Reimbursement Specialist resume examples

Choose and edit as your own

Get inspired by the best resume examples picked for your profession and create your!

Add pre-written phrases

Describe yourself as a professional just in 2 clicks! All the phrases you need are prepared by us

Save and Download your Resume

Save it in PDF format. Ready-to-sent to you employer!

This resume is created in 7 minutes.
Summary

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.

Skills

 

  • 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.
Experience
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)
This resume is created in 7 minutes.
Professional Summary
Meticulous trainer , excellent at juggling multiple tasks and working under pressure. Broad industry experience includes Healthcare, Finance and Real estate.
Skills
  • Team leadership
  • Self-motivated
  • Team liaison
  • Strong verbal communication
  • Conflict resolution
  • Process implementation
  • Extremely organized
  • Budgeting and finance
Work History

TRAINER, WALMART DC Atlanta, GA
  • 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.
Education
High School Diploma: 1992
Mount Vernon High School Mount Vernon, NY
This resume is created in 7 minutes.
Professional Summary
Administrative and Data Entry Professional with demonstrated track record of success in revenue improvement and cost control. Forward-thinking and resourceful with exceptional program management and team building strengths.
Skills
  • Payroll management
  • Revenue generation and management
  • Efficient
  • Quality assurance
  • Leadership experience
  • Clear communication skills
  • Financial administration
  • Data management familiarity
  • Hiring and recruitment knowledge
  • Team leadership
  • Process improvements
  • Decision-making ability
Work History
01/2014 to 01/2017
Reimbursement Specialist Boston Heart Diagnostics Framingham, MA
  • Entered financial data into the Xifin and Blue Cross Blue Shield accounting databases to be verified and reconciled.
  • Generated invoices upon receipt of billing information and tracked collection progress.
  • Managed and responded to all correspondence and inquiries from customers and vendors.
  • Communicated with customers to identify and resolve outstanding payments.
  • Streamlined bookkeeping procedures to increase efficiency and productivity.

01/2012 to 01/2014
Sales Administrative / Invoicing Assistant Paragon Communications Bolton, MA
  • Answered and managed incoming and outgoing calls while recording accurate messages.
  • Completed data entry, and served as the customer service liaison.
  • Compiled company information and related material and distributed it to clients.
  • Screened all visitors and directed them to the correct employee or office.
  • Processed client rebate and replacement reconciliation, reporting and check requests.

01/2010 to 01/2011
Administrative Assistant Adesa Framingham, MA
  • Coordinated background checks on candidates by obtaining information from law enforcement officials, previous employers and references. Scheduled appointments for pre-employment drug screenings.
  • Coordinated employment offers with management and extended offers to selected candidates. Entered personnel and subcontractor data into a central database.
  • Evaluated timecards for accuracy on the regular and overtime hours.
  • Addressed and resolved general payroll-related inquires.
  • Maintained daily logs of  inventory supply. Liaised with vendors to order and maintain inventory of office supplies.

01/2009 to 01/2010
Front Desk Representative Comfort Inn Milford, MA
  • Greeted, registered and assigned rooms to guests of hotels or motels. Made and confirmed reservations.
  • Posted charges for rooms, food, liquor, or telephone calls, to ledgers manually or by using computers. Computed bills, collected payments and made change for guests.
  • Performed concierge duties such as wake-up calls, arranging transportation, and providing outstanding customer service.
  • Managed the inventory and supply ordering for the hotel, to include office and cleaning supplies, as well as food items.

Education
2006
High School Diploma:
Rafael Lopez Landron High School - Guayama, Puerto Rico
This resume is created in 7 minutes.
Summary

To obtain a job that will challenge me and allow me to use my skills and past experiences in a way that is mutually beneficial to both myself and my employer and allow for future growth and advancement.

Education and Training
Certificate: Medical Secretary Field 2000 Abbie Business Frederick, MD, USA

Coursework in Health Services, Coursework in Health Service Policy and Analysis,  Coursework in Business, Marketing and Communications,  Coursework in Business Administration and Organizational Development

Skills
  • Strong organizational skills
  • Seasoned in conflict resolution
  • Courteous demeanor
  • Energetic work attitude
  • Administrative support
  • HIPAA compliance
  • Healthcare billing proficiency
  • Strong medical ethic
  • Computerized charting specialist
  • Medical transcription expert
Experience
Front Desk Receptionist 05/2006 to 08/2008 Dr. Mohammed Khan Frederick, MD
  • Verify patient insurance and referrals
  • Answer phones, take copays and payments
  • Schedule patients
  • Appeal unpaid medical claims
  • Send out patient statements 
  • Excellent customer service skills
  • Served as liaison between management, clinical staff and the community
  • Actively maintained up-to-date knowledge of applicable state and Federal laws and regulations
  •  
Reimbursement Specialist 07/2000 to 04/2006 Business Side Olney, MD
  • Update all demographics for accurate payment of claims
  • Resubmit medical claims
  • Collect payments up to $10K or more each month
  • Answer inbound phone calls
  • Work on special projects with the insurance companies
  • Resolved customer questions, issues and complaints
  • Developed rapport with the customer base by handling difficult issues with professionalism
  • Generated and distributed daily reports and order acknowledgments to appropriate personnel.
Administrative Assistant 01/2000 to 05/2017 MBS TAX SERVICES Derwood, MD
  • Managed the receptionist area, including greeting visitors and responding to telephone and in-person requests for information
  • Designed electronic file systems and maintained electronic and paper files
  • Served as central point of contact for all outside vendors needing to gain access to the building
  • Organized files, developed spreadsheets, faxed reports and scanned documents.
  • Managed daily office operations and maintenance of equipment.
  • Excellent customer service skills