Correctly determined quantities and prices for drugs billed.Verified that payments received were correct according to the contracted fee schedule.Ensured compliance with policies and guidelines outlined in the contract terms and fee schedule for each payor.Followed up on invoices submitted to ensure prompt and timely payment.Monitored and effectively worked order exception report.Monitored cash velocity reports to identify root cause issues and actions to improve velocity.Monitored denial trends and ensured all denials worked timely and effectively.Worked aged invoices effectively in order to achieve or exceed Cash Velocity outlined in the KPIsMaintained and exceeded appropriate levels of collector effectiveness.Worked denials daily and aged invoices timely.Ensured aged claims worked in a 60-day cycle to achieve or exceed AR>90 goals.Maintained BD and Contractual Adjustments to meet KPI.Proactive approach in detailed research and thorough questioning when engaging with payers for denial trends.

Secure inpatient psych admits authorizations for proper billing.Coordinate and update patient authorization status spreadsheet.Follow up on inpatient admission notification status.Analyze and identify admissions missing authorizations from insurances.Calls with behavioral health care managers and clinicians to provide preliminary clinical information.Insurance eligibility verification and benefits for inpatient coverage.Spanish translator for Triage, Clinicians, Social Workers, and other Admissions staffCompletion and faxing of inpatient admit notifications for pre-auth approval.

Analyze and resolve problem accounts within assigned Aging ReportFollow up on claims with insurance company representatives or online.File appeals, grievances and/or provider dispute for unpaid or underpaid patient claims.Calls with patients regarding unpaid accounts and/or for collection effortsClaims research for accurate billing and reimbursement. Charge entry of CCM and RPM billingCustomer assistance/resolution with questions or concernsCoordination in myAbility, New York Medicaid and Zirmed for resolution of missing/invalid electronic claimsAnalyze excel spreadsheets for accurate billing and reimbursement.Patient collections callsGenerate and filter statements for accurate patient billing.Insurance payment posting and adjustments.Follow up on denials and resolve for reimbursement.Identify insurance overpayments and coordinate recoup or refunds to payers.

Eligibility and benefits verification of patient insuranceCharge Entry of daily fee tickets/ superbillsAssign diagnoses to patient visit per doctor progress notes.Assign diagnoses for neurosurgery operative charges.Spanish translator for doctor/ patient office visits/consultationsSpanish translator for patient office callsAnalyze and resolve problem accounts within assigned Aging ReportFollow up on claims with insurance company representatives or online.File appeals, grievances and/or provider dispute for unpaid or underpaid patient claims.File Medicare Redeterminations or Reconsiderations on Medicare portal.File and resolve Medicare and/or DME secondary appeals via mail.File and resolve Medi-Cal paper CIF’s and appeals for payment on disputed claims.Calls with patients regarding unpaid accounts and/or for collection efforts

Prepare and maintain the database for electronic data interchange.Analyze and resolve file transfer errors for government payers.EDI coordination between billing service and insurance payersComplete daily billing department functions including medical coding, claims, 277CA and 999 rejection reports.Update provider and insurance information in Scheduler/ EMR software.Coordinate EDI enrollment with clearinghouse for submission of electronic claims and retrieval of electronic remittance advices.Training of new hires in claims processing (rejections), data entry into software, database maintenance, and electronic error file corrections.The point of contact with onboarding members while billing database is being setup and well after ‘Go live’.Claims research for accurate billing and reimbursement.Customer/ Onboarding assistance/resolution with questions or concerns.Coordination with Phoenix Headquarters in regards Revenue Cycle Management inquiries.Coordination with Change Healthcare and other clearinghouses for resolution of missing/invalid electronic files.Creating spreadsheets for transfer of information, rejection reasons and database verification forms.Creating step by step instructions for training modules for new hires/ onboarding staff.

Medical Billing Clerk performed other office duties as necessary.Insurance claims inquiries, checks processing and deposits.Liaison between doctors and medical billing companyAssisted physicians in administrative duties.Patient dispute calls- gave patient detailed explanation of benefits upon request.Secondary insurance billing, appeal letters, Medi-Cal TAR formsBilling and Patient CollectionsPatient Collections – worked with patients on their balances by offering payment options.Meet projected collection amounts per month.Maintain spreadsheet file for patient collections.Ensured files were properly documented with insurance information required for billing.Liaison between patient and insurance company