Data Entry Specialist - Billing & A/R Expert, 18+ Years Experience
Resume:
Andrea West
+1-904-***-**** • **************@*****.*** • Jacksonville, FL
Summary
Mission-driven Billing Specialist with over 18 years of experience in Health care billing and Insurance A/R management. Expert in navigating complex insurance provider portals to resolve high-volume claim denials and facilitate successful claims appeals. Dedicated to ensuring accurate revenue capture and HIPAA compliance while providing supportive communication to patients regarding payment plans and coverage updates.
Work Experience
Member Advocate September 2024 – Present
CIGNA HEALTHCARE SOLUTIONS, JACKSONVILLE, FL
Investigate and resolve complex health care billing inquiries for Medicare members, ensuring alignment with insurance provider portals and coverage guidelines.
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Process detailed insurance benefits reviews, educating clients on payment posting procedures, deductibles, and patient payment plans.
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Review and resolve billing disputes and complaints, maintaining 100% HIPAA compliance while advocating for accurate revenue cycle outcomes.
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Utilize advanced EMR systems and platforms similar to Athena and EPIC to track member insurance status and claim eligibility.
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Account Receivable Specialist January 2023 – September 2024 AIRPRO DIAGNOSTICS, JACKSONVILLE, FL
Manage Insurance A/R management workflows by reviewing daily dashboards for approved charges and pending claims to ensure timely payment posting.
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Execute high-volume billing cycles on the 1st and 15th of each month, updating client billing information to maintain high data integrity.
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Perform rigorous quality audits on financial calculations, identifying and correcting billing errors to optimize revenue capture and minimize denials.
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Investigate individual vehicle service contracts to validate diagnostic, programming, and calibration scan codes for accurate insurance billing.
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Accounts Receivable Specialist May 2022 – January 2023 FANATICS, INC, JACKSONVILLE, FL
Process credit applications through Bectran, managing complex A/R portfolios and evaluating financial risk for new accounts.
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Utilize Oracle and Cisco platforms to create and manage accounts, ensuring seamless data integration across billing departments.
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Resolve billing discrepancies using advanced analytical skills to investigate historical account data and facilitate payment recovery.
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Generate invoices and track collection progress, identifying aging accounts for targeted follow-up to reduce outstanding A/R balances by 15%.
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Account Receivable Specialist May 2018 – May 2022
CARESPOT URGENT CARE, JACKSONVILLE, FL
Investigate and initiate claims appeals for denied Medicare Advantage (MAPD) claims, successfully overturning denials to secure revenue.
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Review and explain complex billing details to patients, including denied claims, coverage limitations, and financial responsibility.
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Contact patients to discuss payment plans and define insurance terminology such as premiums, deductibles, and coinsurance.
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Maintain accurate patient demographics and insurance information within EMR systems to ensure HIPAA compliance and billing accuracy.
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Medical Biller October 2015 – May 2018
MARION PROVIDER CARE SERVICES, JACKSONVILLE, FL
Process and submit health care billing claims to various insurance carriers, ensuring high-volume accuracy and adherence to filing deadlines.
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Review medical codes (ICD-10, CPT) on patient records and prepare detailed invoices for submission to insurance provider portals.
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Execute payment posting for medical procedures, ensuring all charges and financial documents are reconciled correctly.
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Analyze encounter forms and diagnosis codes to validate accuracy and specificity, reducing the initial claim denial rate.
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Education
Diploma in Medical Billing and Coding June 2007 – July 2008 EVEREST UNIVERSITY-SOUTH ORLANDO, JACKSONVILLE, FL High school diploma August 1992 – June 1993
ENGLEWOOD HIGH SCHOOL, JACKSONVILLE, FL
Additional Skills
Revenue Cycle & Billing: Health care billing, Insurance A/R management, Claims appeals, Payment posting, Revenue Cycle Management, Medical collection, Insurance Verification, Patient payment plans EHR & Technical Platforms: Athena, EPIC, ECW, Oracle, NetSuite, Bectran, EMR Systems, Zendesk, Microsoft Excel, EDI
Compliance & Medical Coding: HIPAA compliance, ICD-10, CPT coding, Medical terminology, Anatomy knowledge, Documentation review, Medical records
Professional Operations: Insurance provider portals navigation, Data entry, Account reconciliation, Phone etiquette, Customer Service, Analytical skills Certifications
• Medical Coding and Billing - Everest University (June 2007)
• Medical Coding Certification (June 2007)
• Medical Billing Certification
Languages
• English
Additional Information
• Proven accuracy and attention to detail
• Accurate with 10 keypads and 65 wpm typist
• Adapt with communication skills with patients
• Hardworking mentality
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