Medical Billing Customer Service

RACHELLE E KNIGHT

**** ****** ***** ***** ********, GA 30144 678-***-**** *****************@*****.***

Medical Billing Supervisor

Dedicated and technically skilled Medical Billing Supervisor with the ability to thrive in a fast-paced, high-volume medical environment.

Excel in resolving employer challenges with innovative solutions, settling patient and insurance accounts.

Ten years of medical office, hospital, and third party billing experience.

Key Skills

Medical Office Management

Teambuilding & Supervision

Insurance Process & Claims Appeal

Written/Oral Communication HMOs, PPOs, Commercial

Medical Billing Auditing

Medical Coding

Multitask & Prioritize Self Pay, Medicare & Medicaid

HIPAA Compliance

Anatomy & Physiology

Advanced Medical Terminology

Experience

PaymentsMD, Atlanta, GA 2010 to Present

Medical Billing Specialist

Perform accounts receivables and revenue analysis, reviewing and analyzing A/R reports to identify problems and execute resolution for hospital Anesthesia charges.

Initiate appeal procedures on denied claims; collected on delinquent accounts and recommendations for outsourced collection efforts as appropriate.

Reviewed and explained insurance plans to patients to guarantee full understanding of payment policies & procedures.

Performed accounts receivable duties including invoicing, cash application, researching charge backs, discrepancies, issuing credit memos, reconciliations and responding to customer requests for documentation.

Galen Billing, Atlanta, GA

2009

Medical Billing Analyst

Followed up on submitted claims and monitored unpaid claims; resubmitted claims with appropriate corrections and documentation.

Worked declined claims and processed appeals.

Ensured that established billing targets for collections, gross, days in A/R, and net collections ratios were met.

Analyzed claims system reports to ensure that underpayments are correctly identified and collected form key carriers.

Worked with payer and provider representatives to negotiate higher rates for claim payments.

Mentored less experienced staff and assist Billing Manager with training.

Reviewed correspondence and rejections from carriers; post rejections and perform reconciliations.

Prepared and submitted referring physician updates and other major dictionary requests to supervisor for approval.

Kennestone Heart, Marietta, GA

2006 to 2008

Medical Reimbursement Supervisor

Supervised a staff of ten and provided ongoing performance feedback, addressing problems, hires, orients & training.

Verified and documented competency and suggested ways to develop skills.

Planned and scheduled work assignments, space, and facilities; monitored workflow and scheduled vacations.

Initiated and implemented on current CPT and ICD coding changes and reimbursement guidelines.

Interpreted and distributed current billing, coding, and reimbursement information including Medicare, Medicaid, Managed Care, other insurers and regulatory guidelines.

Conducted periodic audits of physician’s services in offices and hospitals for proper CPT and ICD coding and documentation; communicates findings and recommends, implements and monitor improvements.

Improved timely paying of bills by developing flexible payment plans for patients.

Implemented new departmental policies and procedures for more efficient billing, decreasing payment processing period from 5 days to 2.

Gastroenterology Consultants, LLC, Atlanta, GA

2004 to 2006

Medical Reimbursement Supervisor

Responsible for directing and coordinating the work of 5 direct reports in all aspects of day to day billing procedure.

Oversaw the accurate, efficient and timely processing of claim filing.

Performed detailed analysis of carious reports to ensure accurate reimbursement.

Provided high level customer service to internal and external customers.

Prepared monthly financial reports; monitored and provided information on coding and reimbursement updates.

Processed Electronic claim submissions daily; maintained and monitored EDI.

Ensured that insurance coverage is verified, prior authorization is obtained and patient demo and insurance information is entered into system using Avisena. (software)

Education

State University of New York at New Paltz, New Paltz, NY 1995-2000

Bachelor of Communications

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