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0-5 years of experience
Assisted in analyzing and developing improved revenue performance for practices through the United States.
- Worked with individual practices to adopt best practices and improve existing processes.
- Conducted on-site visits to analyze and improve processes and utilization of system functions.
- Develop new Policies and Standard Procedure.
- Monitoring Revenue Cycle Management ensure that goals are met.
- Integrate and train staff on new functionality such as Charge Capture to streamline the processes at the practice.
- Acted as a liaison between the Practice and the Home Office to ensure the RCM Goals are met and that implementation are completed in a timely manner.
0-5 years of experience
- Achieved Company goal working Medicare of nearly $1.2B reduced to AR of $785M within 3-month span.
- Cash performance FY2017 reflected slightly over $1.6B.
- Maintained inventory >60 days metric starting at 40% and currently at 15%
- Analyze denied claims, resubmit claims, document claim statuses, request medical records, file appeals, redeterminations, etc.
- Managed six (6) Hospitals from Dignity Health on the west coast working Inpatient, Outpatient, SNF, Ambulatory Surgery, etc.
- Proven record of 95% or above on Quality Assurance scores every Month.
- Progressive experience in third-party, managed care, Medicare, Medicaid, Commercial payers, collections, UB04/1500billing procedures, cash applications, balancing and reconciliation processes.
- Task accounts to vendor seeking approval for CCI billing edits before process of claim.
- Research overlapping dates on claim and change occurrence codes, if necessary prior to submitting claims.
- Task to confirm supporting DX for denied line items before resubmitting corrected claim.
0-5 years of experience
Reviewed all unpaid claims to keep them from aging past 60-90 timeframe
- Processed/Sent and Received medical records for denied claims with anesthesia reports or trip reports
- Follow-up on Government Medicare Advantage plans regarding payments and adjustments
- Adjusted balances left on outstanding claims per contracted rates
- Submitted correct claims to be reconsidered for payment
- Worked extensively with Worker’s Compensation
- Worked with Attorneys and 3rd Party Vendors extensively
0-5 years of experience
- High level understanding of insurance benefits and payment guidelines
- Obtained and maintained all referrals and pre-authorizations to ensure adequate reimbursement
- Maintained insurance verifications, cash posting and collections
- High level of understanding of insurance coordination of benefits and reimbursement
- Implemented new ideas and procedures for efficient workflow
- Established and maintained relationships with new clients as well as patients
- Successfully and efficiently maintained accounts to ensure adequate reimbursement
- Extensive work with insurance payers to ensure proper billing and payment guidelines
- Collected over $300,00 in past due accounts via private pay patients as well as insurance payers
0-5 years of experience
Reviewed delinquent accounts, documented and updated changes
- Proficient in mandatory laws and regulations in processing Medicaid/Medicare/Commercial claims
- Collected payments on overdue accounts
- Maintained patient account balances based on required time frames
- Managed delinquent accounts initiating collections procedures as required
- Gathered medical records to input and update patient information In computer system
- Reported patient and payer credit balances on weekly, monthly basis
- Utilized the NexGen/Epic/Allscripts PM Medical accounting software systems
- Updated and tracked progress on patient accounts via spreadsheets-Excel
0-5 years of experience
- Review both obstetrical and gynecology ultrasound records to ensure accuracy in CPT and ICD diagnostic codes to ensure proper reimbursement
- Review medical records to ensure accuracy in CPT and ICD diagnostic codes for gynecology office and hospital procedures for providers to ensure proper reimbursement for surgical and other specialized, complex procedures.
- Collaborate with providers to resolve clinical documentation inaccuracies, incomplete documentation and corrections when necessary.
- Collaborate with billing department to resolve insurance denial and other billing questions.
- Promote adherence to industry regulations and maintains awareness of current industry trends in order to provide feedback and/or education to physicians and administrative staff.
- Identify opportunities for improvement in staff performance and processes based on analysis of insurance denials.
0-5 years of experience
- Extensive Knowledge of all insurance payers (BCBS, Managed Care, Commercial, Medicaid, Medicare, and Workers Compensation)
- Knowledge of Provider Credentialing and Contracts with HMO Payers
- Researched Insurance Payers to identify requirements for clean claims submission
- Established procedures to ensure sound collection of receivables
- Created Spreadsheets to track denial trends, missing/underpayments and unapplied payments
- Interacted with the Clinical staff and Patients to obtain additional information needed to process claims
- Identified accounts requiring collection agency or legal action and coordinate collections with third party contractors
- Processed Credit Refunds/Contractual Adjustments and Discounts.
- Complies with department safety policies and procedures to help ensure that the safety and physical well-being of patients, family members, visitors and co-workers are maintained
0-5 years of experience
- Recieving denied claims and correcting errors for resubmission
- Sumbitting claims electronically and by mail
- Emailing / calling clinical office sites to obtain correct Patient information for claims
- Verifying insurance eligibility for each patient for claims to be submitted
- Working with insurances such as but not limited to: Mass Health, Network Health, BMC, Neighborhood Health, and Commonwealth Care Alliance
0-5 years of experience
- Liaison between the insurance companies and the physician’s offices with regard to pre-authorizations, billing, collections, refunds, and client relations in order to maximize quality and value for clients.
- Monitoring and review of open account receivable to identify adjustments, refunds, and payment breakdown amounts.
- Communicate with carriers, physician’s offices, patients, and management to achieve resolution of issues and claim payment.
- Meet and maintain accuracy, productivity and turn-around standards established for the department.
0-5 years of experience
- Handle inbound calls and schedule patient appointments
- Verify insurance and patient information
- Collect payments and maintain cash drawer
- Communicates effectively and respectively with patients and team members
- Provides exceptional customer service
0-5 years of experience
- Verified and posted daily sales and cash activity for UCP and the Affiliates.
- Performing different tasks that include posting cash receipts, updating cash flow reports, researching charge backs among multiple insurance companies to ensure accurate payment.
- Handle and track all money received and prepare transactions for daily deposits.
- Code cash receipts to ensure that they are applied to the appropriate accounts in the General Ledger.
- Responsible for credit collections on all accounts by contacting the customers by phone, e-mail and written correspondence.
- Analyze accounts to discover discrepancies and resolve all variances promptly.
- Assist the Director of Accounts Receivable with any projects as assigned.
6-10 years of experience
Appeals
- Payment posting
- Mail return
- Request medical records for appeals for denied claims.
- Communicate with insurance companies pertaining to denial on account to get maximum payment on claims.
- Verify eligibility
0-5 years of experience
- Oversee a small team to ensure business standards are being met
- Resolve second level billing issues from employees on various teams
- Manage billing offices for Enterprise Accounts
- Resolve and submit a high level of claims on a daily basis for various practices
- Follow up with insurance companies to ensure timely payment of claims
- Train representatives on insurance billing practices.
- Answer billing questions from patient, patient services and internal employees
0-5 years of experience
- Thorough knowledge and understanding of DME practices, medical EOB’s, insurance or third party correspondence, contractual payments and adjustments, denials management
- Submit claims for 3 offices within the East Tennessee Region, Average claim process of 600 per week, Bill out DME for 3 offices within the East Tennessee Region
- Accounts receivable for 3 offices, Monitor aging report keeping within 90 days
- Ensure proper documentation is on file
- Responsible for ensuring all claims processed through EMR are correct and compliant
- Ensure all assigned charts are audited and billed; ensure that all billable charges are entered into billing system
- Keeps abreast of and complies with coding guidelines and reimbursement reporting requirements.
- Identify and resolve patient billing issues
- Obtain authorization from insurance company to ensure that claim will be paid, Called insurance companies, Verified insurance online, Called insurance companies to gather authorizations for services as needed
0-5 years of experience
Timely verification of medical insurance benefits
- Re-verified existing patient insurance coverage
- Called private insurance companies, Medicare, and Medicaid to obtain benefit information
- Ensured orders were shipped in a timely manner
- Evaluate and secure the needed documentations to facilitate payments of claims for initial and review/appeals payments.
- Edit and resubmit claims for payment
- Prepares and reviews clean claims for submission to various insurances either electronically or paper
- Identifies and resolves patient billing complaints
- Works closely with contracting to resolve current payer/contracting issues
- Prepares daily EOB and timely filing reports for each collector
- Training new employees, team leads, and supervisors
0-5 years of experience
- Responsible for operations of patient business services, insurance verification and authorizations
- Provide patient revenue management support throughout the revenue cycle, to include: incoming call center, billing and collections, payment posting, pre-registration and charge capture
- Initiate and develop relationships with customers in order to gather and process information or resolve issues in order to receive accurate reimbursement & optimize internal & external customer satisfaction
- Answer and resolve inbound inquires and issues regard patient acco9unt, statements, explanation of benefits, balance due and other patient & insurance scenarios
- Send out claims and patient statements for reimbursement
- Financial and trend analysis work, including low payment monitoring and resolving of outstanding balances
- Analyze data prior to entry or modification to ensure accuracy and integrity
- Remain current with trends, regulatory requirements and business strategies related to the revenue cycle
- Set up payment plans for patient with delinquent medical bills
0-5 years of experience
- Verify patient information, address, phone number, and insurance utilizing EPIC, and various web portals.
- Obtain authorizations and referrals for incoming and outgoing office visits, MRI/CT, outpatient procedures, and inpatient stays and surgeries.
- Identify and submit errors in processing to the appropriate departments for follow up of denials.
- Explanation of benefits and cost to patients about daily charges and procedures.
- Check in/out patients.
- Audit patients’ charges weekly for the provider to insure timely billing.
- Verify CPT codes are appropriate for the ICD10 on claims being billed out.
- File and follow through on appeals for procedures the insurance denied.
- Working with the Patient Experience Committee in teaching AIDET to fellow coworkers
- Providing feedback and process improvement with our Front Office Work Group, to insure all of Legacy has a lean work flow.
0-5 years of experience
- As the sole responsible party for collection efforts, I have committed to demonstrating expertise among a wide range of carriers, and their specific requirements and legal specifications; meeting and often exceeding a cash goal of 1,000,000.00 per month.
- I manage all refund requests, ensuring that requests are highly detailed with special attention to contract rates and stipulations. I am also responsible for all refund correspondence between the various insurance carriers, pricing agencies, and patients.
- Key player in establishing contracts and Single Case Agreements for an expanding Central Business Office
- Assists in initiating and completing appeal requests, to obtain payment and authorization through, mail, fax, and telephone communication.
0-5 years of experience
- Responsible for training of new hires and staff in proper billing procedures.
- Accountable and responsible for the timely and accurate submission of claims to appropriate pay sources.
- Accountable and responsible for the timely and successful follow-up of all outstanding account balances.
- Maintain a high level of accuracy of follow-up while maintaining thorough and concise notes documenting communication with all involved parties
- Develop and manages an established closing schedule and procedures to facilitate billing timeliness on regular basis.
- Update accounts receivable database with new accounts or missed payments.
- Charge entry
- Responsible for accurately posting payments from different pay sources and efficiently balancing accounts.
0-5 years of experience
Analyzed account receivables and corrected all problems.
- Met all productivity and collection goals including dollars collected and accounts handled.
- Initiated appeals of denial of payment for services.
- Reduced rates of delinquent accounts.
- Send Medicaid, Health first, Fidelis, Affinity, and private insurance claims.
- Submit approvals for insurance in timely manner; Submit appeals.
- Verify insurances.
- Submit any documents that insurances need or fax them.
- Have knowledge of Easy dental, Patterson Eagle soft, Dental Exchange, Rennaissance electronic services.
- Supervising duties include monitoring, researching payments, denials.
- Dental coding.
10+ years of experience
- Submit claims to Medical Assistance and GHP for payment.
- Followed up on any unpaid accounts.
- Completed various special projects.
0-5 years of experience
- Identifies revenue cycle issues and implements solutions
- Provides verification of insurance benefits
- Analysis claims/Appeals
- Determines insurance company and financial status classification
- Medicare part A&B management of claims
- Maintains a high level of accuracy to meet productivity and quality requirements
- Confirms amount and collects from patient as appropriate
- Supports revenue cycle acquisitions and mergers activities
- Documents and maintains current Masterfile processes and procedures
- Researches payer and government websites, medical resources, and coding guidelines to identify payer and claim requirements
0-5 years of experience
- Follow up on unpaid claims.
- Correct claims denied in error.
- Verify patient insurance and benefits.
- Submit claims daily via electronic or paper.
- Submit appeals for claims denied based on Medical necessity.
- Post payments and write offs to account.
- Sent patient statements.
- Trained new office staff.
- Assist manager with special projects.
- Team player.
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Revenue Cycle Specialist
Last edited by: Gabriela Barcenas, CPRW, Content Writer II -
Gabriela Barcenas
CPRW, Content Writer IIGabriela is a Certified Professional Resume Writer (CPRW) and career adviser. With 10 years of digital media experience and five years of resume writing expertise, her publication history includes fashion, education, travel, social justice, equitable design and career advice.
