintained up-to-date accounts through the generation and management of aged revenue reports, effectively handling accounts in various stages of aging, including 30/60/90/120 days. Riverside Medical Group (Optum) Secaucus, NJ Billing Specialist July 2019 – December 2020 Administered insurance adjustments, including write-offs, balance transfers, and self-pay accounts. Upheld up-to-date spreadsheets to track the status of claims and regularly communicate progress to management via email.

Handled daily correspondence, both through traditional mail and email, promptly addressing any inquiries or issues. Verified that all work queues assigned for AR were effectively managed and worked according to established protocols.Demonstrated exceptional written and verbal communication skills to provide excellent customer service. Submitted medical records as required to support claims and obtain proper payments from insurance providers. Collaborated with clearinghouses and updated UHC

(UnitedHealthcare) claims edits and reports to ensure claims accuracy. Proactively addressed insurance denials, applying knowledge and expertise to facilitate successful resolutions. Managed accounts receivable for internal medicine and over 50 specialty accounts, demonstrating adaptability and proficiency across various areas of healthcare billing and collections. Front Desk-Patient Care Representative March 2018 – December 2020 Specialized in the Pulmonary & Sleep Department, demonstrating expertise in the field.

Orchestrated insurance eligibility verification processes on the 1st of each month and prior to patient appointments. Checked in patients, providing the necessary forms for both new and established patients. Handled appointment scheduling and confirmation for daily follow-up appointments, as well as appointments for Pulmonary Function Tests (PFT) and Durable Medical Equipment (DME) deliveries. Responded promptly and courteously to emails and phone calls, ensuring excellent customer service. Collected copays, coinsurance, or deductibles from patients on the day of service. Balanced and processed credit card and cash transactions, maintaining accurate financial records. Actively worked on increasing sales activities to boost department specialty revenue. Sustained effective communication with all 35 staff members, practice management, and providers to ensure efficient operations.

Updated prescription refill requests and handled assigned tasks from providers, including managing leave of absence letters.

Trained and mentored new hire employees and provided guidance to established team members. Upheld strict confidentiality by enforcing HIPAA regulations and adhering to healthcare standards. Review & monitor referral & physician order Work Que to provide accurate & timely referral process documentation. Referral process, responsible for overseeing the referral process for the providers assigned

EDUCATION

Bergen County Community College Paramus, NJ Medical Billing & Coding Specialist September 2019 Achieved a GPA of 3.50 SKILLS AND INTERESTS

Technical Skills: Microsoft Office Suite, Google Workspace, Teams, EMR, Insurance portals, UHC, EHR, Availity, Navinet Certifications/Licenses: Certified Billing & Coding Specialist (Licensed) L7R4E3H8, NHA Interests: Reading, Yoga, Fitness & Music, Work out (3x a week)

Languages: English (Native), Spanish (Fluent)

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