Medical Billing and Claim Specialist

Overview

Looking for part-time work (6 hours/day)

at $7.00/hour ($924.00/month)

Bachelors degree

Last Active

July 23rd, 2023 (268 days ago)

Member Since

January 5th, 2021

Profile Description

As a highly skilled Medical Billing and Claim Specialist with over five years of experience in the US Healthcare Industry, I have developed a comprehensive understanding of various domains. My expertise includes collecting payments for healthcare providers, comprehending prior authorization requirements, and providing eligibility and benefit coverage information. Through my collaborative work with third-party companies, providers, and hospitals, I have processed medical claims, identified reasons for denial, and reprocessed claims for payment. My extensive experience across various facets of the industry has expanded my comprehension of how the healthcare system and insurance operations work in the United States.

In my previous role at a billing company, I catered to diverse provider/facility specializations, ensuring equitable reimbursement for providers. My responsibilities often included sending appeals to insurance companies, coordinating with providers, or accessing Electronic Health Records (EHR) to furnish additional documentation to support their claims.

My experience has equipped me with the skill to identify genuine reasons for the denial and provide appropriate and effective resolutions to help providers reprocess claims. I am proficient in handling different lines of business (Medicare, Medicaid, Commercial) across all states and working in a specialized team that caters to Independent Physician Associations (IPA) in the states of California and Nevada. This has given me a unique perspective on how claims are processed from the insurance company's standpoint.

Working in the back office of a diagnostic center that provides Covid-19 tests has given me first-hand exposure to the process of finalizing claims before submitting them to insurance companies. Furthermore, my proficiency in generating reports, such as consolidated weekly and monthly productivity reports of all offshore workforce, which were dispatched directly to the client while working in the directors' office, has added to my skill set.

Regarding pharmacy-related responsibilities, I am adept in verifying pharmacy coverage, scrutinizing prescriptions, confirming prior authorization requirements, and assisting pharmacies or providers in acquiring prior authorization. I support pharmacies in processing claims and provide real-time resolution in line with company protocols and guidelines.

My experience in the industry has prepared me to adapt to changes seamlessly. I have cleared the annual HIPAA risk assessment, achieved the required quality score, and delivered quality customer service experiences with minimal supervision. I am committed to continuing my learning and sharing my experience with others to enhance my skills further.