*Perform billing and collection of commercial insurance revenues.*Adjust and maintain accounts to reflect correct and current balances,*Process transactions in accordance with contractual terms and complex regulations governing Private Pay, Medicare, Medicaid and Managed Care. *Ensure accurate accounting for financial statements and reports in accordance with current acceptable accounting and cost-reimbursement principles relating to the skilled and long-term care operation and as may be directed by the Director of Resident Accounting or the Chief Financial Officer.*Correctly coded and billed medical claims for various hospital and nursing facilities.*Evaluate contracts on a consistent basis to ensure billing criteria is met.•Monitor denial letters and requests for additional information and ensure complete information is sent within required timeframes.*Assess delinquent accounts and prepare reports to identify potential uncollectible balances to assist in establishing an adequate reserve for bad debts.*Review and research unpaid accounts; prepare and process any necessary adjustments; and contact appropriate revenue sources to expedite collection and resolve disputed transactions.*Review ancillary charges on each claim to ensure accuracy to the relative vendor invoice.*Proficient ability to access and utilize available third-party eligibility and insurance software, PCC, Microsoft Word, Excel and Outlook.*Maintain confidentiality of all resident information.*Complete all other duties as assigned.*Monitored accounts for compliance with established payment plans and flagged those in violation.

My responsibilities includeAnswered phones,Scheduled appointments, Verify Insurance, Billing, Correspondence, Reconsideration and appeals. Check in and cashier.

Corrected claim edits for Medicare patients that hit the NCCI/CCI edits. Used correct coding guidelines to correct claim for billing to insurance. Had to review both inpatient and outpatient medical records, have a understanding of CPT procedures, ICD-9-CM, medical terminology. Understand insurance carrier processing guidelines as well as Medicare claim guidelines.

My company is a revenue recovery company who has over a 50 hospital clientele.We resolve underpaid accounts and review these delinquent accounts for resolution and payment from the carrier. I review the coding for the inpatient, outpatient, ambulatory surgical and clinic bills that were denied by the carrier for missed coding issues or other erroneous issues the client may have missed. I review the medical records and assess the issues and come to resolution to help client re-bill claim for correct payment.

Handled the collections for outstanding balances for this company’s client. My duties included, researching for the reason why the patient’s account had an outstanding balance. Contacted the member’s insurance company to obtain status on the patient’s claim(s), and attempt all efforts to bring the account for that patient current. Determined if a claim needed to be refilled or submitted for an appeal with the payer or written off. Reviewed patient information in Medical Manager to determine why claim was unpaid or short paid; at times extensive research was needed to resolve the issue. Reviewed insurance contracts to determine coverage on service and to determine if the insurance company was adhering to the contract. Had to determine if an adjustment was needed if claim was not payable by the insurance company. Documented all collection activities in Medical Manager for patient collections notes and on the collections daily work sheet, sent the completed work sheet to the Collections Supervisor. Kept records of funds that were collected. Printed UB Billing forms as needed to re-bill claims and maintained all records. This position involved extensive research at times.

Process in-patient and out- patient claims and skilled nursing home for both paper and electronically submitted patient claims for four Medicare supplement companies. Other duties include adjusting claims, contacting providers on a needed basis and keep daily records of production.