Senior Medical Billing Specialist

S A R A J A C K S O N

Senior Medical Billing Specialist

Cincinnati, OH

513-***-**** **************@*****.***

PROFESSIONAL SUMMARY

Dedicated and highly experienced Medical Billing Specialist with 15+ years of success in high-volume billing, claims management, denials resolution, and payer follow-up for major healthcare systems. Expert in Epic, Availity, and payer portals with a deep understanding of Medicaid, Medicare, and commercial payer rules. Proven ability to reduce denials, improve clean claim submission, and increase reimbursement accuracy while maintaining exceptional productivity and compliance.

CORE COMPETENCIES

• End-to-End Medical Billing

• Claims Processing & A/R Follow-Up

• Denial Prevention & Resolution

• Appeals & Reconsiderations

• Charge Entry & CPT/ICD-9/10 Coding

• Medicaid, Medicare & Commercial Billing

• Epic, Availity & Payer Portal Expertise

• Documentation Review & Compliance

• Insurance Verification

• High-Volume Productivity

PROFESSIONAL EXPERIENCE

Clinical Health Network for Transformation — Medical Billing Specialist 03/2021 – Present

• Manage follow-up, denials, claim edits, rejections, and retro reviews in Epic

• Prepare and submit detailed appeals and reconsiderations for Medicaid and commercial payers

• Conduct documentation review to ensure coding accuracy and payer compliance

• Resolve claim roadblocks using Epic, Availity, ClaimSource, and portal research TriHealth — Medical Billing Specialist II

05/2017 – 01/2021

• Consistently exceeded productivity benchmarks, processing 100+ claims daily

• Corrected CPT and diagnosis coding for Anthem and Medicaid claims

• Researched charts for prior authorizations, medical necessity, and documentation requirements

• Submitted structured appeals to reverse denials and ensure clean reimbursement Mercy Health — Charge Entry / Claims Follow-Up Specialist 04/2016 – 04/2017

• Recovered revenue by resolving Rural Health Clinic denied claims

• Completed Ohio MITS wrap-around billing with 100% accuracy

• Utilized Epic, Availity, Cactus, NPPES, and payer portals for claim resolution Additional Billing Experience (2004–2016)

Mayfield Clinic • Riverhills Neuroscience • Medical Recovery Systems Sheakley Medical Management • TriHealth • Medisync Midwest

• Corrected coding errors, processed denials, escalated appeals

• Conducted insurance verification and managed patient account inquiries

• Posted payments, balanced daily batches, maintained billing compliance EDUCATION

Colorado Technical University — In Progress

(8 classes remaining toward Associate Degree)

Princeton High School — High School Diploma

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