Medical Office Resume
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Resume:
Billing Specialist III (REMOTE) /-present
Review and submit secondary/tertiary claims by paper or electronically thru Nextgen clearinghouse
Track/review claim denials, correct all claim errors and resubmit within timely filing
Communicate with secondary payers regarding inaccurate reimbursement or EOBs
Post insurance payments and adjustments to patient accounts according to payers contracted rate
Responsible for patient assistance program enrollment (Eylea U, Genentech, Good Days, and Allergan Eye) for patients with financial hardships or uninsured
Communicating with patients and payers to resolve coordination of benefit issues
Communicating and assisting the Retina physicians team with resolving patient assistance issues and drug replacement
Maintain a thorough understanding of payer policies, review payer correspondence, and participate in webinars.
Answer any questions from physicians, patients, A/R staff, and insurance companies.
Responsible for managing monthly aging reports for secondary payers to attain A/R production
Responsible for correcting secondary payer errors in Nextgen clearinghouse
Manage secondary A/R daily task log reconciling account inaccuracies
Lash Group/ Amerisource Bergen
Benefits Verification Specialist (REMOTE) /-/
Verification of IN/OUT of network benefits for Regeneron’s Eylea U and utilizing several payer portals.
Verification of benefits for new and established patients
Understanding of insurance payer deductibles, out of pocket, co-Insurance.
Knowledge of referral and authorization requirements
Responsible for updating insurance information into patients account as well as verifying and updating patient demographics in required systems
Acts as liaison between patient, physician office, and insurance company to assist concerning financial responsibilities
Office Coordinator/Nursing School Liaison
Serenity Nursing Services &Nurse Aide Academy /-/
Created and modified documents such as reports, memos, and letters using word processing, spreadsheet, database and/or other presentation software (Microsoft Office)
Managed the agency referral process.
Processed referrals over the phone, via fax or email and process.
Pre-screened referrals from clinical perspective to determine level of services for clients.
Assist Nursing Coordinator with auditing client medical record according to government program guideline
Ensured all approved authorizations were processed and assigned to a government program (VA, CAP, CAP-C, Medicare) and home health aide within required timeframes.
Processed new hires, separations, and job changes
Managed employee vacation, sick time and pay adjustments.
Timely and accurately keying payroll information
Posting of client ancillary charges into SEMBRE Care (home health billing software program)
Coordinated and scheduled annual nurse visits with clients
Reviewed all claims for completeness, reasonableness of charges, appropriateness of ICD-/CPT billing codes, and payer information before electronic submission
Pursued timely collection of each claim using thorough follow-up efforts appropriate to each payer, also follow up on insurance claim denials, and exceptions or exclusions.
Conducted billing utilizing most efficient resources to secure timely payment of open claims or invoices.
Regularly met with billing manager to discuss and resolve reimbursement issues or billing obstacles.
Adhered to a strict code of ethics and complied with all Serenity Nurse Aide Academy policies and procedures, NC State and Federal laws and accrediting body regulations.
Consulted with students regarding problems or concerns and assisted students in obtaining support to meet these specific needs.
Advised students including career choices, curriculum options, personal assistance, and academic support.
Maintained student records on advising activities; updated student information and pulled inactive student files.
Home Health Aide-Charlotte, NC
Amore Home Care /-/
Provided various personal care giving services in accordance with established plan of direct care.
Provided for the personal needs and comfort of the client in his/her own home
Assisted clients with activities of daily living including bathing, dressing, grooming, and toileting etc
Prepared client meals and special diets
Performed light housekeeping
Provided transportation assistance to and from appointments
Provided compassionate companionship to clients
Medical Secretary-Charlotte, NC
West Med Practice Partners /-/
Responsible for inbound phones calls for three specialty sites (Internal Medicine, OBGYN, Pediatrics)
Appropriately scheduled patient appointments based on physician guidelines
Accurately documented patients medical request via EHR for physician to review
Responsible for handling all calls efficiently to attain daily call production goals
Coordinated work efforts with other team players to achieve an efficient workflow and time adherence within the office
Maintained strong knowledge of all site protocols and physician schedules/changes to ensure appropriate information is provided to patients
Performed other office duties as assigned by the manager
Insurance Verification Specialist / Surgery Scheduler-Charlotte, NC
Surgical Specialists of Charlotte //-/
Responsible for scheduling inpatient and outpatient surgical procedures
Reviewed surgical orders to ensure that the surgical facility and anesthesia screening requirements were current and accurate
Verified eligibility, initiated pre-authorizations, and collected surgery deposits
Communicated with the patient and coordinated all visits that were required during the preoperative period, postoperative period, and provided patients with procedural instructions given by the physician
Tracked patient lab results and surgical clearance statements prior to surgery for physician to review
Communicated/documented any change in the patients medical condition as reported by the patient to the physician
Provided clinical support as needed
Maintained monthly scheduled surgery report
EDUCATION AND PROFESSIONAL DEVELOPMENT
Bachelor of Health Sciences -Health Information Management /- Present
Southern New Hampshire University
Associate of Health Sciences - Medical Office and Billing Specialist /-/
Ultimate Medical Academy - Clearwater - Clearwater, FL
Medical Reimbursement /-/
Central Piedmont Community College - Charlotte, NC
Certified Nursing Assistant Program /-/
Central Piedmont Community College - Charlotte, NC
High School Diploma /-/
West Mecklenburg High School- Charlotte, NC
