Medical Biller & Records Retrieval Specialist

Overview

Looking for full-time work (8 hours/day)

at $8.00/hour ($1,408.00/month)

(2014-2018)
College: Negros Oriental State University
Course: BSBA Major in Financial 
Management
(2013-2014) 
High School: Sibulan National High School
(2007-2013)
Elementary: Tubtubon Elementary School

Last Active

May 3rd, 2024 (2 days ago)

Member Since

February 1st, 2016

Profile Description

Combined with strong and progressive  8+ years of experience in medical billing and records retrieval. I have developed comprehensive knowledge with ICD-10 coding, CPT codes, modifiers, Medical Terminologies, Insurance Billing processes, guidelines, clearinghouse rejections, credentialing, prior authorization, insurance verification, and personal injury - chronological treatments of patients.

Medical Billing and Collection Specialist:

I have worked on all functions of medical billing and also did quality checks for the same. I have great experience working on the below-mentioned functions of medical billing.

1.  Patient Registration 
2.  Insurance Verification 
3.  Pre Authorization Request and verification 
4.  Charge Posting / Superbill review 
5.  Evaluation of valid HCPCS codes, ICD 9-10 and Modifier 
6.  Fixing Rejected Electronic claims 
7.  Checking clearinghouse reports (Phicure, Trizedo, Availity) 
8.  Provider PIN calling ( for verifying provider TAX id, NPI, and billing address) 
9.  EOB and check search via websites and batches 
10.  Payment Posting of Insurance and Patient 
11.  AR Follow up on denied claims via call or websites 
12.  Appeal project 
13.  Collection / Refund / Over-Payment 
14.  Scheduling new patients

Project Specialization:

1.  Daily Audit of sample size. 
2. Publishing weekly/monthly dashboard, production, and accuracy report to clients.
3. Working on new ideas to improve process accuracy and productivity. 
4. Doing calibration with QCA, Team, and Client to reduce process variances. 
5. Tracking or identifying root causes of insurance denials and low revenue.
 6. Conducting PKT (Process knowledge test) to bridge the knowledge gap. 
7. Suggesting corrective actions, implementing solutions, and reviewing implementation 
8. Providing feedback and refresher training to individuals and teams. 
9. Doing remotely and side by side audits of associates 
10.  Analyzing trends in quality check and fixing the bulk issue right away.

I have worked for the below-mentioned specialties of the provider’s claim specialties:

1. Physical Medicine and Rehabilitation
2. Behavioral Care Solution/Mental Health 
3. Weight loss 
4. Genetic Testing Laboratory 
5. DME 
6. Dental 
7. Physical Therapy 
8. Skill Nursing Facility 
9. Family Medicine / Doctor's clinic 
10. Internal Medicine

Software Work Experience:

1. Waiting Room Solutions 
2. Athena One
3. AdvancedMD
4. Simplepractice
5. Therapy Notes
6. ECW
7. HealthArc
8. ChiroTouch
9. Alleva

Major follows up Insurance:

1. Medicare 
2. Medicaid 
3. BCBS 
4. Aetna 
5. UHC 
6. Cigna 
7. Molina 
8. Tricare 
9. ChampVA
10. Humana 
11. Guardian 
12. Oxford 
13. Workers Compensation

Records Retrieval Specialist:

Software:

1. Smokeball
2. Filevine

Major Follow up of copy services:

1. MRO
2. CIOX
3. Chartswap
4. Healthmark
5. Itemizedbilling
6. Chartrequest

• Versatility in multiple assignments and tasks by identifying their level of importance 
•  Concentrating attentiveness, writing and speaking effectively. 
•  Excellent interpersonal abilities maintaining a good relationship between employer and colleagues.

I am willing to be trained and open to learning new things. I am a quick learner and self-motivated. Looking forward to working with you.

Here's the link of my resume for reference: Upgrade to see actual info