Medical Billing Data Entry

SharonMoses

Northridge, CA *****

Summary

Skilled in document handling, including copying, scanning, faxing, and organizing critical documents related to patient accounts, medical records, and insurance claims.

Proficient in Cerner software, leveraging its capabilities for seamless management of patient records and efficient claims submission

Demonstrated ability to maintain strict adherence to HIPAA guidelines, ensuring privacy and confidentiality while managing sensitive patient information.

Proven track record of managing administrative duties, such as scheduling, managing multi-line phone systems, and coordinating day-to-day office operations, contributing to a productive and organized work environment.

Expert in insurance verification, including HMO and PPO coverage confirmation, identifying plan-specific requirements, and resolving discrepancies to ensure accurate billing and claims processing.

Extensive experience in handling medical billing and collections, working with both government and commercial insurance providers to resolve denied claims, manage appeals, and ensure timely reimbursements.

Expert in insurance verification, confirming coverage, and addressing discrepancies to ensure accurate billing and claims processing.

Education

Kee Business College Sep 1983

Newport News, VA

Bachelor’s in business management

Skills

Cerner

claims

Billing

Accounts Receivable

Filing

Collections

Office Experience

Multilingual

Hospitality Experience

Admin Assistant

AR

Ap

Insurance Verification

Medical Billing

Medical Collections

HMO

PPO

Professional Experience

Protiviti (Dental)- Contract Jan 2025 – Mar 2025 Cash Receivable Payment Poster

Accurately posted cash payments from various sources, including insurance providers, patients, EFTs, and checks,

into the appropriate patient accounts using dental practice management systems.

Reviewed Explanation of Benefits (EOBs) and remittance advice to ensure accurate payment allocation and proper

handling of denials.

Identified and resolved payment discrepancies, such as underpayments, overpayments, and unapplied funds.

Collaborated with billing and accounts receivable teams to reconcile daily deposits and maintain precise financial

records.

Accurately posted cash payments from various sources—including insurance providers (HMO and PPO plans), patients, EFTs, and checks into appropriate patient accounts using dental practice management systems.

Investigated and followed up on missing remittance details or misapplied payments to ensure timely resolution.

Always ensured strict compliance with HIPAA regulations and upheld patient confidentiality.

Generated and maintained routine cash posting reports to support internal tracking and audit requirements.

Assisted in auditing and verifying payment batches for accuracy and completeness.

Responded to internal inquiries regarding payment status, discrepancies, and account adjustments.

Centene CA Jul 2023 – Nov 2024

Medical Billing and Collections/Credentialing

Utilized Cerner software to manage electronic health records, ensuring efficient claims processing and accurate patient data management.

Ensured all provider documentation, including NPI, licenses, and Tax IDs, were verified, up-to-date, and compliant with regulatory standards.

Managed the billing process, followed up with insurance carriers for status updates on claims, and worked diligently to resolve claim denials.

Prepared and submitted appeal letters for denied claims, taking necessary steps to ensure resubmission of payment.

Communicated directly with both commercial and government insurance providers to ensure accurate and timely claims processing.

Performed essential administrative tasks, including copying, scanning, and faxing critical documents related to patient accounts and claims.

Maintained strict adherence to HIPAA guidelines in all communication, documentation, and claims handling to ensure privacy and confidentiality.

Robert R Half/Heartland Dental Jun 2021- July 2023

Workers Comp Representative/ Client Financial Service Specialist

Accurately posted payments to patient accounts, processed adjustments, applied discounts, and managed disputes to ensure account accuracy.

Provided exceptional customer service by resolving patient and insurance-related issues, ensuring satisfaction and efficient resolution.

Utilized Cerner software to manage electronic health records, ensuring efficient claims processing and accurate patient data management

Maintained detailed records of individual appeals and grievances, coordinating with the Grievance and Appeals Committee as needed for timely resolution.

Supported the pay-for-performance initiatives by entering and tracking data, organizing information, and conducting research to ensure accurate reporting.

Assisted with HEDIS production functions, including data entry, contacting providers’ offices, and conducting claims research to ensure compliance and accuracy.

Managed large volumes of incoming documents, including copying, faxing, scanning, and organizing mail for efficient workflow.

Barren River District Health Dept Dec 2020 – Mar 2021

Bowling Green

Managed a multi-line phone system, efficiently answering calls and directing inquiries as needed.

Updated client records, entered data accurately, and maintained organized files to ensure seamless operations.

Prepared metered mail and FedEx labels for outgoing shipments, ensuring timely delivery.

Performed various administrative tasks including filing, copying, scanning, and faxing documents as required.

Provided excellent customer service by assisting clients with inquiries and addressing concerns in a professional manner.

Scheduled and coordinated appointments to optimize time management and client satisfaction.

Stifel Nicolaus Apr 2020 - Aug 2020

Bowling Green, KY

Administrative Receptionist Assistant

Answered a multi-line phone system, efficiently managing incoming calls and directing them to the appropriate departments or personnel.

Updated and maintained client records, ensuring all data entry was accurate and current to support seamless operations.

Prepared metered mail and FedEx labels for outgoing shipments, ensuring timely and accurate delivery.

Performed general administrative tasks including filing, copying, scanning, and faxing important documents.

Delivered exceptional customer service, assisting clients with inquiries, concerns, and service requests in a professional and courteous manner.

Coordinated and scheduled appointments, managing calendars to optimize time and resource efficiency.

Ensured confidentiality of sensitive reports and documents, adhering to HIPAA guidelines and organizational policies.

Worked with Cerner documents, ensuring accurate data entry, organization, and retrieval of patient records for smooth clinical workflows.

Assisted with maintaining and organizing electronic and physical files, ensuring easy access to critical documentation when needed.

Collaborated with team members to streamline administrative processes, improving overall office efficiency and effectiveness.

Murfreesboro, TN Mar 2019 - Jun 2019

A/R Specialist/Administration

Comprehensive Pain and Neurology

Managed billing and collections of medical claims, ensuring accurate submission and timely follow-up on denied claims with insurance companies.

Conducted regular reports and data entry to track and resolve outstanding claims, ensuring proper documentation in electronic records.

Handled self-pay collections, establishing and managing payment plans for patients to ensure financial obligations were met.

Served as a Documentation Specialist and EDI Specialist, ensuring the accuracy of financial documentation and facilitating electronic data interchange.

Summarized current financial status by collecting relevant data and preparing balance sheets, profit and loss statements, and other financial reports.

Audited financial documents to substantiate transactions, ensuring all records were accurate and compliant with regulations.

Maintained accounting controls by recommending and preparing policies and procedures to safeguard financial operations.

Coordinated accounting clerical staff activities, providing guidance, answering queries, and ensuring efficient workflow.

Reconciled financial discrepancies by thoroughly analyzing and collecting account information to identify and resolve issues.

Secured financial information through regular database backups and adherence to confidentiality and security protocols.

Ensured financial security by strictly following internal controls and safeguarding sensitive financial data.

Parallon Healthcare Jan 2018 - Jun 2019

Workers Comp Representative / Medical Billing/ Collections Representative

Managed outstanding Accounts Receivable (A/R), working diligently to resolve aged accounts and ensuring timely resolution.

Addressed claim denials, contractual adjustment issues, and facilitated payment processing while ensuring accurate and up-to-date patient information.

Provided exceptional customer service (CSR) by assisting patients with account inquiries and maintaining thorough documentation of all accounting activities.

Performed duties as a Documentation Specialist, handling A/R and A/P, data entry, and addressing denials and appeals to ensure reimbursement accuracy.

Summarized financial status by collecting necessary data, preparing balance sheets, profit and loss statements, and other financial reports.

Audited financial documents to substantiate transactions, ensuring proper documentation and compliance with company policies.

Supported accounting controls by recommending and preparing policies and procedures to improve financial operations and safeguard resources.

Guided accounting clerical staff, coordinating activities, answering queries, and providing training to maintain efficient office procedures.

Reconciled financial discrepancies by analyzing and collecting detailed account information to resolve any inconsistencies.

Secured financial data by completing database backups and adhering to security protocols to protect sensitive information.

Maintained financial security by strictly following internal control measures, ensuring the confidentiality and integrity of financial data.

Healthcare Provider Solutions Nashville, TN Jan 2017 - Jan 2019

Workers Comp Representative/ Medical Collections Specialist

·Managed medical collections for both high-dollar and mid-dollar accounts, working to collect past due payments from payers and resolving any billing and collection issues.

Handled denials and appeals, addressing coding issues and collaborating with both commercial and government insurance providers to facilitate accurate and timely payments.

Worked on authorization and referral processes, ensuring proper documentation and approval for services rendered.

Processed payment postings and handled refunds to ensure accurate financial tracking and patient account resolution.

Conducted insurance verification to confirm patient coverage and resolve any discrepancies with payers.

Served as an EDI Specialist, facilitating electronic data exchange to ensure accurate processing of claims and payments.

Summarized the current financial status by collecting relevant data, preparing balance sheets, profit and loss statements, and other financial reports.

Substantiated financial transactions by auditing documents, ensuring all financial records were accurate and in compliance with regulations.

Maintained accounting controls by recommending and preparing policies and procedures to strengthen financial processes and improve efficiency.

Coordinated activities within the accounting clerical team, answering queries and providing guidance to maintain smooth operations.

Reconciled financial discrepancies by collecting and analyzing account information, resolving any issues and ensuring consistency in records.

Secured financial data by completing regular database backups and adhering to strict confidentiality and security guidelines.

Maintained financial security by following internal control measures, ensuring the protection of sensitive financial information and compliance with industry standards.

Centerstone Behavioral Health Antioch, TN Apr 2016 - Feb 2017

Medical Billing and Collections /CSR

Verified insurance information and updated patient demographics to ensure accurate billing and claims processing.

Provided superior customer service by addressing inquiries, assisting with issues, and maintaining positive patient and payer relationships.

Managed administrative tasks such as faxing, scanning, and copying documents, ensuring proper documentation for all accounts.

Ran outstanding A/R reports and followed up on claims, coordinating with both government and commercial insurance providers for timely resolution.

Worked on denied claims, addressing contractual adjustment issues, and preparing appeals to facilitate reimbursement.

Performed data entry, accurately documenting account details, processing payments, and posting cash to patient accounts.

Utilized dual screens to efficiently manage multiple tasks, prioritizing workloads and maintaining productivity.

Resolved billing and account issues by working directly with various insurance companies and payer systems.

Experienced in working with multiple billing systems, including Star, Barr, and McKesson, ensuring smooth claims processing and payment resolution.

Pulled and organized electronic medical documents, including records, visit summaries, consent forms, and doctors' notes for claim verification and review.

I acted as an EDI Specialist, ensuring seamless electronic data interchange for claims submission, reimbursement tracking, and data accuracy.

United Surgical Partners Group Brentwood, TN Jun 2014 - Apr 2016

Patient Account Representative/CSR

Managed medical billing and collections, handling denied claims and appeals, and resolving contractual adjustments to ensure timely reimbursement.

Checked claim status and contacted both government and commercial insurance providers to resolve outstanding issues.

Documented each account accurately, ensuring clear records of all interactions and payments.

Verified insurance information and provided updates as needed to ensure proper billing and claims processing.

acted as an EDI Specialist, managing electronic data interchange for efficient claims submission and reimbursement tracking.

Led training for a new billing system implementation, ensuring staff were proficient in the new software and processes.

Utilized accounts receivable knowledge and data entry skills to manage and resolve billing issues.

Proficient in Microsoft Word and Excel, running detailed reports to track outstanding claims and payments.

Demonstrated strong written and oral communication skills while managing 100+ calls per day to resolve billing and insurance inquiries.

Delivered exceptional customer service, addressing concerns and guiding patients and providers through billing processes.

Community Health Systems Brentwood, TN Apr 2011 - Jun 2014 Patient Account Billing Rep. and Electronic Claims Specialist

Delivered superior customer service, demonstrating professionalism and promotability through effective communication and problem-solving.

Contacted third-party organizations regarding claim status to ensure timely updates and resolution of outstanding issues.

Monitored aging accounts to ensure timely filing of appeals and reviewed claims to verify correct pricing.

Reviewed payer contracts to ensure accurate payment was received in accordance with agreed terms.

Pursued all collection limitations as per payer guidelines to ensure compliance and maximize reimbursement.

Conducted daily follow-ups with insurance payers to resolve outstanding issues and ensure claim processing.

Entered daily charges for each clinic worked by representatives to ensure accurate data for month-end close.

Documented account notes with clear descriptions of actions taken on each claim to maintain comprehensive records.

Verified insurance information for accuracy and ensured proper billing for claims processing.

Worked as a Billing and Collection Specialist, managing claims, billing, and collecting in an efficient and organized manner.

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