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Posted : Tuesday, September 03, 2024 04:23 AM
PROFESSIONAL PROFILE
Accomplished, passionate and self-motivated Medical Billing Specialist/Trainer with a keen eye for
excellence, looking for the next challenge! I am currently open and accepting new clients remotely on a 1099 basis.
With over 20 years of diverse experience in hospitals and private clinics.
Proficient in working with private insurance companies, VA, Medicare, and Medicaid.
Recognized for exceptional accuracy and attention to detail, ensuring precise billing and reimbursement processes.
Adept at training and mentoring staff, driving efficiency and compliance.
Strong organizational and problem-solving skills, coupled with a deep understanding of medical billing regulations and procedures.
CORE COMPETENCIES • Extensive knowledge of medical billing procedures, and regulations for hospitals and private clinics.
• Proficient with various insurance companies, including private insurance, VA, Medicare, and Medicaid.
• Demonstrated expertise in coding medical procedures, diagnoses, and treatments for reimbursement.
• Strong attention to detail, ensuring precise documentation and billing to avoid errors and audit issues.
• Proven ability to train and mentor medical billing staff, effectively communicating complex concepts and ensuring compliance with industry standards.
• Exceptional problem-solving skills, adept at resolving billing discrepancies and navigating insurance claim denials to maximize revenue for healthcare organizations.
PROFESSIONAL EXPERIENCE Billing Specialist Jan 2023 – Present Say The Word Speech Therapy - Berkeley, CA 94578 • Prepare and send invoices and account updates to clients in a timely manner.
• Maintain accurate record of client accounts, including outstanding balances and payment history.
• Receive, sort, and track incoming payments, check for allocation to the respective client accounts.
• Validate debit accounts to verify the credibility of payments and minimize fraudulent transactions.
• Issue receipts for received payments, ensuring proper documentation and providing proof of payment.
• Address client concerns, and issues related to billing, ensuring a high level of customer satisfaction.
• Safeguard client data and payment information, adhering to strict security protocols confidentiality.
• Generate regular and accurate reports of billing data, providing insights on accounts receivable, payment trends, and outstanding balances for effective financial management.
Billing/ Collection Specialist Nov 2018 – Present Alameda Health Systems • Completed billing WIP and followed up on WIP, activity reports, work-lists, and batch QUIC logs.
• Worked closely with multiple departments to ensure compliance and accuracy with protocol for charge entry; Reviewed CPT, ICD, DRG, and HCPC codes to ensure proper billing and maximum reimbursement.
• Reviewed and prepared claims to be released the same day as received as well as claims paid information against contracted rates • Reviewed electronic charges entered by Physicians in the patient electronic health record.
• Followed up with payers regarding unpaid claims; performed collections calls to patients and submitted claims to collection services.
• Was responsible for daily reporting of failed claims and processed aging claims through EPIC system.
• Reviewed and investigated contracts in regard to over/underpaid claims and entered medical claims accurately into the database.
• Answered all questions from Physicians' Offices, staff, HMO companies, and members via telephone.
• Performed submission of hospital claims to insurance companies, particularly specializing in Medi-Cal.
• Verified insurance eligibility and coverage for various state-funded programs.
• Demonstrated a thorough understanding of stop-losses, per-diems, carve-outs, and other contract terms and conditions.
• Processed Capitation payments/charges; performed data entry into MS Excel Work error reports and transmitted corrections on electronically submitted claims as required.
Claims Resolution Medical Specialist Sep 2013 – Feb 2017 UCSF Benioff Children’s Hospital of Oakland • Collaborated with multiple departments to ensure compliance with charge entry protocols; • Reviewed CPT, ICD, DRG, and HCPC codes to ensure proper billing and maximum reimbursement.
• Reviewed and prepared claims for same-day release upon receipt.
• Reviewed electronic charges entered by Physicians in the patient electronic health record.
• Verified claims paid information against contracted rates.
• Followed up with payers regarding unpaid claims; conducted collections calls to patients and submitted claims to collection services when necessary.
• Accountable for daily reporting of failed claims and processed aging claims through the EPIC system.
• Processed Capitation payments/charges; performed data entry into MS Excel Work error reports and transmitted corrections for electronically submitted claims as required.
• Reviewed and investigated contracts related to over/underpaid claims and accurately entered and processed medical claims into the database.
• Provided comprehensive telephone support, addressing questions from Physicians' Offices, hospital staff, HMO companies, and members.
• Ensured timely submission of hospital claims to various insurance companies, specializing particularly in Medi-Cal.
• Verified insurance eligibility and coverage for various state-funded programs.
• Demonstrated a thorough understanding of stop-losses, per-diems, carve-outs, and other contract terms and conditions.
• Researched and resolved initially rejected EDI claims for correct providers and member eligibility.
• Created daily records of EDI claims batches loaded into EZ Cap Alerts Claims Manager or Database Admin for adjudication assignment.
Coordinated Primary Care Physicians (PCP) member assignments with PCP office representatives on a monthly basis.
Follow Up Representative Aug 2007 – Sep 2017 Bay Medical Mgmt.
• Responded to inappropriate payment/denied claims by working with EOBs.
• Handled incoming calls from patients and insurance companies.
• Worked with insurance providers to expedite claims processing and ensure compliance with pre-authorization requirements.
• Completed UB04 and UB92 claims forms to initiate payment from insurances.
• Calculated expected reimbursement and recommended accounts for collection agencies.
• Requested, processed, and posted claim refunds and voids accurately and in a timely manner.
• Processed claims line by line according to Medi-Cal guidelines, entered, and determined PPO contract allowances.
• Reviewed and processed refunds, transfers, and adjustments to patients' accounts.
• Ensured accurate coding of diagnoses and procedures based on medical reports.
• Managed daily workload of rejected claims (Medicare, HMO, PPO, etc.
).
• Documented and tracked authorizations from insurance companies for specialty visits.
• Conducted routine investigations on rejected and denied claims, researching overdue account balances.
• Resolved discrepancies and prepared adjustments and refunds when necessary.
• Analyzed complex accounts, trouble shoot problems, processed trauma billing, and appeal processing.
• Responded to patient and insurance company inquiries regarding accounts.
• Ensured accurate coding of diagnoses and procedures based on medical reports.
• Verified patient demographics and insurance eligibility to determine appropriate payer for collections and billing.
• Requested patient medical information from hospitals and providers' offices to support medical necessity.
• Followed up on assigned accounts through letters, emails, faxes, or telephone communication.
• Provided training in the front and back office on proper billing protocols.
ACHIEVEMENTS • Implemented a complex system that delivered instant alerts on unpaid claims, significantly reducing the waiting time for denied list generation.
• Demonstrated proficiency in processing over 100 insurance claims within a 5-day time-frame for timely reimbursement for healthcare services.
• Led and trained a team of 5+ personnel in medical billing, guiding them through comprehensive courses focused on accurately translating medical procedures into industry-defined codes.
• Consistently posted and submitted claims within a remarkable 48-hour time-frame upon receipt, streamlining the billing process and minimizing delays in reimbursement.
Please feel free to reach out to me with any questions or concerns you may have.
I look forward to hearing from you soon! Thank you, Tiffany
With over 20 years of diverse experience in hospitals and private clinics.
Proficient in working with private insurance companies, VA, Medicare, and Medicaid.
Recognized for exceptional accuracy and attention to detail, ensuring precise billing and reimbursement processes.
Adept at training and mentoring staff, driving efficiency and compliance.
Strong organizational and problem-solving skills, coupled with a deep understanding of medical billing regulations and procedures.
CORE COMPETENCIES • Extensive knowledge of medical billing procedures, and regulations for hospitals and private clinics.
• Proficient with various insurance companies, including private insurance, VA, Medicare, and Medicaid.
• Demonstrated expertise in coding medical procedures, diagnoses, and treatments for reimbursement.
• Strong attention to detail, ensuring precise documentation and billing to avoid errors and audit issues.
• Proven ability to train and mentor medical billing staff, effectively communicating complex concepts and ensuring compliance with industry standards.
• Exceptional problem-solving skills, adept at resolving billing discrepancies and navigating insurance claim denials to maximize revenue for healthcare organizations.
PROFESSIONAL EXPERIENCE Billing Specialist Jan 2023 – Present Say The Word Speech Therapy - Berkeley, CA 94578 • Prepare and send invoices and account updates to clients in a timely manner.
• Maintain accurate record of client accounts, including outstanding balances and payment history.
• Receive, sort, and track incoming payments, check for allocation to the respective client accounts.
• Validate debit accounts to verify the credibility of payments and minimize fraudulent transactions.
• Issue receipts for received payments, ensuring proper documentation and providing proof of payment.
• Address client concerns, and issues related to billing, ensuring a high level of customer satisfaction.
• Safeguard client data and payment information, adhering to strict security protocols confidentiality.
• Generate regular and accurate reports of billing data, providing insights on accounts receivable, payment trends, and outstanding balances for effective financial management.
Billing/ Collection Specialist Nov 2018 – Present Alameda Health Systems • Completed billing WIP and followed up on WIP, activity reports, work-lists, and batch QUIC logs.
• Worked closely with multiple departments to ensure compliance and accuracy with protocol for charge entry; Reviewed CPT, ICD, DRG, and HCPC codes to ensure proper billing and maximum reimbursement.
• Reviewed and prepared claims to be released the same day as received as well as claims paid information against contracted rates • Reviewed electronic charges entered by Physicians in the patient electronic health record.
• Followed up with payers regarding unpaid claims; performed collections calls to patients and submitted claims to collection services.
• Was responsible for daily reporting of failed claims and processed aging claims through EPIC system.
• Reviewed and investigated contracts in regard to over/underpaid claims and entered medical claims accurately into the database.
• Answered all questions from Physicians' Offices, staff, HMO companies, and members via telephone.
• Performed submission of hospital claims to insurance companies, particularly specializing in Medi-Cal.
• Verified insurance eligibility and coverage for various state-funded programs.
• Demonstrated a thorough understanding of stop-losses, per-diems, carve-outs, and other contract terms and conditions.
• Processed Capitation payments/charges; performed data entry into MS Excel Work error reports and transmitted corrections on electronically submitted claims as required.
Claims Resolution Medical Specialist Sep 2013 – Feb 2017 UCSF Benioff Children’s Hospital of Oakland • Collaborated with multiple departments to ensure compliance with charge entry protocols; • Reviewed CPT, ICD, DRG, and HCPC codes to ensure proper billing and maximum reimbursement.
• Reviewed and prepared claims for same-day release upon receipt.
• Reviewed electronic charges entered by Physicians in the patient electronic health record.
• Verified claims paid information against contracted rates.
• Followed up with payers regarding unpaid claims; conducted collections calls to patients and submitted claims to collection services when necessary.
• Accountable for daily reporting of failed claims and processed aging claims through the EPIC system.
• Processed Capitation payments/charges; performed data entry into MS Excel Work error reports and transmitted corrections for electronically submitted claims as required.
• Reviewed and investigated contracts related to over/underpaid claims and accurately entered and processed medical claims into the database.
• Provided comprehensive telephone support, addressing questions from Physicians' Offices, hospital staff, HMO companies, and members.
• Ensured timely submission of hospital claims to various insurance companies, specializing particularly in Medi-Cal.
• Verified insurance eligibility and coverage for various state-funded programs.
• Demonstrated a thorough understanding of stop-losses, per-diems, carve-outs, and other contract terms and conditions.
• Researched and resolved initially rejected EDI claims for correct providers and member eligibility.
• Created daily records of EDI claims batches loaded into EZ Cap Alerts Claims Manager or Database Admin for adjudication assignment.
Coordinated Primary Care Physicians (PCP) member assignments with PCP office representatives on a monthly basis.
Follow Up Representative Aug 2007 – Sep 2017 Bay Medical Mgmt.
• Responded to inappropriate payment/denied claims by working with EOBs.
• Handled incoming calls from patients and insurance companies.
• Worked with insurance providers to expedite claims processing and ensure compliance with pre-authorization requirements.
• Completed UB04 and UB92 claims forms to initiate payment from insurances.
• Calculated expected reimbursement and recommended accounts for collection agencies.
• Requested, processed, and posted claim refunds and voids accurately and in a timely manner.
• Processed claims line by line according to Medi-Cal guidelines, entered, and determined PPO contract allowances.
• Reviewed and processed refunds, transfers, and adjustments to patients' accounts.
• Ensured accurate coding of diagnoses and procedures based on medical reports.
• Managed daily workload of rejected claims (Medicare, HMO, PPO, etc.
).
• Documented and tracked authorizations from insurance companies for specialty visits.
• Conducted routine investigations on rejected and denied claims, researching overdue account balances.
• Resolved discrepancies and prepared adjustments and refunds when necessary.
• Analyzed complex accounts, trouble shoot problems, processed trauma billing, and appeal processing.
• Responded to patient and insurance company inquiries regarding accounts.
• Ensured accurate coding of diagnoses and procedures based on medical reports.
• Verified patient demographics and insurance eligibility to determine appropriate payer for collections and billing.
• Requested patient medical information from hospitals and providers' offices to support medical necessity.
• Followed up on assigned accounts through letters, emails, faxes, or telephone communication.
• Provided training in the front and back office on proper billing protocols.
ACHIEVEMENTS • Implemented a complex system that delivered instant alerts on unpaid claims, significantly reducing the waiting time for denied list generation.
• Demonstrated proficiency in processing over 100 insurance claims within a 5-day time-frame for timely reimbursement for healthcare services.
• Led and trained a team of 5+ personnel in medical billing, guiding them through comprehensive courses focused on accurately translating medical procedures into industry-defined codes.
• Consistently posted and submitted claims within a remarkable 48-hour time-frame upon receipt, streamlining the billing process and minimizing delays in reimbursement.
Please feel free to reach out to me with any questions or concerns you may have.
I look forward to hearing from you soon! Thank you, Tiffany
• Phone : NA
• Location :
• Post ID: 9092414719
