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Skillful Reimbursement Specialist resume

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  • Problem solving
  • Customer service
  • Maintains confidentiality
  • Dedicated team player
  • Office support (phones, faxing, filing)
  • Familiar with commercial and private insurance carriers
  • Account auditing
  • Close attention to detail
  • Insurance and collections procedures
Work History
Account Receivable Representative, 06/2017 to 09/2017
MedSynergies, Inc. Irving , TX
  • Contacted government(Medicare, Medicaid) commercial & managed care insurances via web/ phone to verify claim status
  • Appealed denials with appropriate documentations
  • Researched contracts to verify correct payments
  • Verified and updated patient information
  • Worked correspondence
  • Consulted with hospital/provider office for procedure accuracy
  • Submit Medical Records/Prior Authorization
  • Updated Provider credentialing
  • Verifyinsurancebenefits
  • Verify authorization for services
  • Request retro authorization if applicable
Senior Reimbursement Analyst, 01/2017 to 05/2017
Evolution Health Dallas , TX
  • Maintained strict patient and physician confidentiality.
  • Confidently and adeptly handled claim denials and/or appeals.
  • Submitted electronic/paper claims documentation for timely filing.
  • Reviewed and resolved claim issues captured in TES/CLAIMS edits and the clearing house.
  • Confirmed accurate completion of forms/reports for the admission, transfer and/or discharge of each resident.
  • Assisted in the maintenance of medical charts and/or electronic medical record (filing, Op Reports, test results, home care forms).
  • Verified patients\' eligibility and claims status with insurance agencies.
Commercial Insurance Biller, 12/2015 to 03/2016
CHRISTUS Health Irving , TX
  • Completes all third party electronic and manual billing timely and accurately in accordance with appropriate rules and regulations.
  • Completes all payer specific edits identified through the billing system.
  • Resolves issues associated with incomplete claims including follow up of non-transmitted claims.
  • Submit adjustment claims to Commercial and Third Party through use ofChristusHealthsoftware programs.
  • Requesting appropriate documents when billing manual claims including ER reports, itemized bills, implant invoices and other medical records.
  • Rebilling claims electronically to commercial insurances and third party payers daily.
  • Works all daily reports as assigned.
  • Records daily productivity of claims billed and assures proper documentation in the notes of the patient accounting systems.
  • Completes all monthly required in-services and educational training as required.
  • Other duties as assigned
Reimbursement Specialist, 09/2015 to 11/2015
US Renal Care, Inc. Plano , TX
  • Follow up on unpaid and underpaid account balances for OON insurances carriers.
  • Complete re-bill request as necessary to facilitate timely and proper claims payment.
  • Performs claims appeals as required
  • Performs retro-authorization appeals as required
  • Review and researched insurance correspondence and makes necessary corrections to ensure claims payment.
  • Provides insurance carries with requested information to facilities payment.
  • Prepares forms and necessary information to transfer payment and/or missing payment to be posted.
  • Work on special projects as need it.
Billing Coordinator, 04/2008 to 07/2015
University of Texas Southwestern Medical Center Dallas , TX
  • Reviews and processes Insurance claims through Epic billingsystem, including Medicaid, Medicare, Commercial Insurance, Veteran Affairs, Worker\\'s Compensation and third party payers.
  • Identify problems and inconsistencies.
  • Function as a resource person for departmental personnel to answer questions and assist with problem resolution.
  • Resolve electronic claims rejections and EOB\\'s denial in a timely manner
  • Review and resolved correspondence from all organizations
  • Upon receipt of insurance payment, bill secondary insurance and/or patient
  • Contact patients to obtain insurance information needed to process claims such as COB information, accident details, preexisting questionnaire, etc
  • Prepare adjustments such as refunds, contractual differences and write-offs for approval and processing
Medical Eligibility Specialist, 02/2018 to Current
Health and Human Services Commission Austin , TX
High School Diploma: 1987
DeVry University - Irving , TX
  • Medical Terminology
  • International Classification of Disease Coding 9/10
  • Current Procedure Terminology
  • Fundamentals of Human Anatomy and Physiology Pathopharmacology Introduction to Health Services and Information Systems

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    Job-winning Reimbursement Specialist resume

    This resume is created in 7 minutes.

    A highly trained Reimbursement Specialist with excellent qualifications seeking a position in which my knowledge can be fully utilized to assist doctors and patients obtain required authorizations for medical treatment.



    • More than 18 years experience in ICD-10 and CPT coding.
    • Remarkable ability to analyze treatment prescriptions and submit clinical documentation to support medical necessity.
    • Thorough knowledge of medical insurance claims procedures and documentation as well as medical terminology. 
    • Uncommon ability  to use independent judgment and to manage and impart confidential information.
    • In-depth knowledge of medical billing procedures - submission of insurance claims.

    • Capable of working independently or with a group of people. 
    • Exceptional ability to prioritize work to meet goals and objectives within acceptable time frames.
    • Professional when conversing with patients, doctors and insurance representatives.
    • Through in all paperwork and research relevant to each case.
    • Excellent work ethic and strong desire to perform the job well.
    Putnam Hospital Center, Health-Quest February 2008 Reimbursement Specialist
    Carmel, NY
    • Coordinate patient work flow, financial clearance process, and secure reimbursement for Radiation Therapy. 
    • Verify insurance benefits and determine financial liability and prior authorization requirements for all out patients by reviewing patients insurance policy. 
    • Complete physician work sheets and submit medical information to obtain prior authorization for Radiation treatments ordered by five doctors.
    • Schedule peer to peers for physicians if medical necessity was not meet.
    • Submit clinical information for Radiology tests ordered by five Doctors daily to obtain required authorization.
    • Discharge patients accounts in Mosiaq and Cerner when patient finals.
    • Review daily charges for all four sites add modifiers and export charges daily.
    • Complete daily charge audit of all Radiation charges and export charges for four sites.
    • Complete patient end of treatment charge audit to verify accurate billing.
    • Reconcile reports daily and make necessary corrections.
    • Register patients in Cerner and enter ICD-10 code for every consult.
    Pediatric Associates of Putnam December 2007 to December 2008 Medical Biller
    Carmel, NY
    • Submit claims to insurance companies electronically and paper claims.
    • Maintain supporting documentation files and current addresses.
    • Process patient statements, data entry, post transactions, and verify accuracy of input to records generated.
    • Research and respond by telephone and in writing to patient inquiries billing issues and problems.
    • Follow up on submitted claims.
    • Monitor unpaid claims as necessary.
    • Post and Reconcile payments to patient ledgers.
    • Balance daily batches and report, prepare income reports and statistics.
    • Maintain patient demographic information and data collection systems.
    • Participate in development of organization procedures and update forms and manuals.
    • Perform backup duties for accounts receivable and front desk operations.
    • Enter daily bank deposits and monitoring EFT payments.
    • Ensure strict confidentiality of financial records.

    Benita Gross, MD March 2000 to December 2007 Office Manager of OB GYN Practice
    New Rochelle, NY
    • Submit claims to insurance companies electronically and paper claims.
    • Scheduled consult, and follow up appointments.
    • Posted all charges, collections, and follow up functions.
    • Sent statements to patients.
    • Interacted with insurance companies.
    • Scheduled OR cases and out patient office anesthesia.
    • Trained all new hires.
    • Cleaned, wrapped and sterilized instruments.
    US Health Mgt Corp November 2000 to June 2001 Medical Receptionist of Open MRI Facility
    Brewster, NY
    • Scheduled and confirmed patient appointments.
    • Handled heavy call volume.
    • Checked patient eligibility.
    • Obtained prior authorizations from insurance companies.
    • Demographic data entry.
    • Handled all patient inquiries.
    • Faxed reports to prescribing doctor offices.

    Yonkers Contracting Co Inc February 1987 to February 1991 Accounts Payable Supervisor
    Yonkers, NY
    • Balanced monthly accounts payable reports, printing and releasing checks to subcontractors.
    • Assisted in processing job site invoices.
    • Liaison between accounts payable department and controller.
    • Liaison between job sites and subcontractors.
    • Supervised data entry of five accounts payable clerks.
    Education and Training
    Christopher Columbus High School 1987 Bronx, NY, 10466
    Certified Billing and Coding Specialist (NHA)

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    Experienced Reimbursement Specialist resume

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    Professional Summary
    Meticulous trainer , excellent at juggling multiple tasks and working under pressure. Broad industry experience includes Healthcare, Finance and Real estate.
    • Team leadership
    • Self-motivated
    • Team liaison
    • Strong verbal communication
    • Conflict resolution
    • Process implementation
    • Extremely organized
    • Budgeting and finance
    Work History

    • Train all newly hired individuals and those inducted through job rotation activities by ensuring that they comprehend warehouse processes.
    • Instruct safety techniques of packing/fulfill order (container and label placement) In consolidation department.
    • Interpret procedures, processes and regulations appropriately and apply interpretation to consolidation daily production.
    • Effective presentation of training topics to trainees and other facility trainers.
    • Ascertain that trainees are aware of order accuracy procedures and conformity at each stage of the training.
    • Ensure and maintain quality customer satisfaction.
    • Observe employees to determine the efficacy of training programs and ensure that any additional training requirements are fulfilled.
    Office Manager Aug 2009 - Sep 2016
    Access One Consultations Hallandale Beach, FL
    • Support the accounting department with customers demographics, tax preparations, setting/follow up appointments and general office duties.
    • Bookkeeping, responsible for all bookkeeping duties.
    • including AP, AR, Payroll, and Monthly Accrual Journal Entries.
    • Monitors and analyzes department work to develop more efficient procedures and use of resources while maintaining a high level of accuracy.
    • Document and counsel customers financially regarding outstanding charges and effectively resolve problems (Highest customer service skills and etiquette).
    • Provide administrative support as necessary to the owners.
    • Coordinate with external CPA firm on tax filings.
    • Conduct transaction requests as directed by financial advisor.
    • Maintain client contact during the financial planning process.
    • Meet department production standards consistently as defined by department management.
    • Transcribe compliance related changes and/or implementations.
    • Accurately counts and tracks all daily activities.
    Auditing Reimbursement Specialist Jul 2007 - Jul 2009
    Health Check Inc Dania Beach, FL
    • Researched contract language & agreements made between hospitals & insurance companies.
    • Conducted audits for revenue cycle, followed established protocols, reviewed medical record documentation against billing to assess compliance with all laws(various states), rules, policies and procedures, and regulations,.
    • Identified charge error rates, procedural weaknesses, system weaknesses, coding appropriateness.
    • Performed coding and billing accuracy reviews.
    • Identified billing errors and posted discrepancies in registration.
    • Increase hospitals revenue hundreds of thousand dollars.
    • Collaborate with other management staff in strategic planning or development activities with the goal of ensuring ongoing effective billing and reimbursement.
    • Promotes and maintains harmonious and effective relationships and communications within the department, with government representatives and with customers.
    • Consistently updates knowledge of regulations, procedures and standards to assure compliance with contractual obligations and directives from governmental and regulatory agencies, fiscal intermediaries and contracting entities.
    • Manage all third party denials and appeals, making certain that all appeals are completed on an accurate and timely basis.
    • Works with the Billing Manager to implement and maintain written policies and procedures so that the appropriate submission, billing and payment agreements of contracted accounts are maintained.
    • Participates as a Revenue Cycle Department member and provides input via reporting observations, concerns and asking appropriate questions.
    • Advanced understanding of payment methodology for both Hospital and Physician services.
    • Understanding of Revenue Codes, DRG, APC, CPT, ICD-9, HCPCS and CDT.
    • Sound Understanding EOB, EFT, Denials, COB,.
    • Knowledge of Medicare, Medicaid, and other commercial payers (HMO, PPO) .
    Patient Account Representative Medical Manager Oct 2004 - Jul 2007
    Dania Beach, FL
    • Perform all of the billing and collection activities for assigned programs, ensuring timely and accurate billing.
    • Provide high level of customer service to patients regarding their bill or insurance, gather information and problem solve to achieve account resolution.
    • Confirm census, financial eligibility data, authorizations.
    • Complete paper and/or electronic billing to multiple payers.
    • Post payments, manually and electronically.
    • Identify under/overpayments and process refunds.
    • Respond to claim denials based on insurance requirements.
    • Identify bad debt and complete write off requests.
    • Follow up on unpaid charges and determine best method to collect open balances quickly.
    • Identify/complete billing adjustment.
    • Complete month end reconciliation.
    • Responsible for managing and resolving open balance accounts.
    • Stay current on insurance policies and procedure.
    • Make corrections to charges as needed based on medical documentation (i.e.
    • add modifiers, duplicate denials, correction of date of service, diagnosis corrections).
    • Respond to insurance or patient telephone inquiries and correspondence regarding claims/reports.
    • Handle inbound patient billing and making outbound collections phone calls.
    • Update account information as needed.
    High School Diploma: 1992
    Mount Vernon High School Mount Vernon, NY