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Professional Summary

Medical Office Manager and Biller with 15+ years experience leading a team of employees. Driven, energetic and highly motivated with strong communication and interpersonal abilities, which help provide the necessary skills to accomplish daily tasks. Excel in both independent and team environments.

Skill Highlights
  • Office Management procedures
  • Healthcare Billing
  • Insurance Carriers
  • Ophthalmology, OB-GYN, Orthopaedics, Surgery,  Physical Therapy & ENT
  • Surgery Coordination
  • ICD-9 and ICD-10 Coding
  • CPT and HCPCS Coding
  • EMR Proficient
  • Business Development
  • Schedule Management
  • Accounts Payable/Receivable
Professional Experience
Medical Office Manager 03/2017 to Current Shasta ENT Specialists Redding, CA
 
Responsible for ensuring day to day activities within the practice run efficiently and provide structure for the provider and office staff. 
 
  • Exhibit expert knowledge of policies, procedures, ethical standards and laws regarding a Medical Practice.
  • Manage Doctor's Calendar/Schedule.
  • Coordinate office activities to secure efficiency and compliance.
  • Supervise office staff to ensure patient needs are met.
  • Ensure compliance and maintain awareness of payers, reimbursement policies and health insurance guidelines.
  • Hire, train and supervise staff in Medical Office procedures.
  • Assist with Insurance verification's, authorizations and pre-certifications for surgery and office procedures.  
  • Support front office, surgery and back office when necessary.
  • Patient billing Inquiries.
  • Order and track office supplies. 
  • Maintain office Policies and Procedures
  • Manage office Accounts Payable   
  • Monitor Employee Time Cards and Personal time off  
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Medical Billing Manager 07/2012 to 03/2017 Waxahachie Orthopaedics & Sports Medicine; Excel Well Rehab Waxahachie, Texas

 

Managed all billing practices. Maintain quality control, patient data entry and insurance carrier information in addition to tracking EDI responses. 

  • Verify electronic payments and ensure correct postings. 
  • Ensure timely and accurate claim submissions.
  • Utilized hospital portal, operative notes, demographics and insurance information for surgery patients.
  • Correctly identified billing errors and refile denied/rejected claims.
  • Post payments and adjustments accordingly.
  • Oversaw practice A/R to minimize the number of unpaid claims and patient account balances.
  • Handle patient inquiries regarding billing and insurance.
  • Support the front office and surgery coordinator when needed.
  • Preformed insurance verification's, authorizations and pre-certifications as needed. 
  • Credentialing 
  • Support the physician, provide employee training, maintain current policies and procedures, handle insurance carrier re-validations and generate financial reports.
Office Manager / Surgery Coordinator / Medical Biller 10/2009 to 07/2012 Dr. Rebecca Robert, MD Grapevine, Texas

 

Led a staff of six team members, engaging in cross-training and the implementation of administrative policies and procedures.

  • Implemented a new EMR system and supervised employee training. 
  • Delivered administrative support for two physicians.
  • Monitored time cards and personal time off. 
  • Served as an experienced surgery coordinator, scheduling in-patient and out-patient surgeries and procedures.
  • Completed insurance verifications, authorizations and pre-certifications.
  • Ensured timely and accurate claim submissions.
  • Posted payments and adjustments accordingly.
  • Correctly identified errors and re-filed denied/rejected claims.
  • Managed the practices A/R and completed required reports.
Education and Training
Medical Terminology Shasta College Redding, Ca 2017
Certified Medical Billing AAPC / American Academy of Professional Coders Member Since 2014
Accounting Certification 2008 Shasta College Redding, CA
This resume is created in 7 minutes.
Professional Background
Responsible for the overall success of the Sutherland's engagement. Guiding it from inception through development and implementation, providing continuity for the client through the lifetime of the relationship. An Account Manager is responsible for ensuring a high degree of client satisfaction by managing expectations, facilitating communication and focusing effort on the engagement both internally and externally.
Skill Highlights
Windows, MS Word, Excel, Power Point, Visio, Explore, Lotus Notes, Outlook, Readyline, ECenter, Health EMS, Internal share drives, Carrier Websites, Accurint, View and Deliver, Decision Analyzer, WS FTP Pro, Mainframe Application, Database & Report Query Application
Professional Experience
Account Manager
February 2005 to Current
EMS
  • Serve as client advocate, ensuring that the client's issues and concerns are fully understood and appropriately addressed by Sutherland.
  • Troubleshoot; provide direction and support employees and managers with day to day inquiries.
  • Maintain continuity in the engagement by establishing and leading regular business meetings with the clients, including preparation of agenda, executive summary and post meeting update (Trip Report).
  • Develop and maintain good relationships with the clients.
  • Negotiate schedules and deadlines with Service Center, programming, and the client.
  • Obtain input from the Service Centers prior to each business meeting with the client.
  • Maintain documentation for project team availability.
  • Identify and implement new healthcare rules into existing processes.
  • Responsible for analyzing data using Readyline.
  • Monitor new/old business technical projects for Mainframe programming and process flow.
  • Submit and prioritize detailed programming specs, work with programming and quality assurance to test/approve results.
  • Planning, organize and coordinate critical time sensitive and accurate execution of client billing, while helping improve program efficiencies - measurably reduce processing time and problems.
  • Collaborate with client s and internal team members to develop business and product-deployment strategies.
  • Establish data processing, tracking protocols to ensure timely and efficient processing.
  • Develop customized reports for the client to fit their needs.
  • Provide monthly reports (remittance report, close report, credit balance etc).
  • Manage the Lockbox reconciliation from Service Center.
  • Perform benchmarking and conduct audit reports (Aging A/R, Credit Balances etc).
  • Provide feedback/update to service center for reconciliation.
  • Review policy and procedures relating to insurance verification, signature authorization, payment posting, denial management, and identity theft.
Account Specialist/ Medical Biller
May 2004 to February 2005
  • Initiated billing of emergency medical services (ambulance).
  • Hardcopy and electronic claim submissions to all payers groups Including Medicare, Medicaid, Blue Cross Blue Shield and other commercial carriers.
  • Followed up status on billed claims to all insurance carriers and with patients for insurance information.
  • Posted cash and adjustments / allowances for Medicare, Medicaid, Blue Cross Blue Shield and other commercial insurances direct payments and personal checks.
  • Explanation of Benefits and payment voucher interpretation with full disposition of posted accounts.
  • Prepare refund packages.
  • Supervised team of five or more in their daily duties.
  • Assisted in special projects when needed.
  • Provided understanding to insurance carries regarding any relevant inquires related to claim adjudication.
  • Responsible for printing and mailing of claims.
February 2004 to Current Sutherland Global Apollo Health Street New York, NY
Customer Service Specialist
February 2004 to May 2004
  • Handled inbound calls from patients, attorneys and insurance carriers.
  • Verified Patient demographic for accurate billing.
  • Verified Insurance information for accurate billing.
  • Assisted patients and attorneys with coordination of benefits and payment plans.
  • Ensured that all paper work containing PHI and sensitive patient financial data was filed away in locked cabinets.
Education and Training
Certificate Program - Medical Billing Certificate : May 2004 Computer Career Center Queens, NY
High School Equivalency Diploma : July 2001 LaGuardia Community College Long Island, New York
Languages
Fluent in Spanish
Skills
ambulance, audit reports, balance, benchmarking, Benefits, billing, develop business, Credit, client, clients, data processing, Database, dependable, direction, financial, FTP, Insurance, interpretation, Lotus Notes, mailing, Mainframe, Medical Billing, meetings, Excel, Outlook, Power Point, Windows, MS Word, organization skills, processes, programming, protocols, quality assurance, Maintain documentation, Fluent in Spanish, Troubleshoot, View, Visio, Websites
This resume is created in 7 minutes.
Professional Summary
An organized, highly-skilled office manager and medical biller. Efficient in fast-paced, multitasking environments, and can prioritize efficiently in any situation.
Skill Highlights
  • Fluent in Spanish
  • Experience with Medicare, Medicaid policies.
  • Experience with managing claim denials, resubmitting claims and adding modifiers
  • Proficient in Computer Skills
  • Experience with major insurance companies, Aetna, Ghi, United Healthcare, and Oxford.
Professional Experience
Medical Biller
January 2014 to November 2015
Medstar Consulting Pomona, NY
  • Follow up medical claims for OB GYN and all podiatry accounts
  • Re-submitted claims with modifiers
  • Answered patient questions
  • Reported medical policies
  • Experience with Medicare claim denial policies
Office Manager
August 2007 to December 2013
Bennett J. Berkowitz MD Suffern, NY
  • Ordered and ensured that supplies were fully stocked
  • Made appointments
  • Scheduled surgeries
  • Assisted doctor in medical procedures
  • Obtained authorization from insurance companies
  • Responsible for billing and posting payments
  • Conducted follow-up calls and collections
  • OB GYN Coding
Front Desk Receptionist
April 2004 to March 2006
Cornell MRI New York, NY
  • Answered phones
  • Greeted and registered patients
  • Scheduled appointments
  • Verified insurance coverage and obtained authorization
  • Experience with and knowledge of IDX and CERNER
Education and Training
Associate of Arts : Liberal Arts, 2000 Mercy College Bronx, NY
This resume is created in 7 minutes.
Summary
Dedicated and focused team player who excels at prioritizing, completing multiple tasks simultaneously and following through to achieve project goals. Seeking a role of increased responsibility and authority.
 
Highlights
  • Self-directed
  • Time management
  • Professional and mature
  • Results-oriented
  • Insurance eligibility verifications
  • Workers' compensation knowledge
  • Claims appeal procedures
  • Patient charting
Experience
October 2013
to
June 2016
Mad River Community Hospital Arcata, CA Medical Biller
Cooperated with Medicare, Medicaid and private insurance providers to resolve billing issues.
Organized files, developed spreadsheets, faxed reports and scanned documents.
Made copies, sent faxes and handled all incoming and outgoing correspondence.
Handled Workman's Compensation claims.
Billed secondary insurance claims.
November 2010
to
July 2011
Griffith Luoma Chiropractic Eureka, CA Receptionist
Managed the receptionist area, including greeting visitors and responding to telephone and in-person requests for information.
Maintained the front desk and reception area in a neat and organized fashion.
Made copies, sent faxes and handled all incoming and outgoing correspondence.
Education
1997
Eureka High School Eureka, CA General