Highly skilled, knowledgeable, and proficient Medical Biller bringing extensive, specialized experience working in medical billing, collections, patient accounts management, and customer care capacities throughout hospital and independent medical billing environments. Key qualifications:
* Recognized for a proven ability to efficiently process medical claims for major and private insurance carriers including HMO/PPO, Blue Cross/Blue Shield, Medicaid/Medicare.
* Highly skilled with a demonstrated knowledge of medical terminology, ICD-9/CPT codes, No Fault, and Worker’s Compensation claims.
* Keenly recognize, investigate and resolve discrepancies leveraging extensive experience going through appropriate channels to facilitate medical claims review and appeal processes.
Medical Office Management
Personnel Management . . . Inventory Control/Purchasing . . . Payroll Processing/Distribution . . . Accounts Payable/Receivable . . . Budget Control . . . Policy/Procedure Development . . .
Special Project Coordination . . . Patient/Physician Relations . . . Regulatory Compliance
Med-One Processors, Hendersonville, TN – 2007 to Present
Medical Billing Specialist
* Process in excess of 60 healthcare claims per day for ABC Administrators, a third-party administrator of health benefits, in areas of surgical, dental, mental health, and physical therapy cases.
* Respond to inquiries from providers on a broad scope of coverage issues pertaining to eligibility, coordination/explanation of benefits, and payment schedules
* Carefully research and review individual/group claims exercising a strong working knowledge of major medical plans and leading healthcare networks
* Proficiently utilize the RIMS program and collaborate with Claim Review Department to expedite the resolve of claim discrepancies and insufficient information.
* Acted as Professional Relations Representative for between the main office and three regional locations to ensure the timely and accurate processing of insurance claims.
* Trained and supervised personnel on accident insurance claim processing and approval procedures.
Medical Account Managers, Nashville, TN – 2001 – 2007
Medical Biller / Collections Associate
* Implemented an efficient follow-up system to expedite the recovery of 30-day outstanding payments from non-responsive insurance carriers.
* Reconciled outstanding balances and incidents of returned claim checks from Medicaid/Medicare.
* From a group of 20 medical billers and collection associates, was most frequently requested by physicians and attorneys to expedite the location and processing of patient charts.
* Gained a reputation for accuracy and timely responses to requests, most frequently requested associate by physicians and attorneys offices to locate and process charts.
Surgical Center of American, Nashville, TN – 1997 – 2001
Office Manager / Medical Biller
* Managed the main office, overseeing administrative functions for a busy oral and maxillofacial surgeon specializing in reconstruction surgery, dental implants, and facial trauma.
* Supervised a staff in the areas of recruitment, training, supervising, and performance evaluations.
* Coordinated appointment scheduling and confirmations, processed bi-weekly payroll, and handled accounts payable and receivable functions.
* Processed computerized medical and dental billing for 1,200 patients under private, No Fault, and Worker’s Compensation insurance plans.
* Followed up with insurance carriers and patients to expedite the recovery of payment obligations.
* Handled contracts, monitored inventory, and authorized the purchase of equipment and supplies.
* Coordinated conferences, seminars, and luncheon meetings, as well as agenda planning, guest list creation, registration confirmation, travel arrangements, and menu planning.
* Developed slideshow presentations and assisted during lectures on cutting-edge medical procedures.
College, Town, XX
Degree Name, Major, Date
MS Word, Excel and PowerPoint; Patient Management System (PMS)