Insurance Billing & Collections Specialist
Resume:
Shafawn Carver
**************@*****.***
Professional Summary
• Insurance Billing and Collections Specialist / Billing /Clerk for 3 years: o Healthcare insurance account collection
o Coding, Billing, Insurance Verification & Coding o Vast knowledge of medical terminology, CPT and ICD-10 coding & payer requirements.
• Skilled in investigating and resolving claim denials – detailed and results oriented
• Reducing outstanding accounts receivable
• Maintaining positive relationships with Team members, insurance carriers and patients.
• Adept at using Microsoft Word, Excel, Availity, Trauma Soft, Waystar, various Insurance web portals.
• Core Skills
o Insurance claims collection (Commercial) & (Facility ] o Denial management Payor of last resort
o CPT, ICD-10, and HCPCS coding
o HIPAA compliance and confidentiality
o EOB and ERA review
o Electronic health record (EHR) and practice management software o Communication and negotiation skills - Accuracy under deadlines Work Experience
.City Ambulance – Billing Clerk
• Perform collections activities on complex denials on outstanding balances in the professional/facility fee environment.
• Follow up on unpaid claims to ensure timely resolution and payment.
• In-depth working knowledge medical insurance and demonstrated excellent written and verbal communication
with insurance facilities .
• Review invoices to insure correct CPT codes will be added to UB 1500 form or create invoice for some faculties.
• Generated daily aging reports and supported AR cleanup efforts.
• Monitored payer trends and reported recurrent denials for process improvement.
• Worked with posting department to ensure accounts are posted correctly.
• Ensured compliance with HIPAA and internal policies for data privacy.
• Monitored claim status
• Collaborated with third party institution to resolve denials and rejection.
• Identified denial trends and worked with leadership team and resolved payment and billing to be sent directly to patients.
• Make sure correct diagnoses was on UB 1500 before claim could be billed for timely submission of electronic and paper claims to the appropriate insurance providers..
• Reviewed, and updated patients’ information into the EMR with 100% accuracy to ensure claim would not be rejected.
• Verified insurance for UTMB inmates.
• Educated patients and families on insurance coverage and billing prior to the scheduled appointments. Education & Certifications
College of Health Care Professions Medical Coding & Billing Program Training Academy Medical Assisting Diploma Nationally Registered Certified Coding Specialist NRCC American Heart Association BLS for Healthcare Providers (CPR, First Aid & AED) Certifications OSHA & HIPAA Certifications
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