Medical Billing Accounts Receivable

Barbara L. Vaughn

**** ******** ****, ********, ** 43213

Cell: 614-***-****

*********@*****.***

Personal Statement

Motivated medical billing and coding specialist with over twenty years of experience in healthcare management operations, billing, coding and accounts receivable. Highly skilled in analyzing and validating patient information, diagnoses, posting patient and insurance remittance, and billing data. Demonstrated leader and team-member who is capable of processing high volumes of patient information to achieve revenue generation goals. Professional Objective

Obtain a permanent full-time position as an Accounts Receivable Specialist or Medical Billing and Coding Specialist in a professional office setting, where providing superior customer service and supporting clients is the organization’s top priority. Core Competencies

● Expert in ICD-10, HMO, PPO, CPT and HCPCS (Medicare and Medicaid) coding

● Extensive experience in Operations Management, Quality Assurance, Medical Billing, Medical Records Management, Accounts Receivable, and Patient Confidentiality (HIPAA Compliance)

● Proficient with Availity, Exscribe, NexExtender, PHP, Priority, Department of Labor, and other insurance portals

● Medical Management experience including medical accounting, filing, and charting

● Skilled usage of Microsoft Office Suite, Medisoft and Electronic Health Records (EHR)

● Excellent interpersonal, oral and written communication skills, thrives on solving complex problems in fast paced work environment

● Trained in the operation and use of all common office equipment

● Skilled in office workplace settings or work-from-home environment Work Experience

Medical Billing Specialist February 2024-July 2025 Primary One Health, Columbus, OH

● Temporary employee for first 90-days, selected over several others candidates to become a permanent hire

● Chosen as the go-to person for management in crisis situations; and served a trainer for new employees in billing operations

● Performed error free billing and collections from multiple payer sources

● Reviewed claims for completeness and accuracy before claims were released

● Served as customer service liaison and answered billing questions

● Researched and made corrections to denial of claims

● Documented correspondence with patients, insurance carriers, and providers

● Retrieved patient and insurance payment remittance in a clinical setting and posted daily and monthly balances

● Updated or corrected patient insurance coverage for proper billing of claims

● Helped business associates with questions

● Received a 5 percent merit-based pay increase during first six months of employment

● Awarded a second 2 percent merit-based pay raise on 1 June 2025; based on superior work performance, initiative, leadership and team-work

● Due to extensive knowledge of medical billing selected to work on special projects with high visibility and short timelines for execution

Medical Billing Specialist October 2021-Sept. 2023 Specialized Medical Billing, Worthington, OH

● Performs as manager/team lead in Medical Billing supervisors’ absence.

● Based on experience and expertise chosen by the management team to train new hire billing specialists.

● Collected, posted, and managed patient account payments, and prepared and submitted claims forms to insurance companies and other third-party payers.

● Performed insurance verification, pre-certification, and pre-authorization.

● Entered procedure and diagnosis codes and requisite patient information into billing software to streamline invoicing and account management; added modifiers, verified diagnoses, and coded narrative diagnoses.

● Reviewed and validated accuracy of charges, including dates of service, services provided, location, patient identification, and provider signature.

● Used electronic charge capture practices such as billing and account receivables (BAR) system and medical billing clearinghouse accounts to submit codes and invoices on-time.

● Responded to staff and client inquiries regarding CPT and diagnosis codes.

● Communicated with patients and healthcare providers for verification of billing information.

● Process routine claims, investigate pending claims and resolve discrepancies, and submitted appeals.

● Receive, process, post, transfer payments to patient’s accounts and correct insurance posting payments as needed.

● Routinely exceeded hourly production quotas.

● Uphold and reinforce compliance with hospital policies and federal regulations such as HIPAA.

Medical Claims Analyst February 2015-Janurary 2021 HealthScope Benefits/United Health, Westerville, OH

● Based on demonstrated proficiency chosen by management to train new hire claims analysts.

● Maintained a comprehensive understanding of laws and guidelines concerning medical claims.

● Collected and processed requisite information to complete medical insurance claims.

● Analyzed each claim to ensure compliance with requisite guidelines and procedures.

● Was responsible for maintaining and ensuring claims archive was accessible.

● Created monthly reports for management on financial status of outstanding and paid claims.

● Processed routine claims, investigated pending claims and resolved discrepancies. 2

● Received and immediately processed government medical claims to ensure prompt payment.

● Scanned new claims into the computer system for archiving purposes.

● Contacted patients and healthcare providers for verification of claims.

● Remained current on explanation of benefits.

● Routinely exceeded hourly processing quotas.

Q2A Medical Claims Administrator June 2014 – January 2015 Maximus, Westerville, OH

● Completed initial entry and multi-bene portions of claims forms for Medicaid - Part B Appeals; personally responsible for processing thousands appeals in less than 5 months resulting in hundreds of thousands in cost savings, cost reimbursement, shorter processing times, faster claims payouts and with less fraud.

● Determined whether documents were provider or beneficiary requests; used extensive knowledge of billing and coding to develop and issue firm Acknowledgement Letters.

● Ultimately responsible for processing 50 percent of client claims and distributing firm decisions on beneficiary and service provider requests.

● Received mail, reviewed and determined appropriate jurisdiction for claims processing.

● Enabled faster claims processing times by researching claim requests related to Dates of Service and attaches supporting evidence to acknowledgement letters to facilitate claims adjudication; for service providers and beneficiaries.

● Verified codes match services provided, and claims submissions, and/or appeals paperwork based on CPT codes; ensured requests were answered in a timely manner and distributed within the allotted timeframe.

● Updated and filed EHR.

Administrator Clerk I December 2013 – June 2014

MedScribe, Fairport, NY

● Completed initial entry and multi-bene portions of claims forms for Medicaid Part B Appeals; personally responsible for processing over thousands appeals in less than 5 months resulting in hundreds of thousands in cost savings, cost reimbursement, shorter processing time, faster claims payouts, less fraud.

● Determined whether documents are provider or beneficiary requests; uses extensive knowledge of billing and coding to develop and issue firm Acknowledgement Letters.

● Responsible for processing client claims and distributing firm decisions on beneficiary and service provider requests.

● Received mail, reviewed and determined appropriate jurisdiction for claims processing.

● Enabled faster claims processing times by researching claim requests related to Dates of Service and attaches supporting evidence to acknowledgement letters to facilitate claims adjudication; for service providers and beneficiaries.

● Verified codes match services provided, and claims submissions, and/or appeals paperwork based on CPT codes; ensured requests were answered in a timely manner and distributed within the allotted timeframe.

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● Updated EHR.

● Based on superior performance selected for permanent position after 6 months as Claims Administrator over 5 other new hires.

Data Entry/Mailing Specialist November 2001 - November 2013 Shawan-Marquis Agency, Inc., Dublin, OH

● Served as principal Data Entry specialist responsible for compiling, sorting, and verifying data accuracy prior to inclusion in corporate insurance marketing database.

● Prepared and compiled product marketing documents, performed quality control and supervised distribution of insurance products to customers.

● Validated and verified data with original source documents to prevent data entry errors.

● Identified and corrected existing data entry errors; prepared and provided consolidated report of corrections to managing supervisor; attention to detail credited with increasing customer database by 25 percent.

● Read source documents and entered data in specific data fields or onto tapes or disks for subsequent entry.

● Responsible for managing, replenishing and maintaining requisite level of office supplies.

● Solely responsible for proper storage, transmission and retrieval of Chamber of Commerce documents.

Member Services Representative June 2000 - October 2001 Merck-Medco, Columbus, OH

● Designed forms for receiving, processing, and tracking customer data.

● Developed project-specific data management plans and work flow processes to address coding, reporting, and transfer.

● Processed clinical data including receipts and payment data; verified data accuracy prior to filing.

● Analyze clinical data using appropriate statistical analysis tools.

● Conferred with end users to define and implement clinical system requirements, including data release forms, delivery schedules, and testing protocols.

● Answered general database queries, and performed validation checks.

● Captured errors or omissions during quality control checks and resolved discrepancies.

● Monitored work productivity, performance, and prepared progress reports for management team.

● Tracked workflow including in-house data flow and electronic transfer forms.

● Compiled, organized, and produced protocols, clinical study reports, regulatory submissions, and other controlled documents.

● Prepared data reports as requested.

● Provided on-site support and information to functional areas including marketing team, clinical monitors and medical affairs.

Education and Training

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Associate of Arts in Healthcare Administration 2012 Concentration in Medical Billing & Coding - University of Phoenix, Phoenix, AZ Administrative Assistance Program 1991

Eastland Career Center, Groveport, OH

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