Obtain patient information from APP4TMS software.Verify patients’ eligibility, initiate prior authorizations if needed. Timely submission of CMS-1500 claims, with proper ICD-10 codes. Provide follow-up with payors for claim denials and rejections. Proficient in Tebra/Kareo EMR software. Provides additional support to the clinic on an as needed basis, including social media, outreach programs, and collaborating with marketing.

Provides prebilling/billing and follow up activity on open insurance claims by exercising revenue cycle knowledge (i.e; CPT, ICD-10, HCPS, NDC, revenue codes and medical terminology) Accurately enters and/or updates patient insurance information into Epic EMR. Appeals claims to assure contracted amount is received from third party payers. Compiles and maintains clear, accurate, online documentation of all activity relating to billing and follow-up efforts for each patient account, utilizing established guidelines.

Enter billing info into Availity.Create and file/submit insurance claims for clients using Availity.Verify benefits and communicate with insurance companies and clients/therapists.Update accounts receivable database with new accounts or missed payments.

Lead Medical Billing Account Specialist August 2023 – PresentConduct weekly meetings with the payment center staff to inform them of any policy changes, new clinic openings and to answer any questions or concerns. Train new hires on the principles of revenue cycle and payment center processes. Proficient in Epic EMRPerform QA on payment center calls weeklyRun Tempus report for Operations manager.Create schedules 3 months in advance and coordinate coverage when needed. Developed reference materials for the payment center.Other revenue cycle related duties as assigned by the operations manager. Medical Billing Account Specialist February 2023 – August 2023Answer and resolve any questions or issues relating to the patient account, including explaining insurance benefits to the patient, or authorized third-party callers.Assist patients with terms for repayment structures as well as negotiate any overdue balance to recover payment from patients.Collect payments from patients for processing.Process and manage medical billing claims.Contact insurance companies to verify eligibility.Perform other duties as assigned by the payment center manager.Reports as directed to the payment center manager.

Handle customer escalations, billing, and/or product use questions. Experience promoting and/or selling products and services.Proficiency with technology and how to apply it to solving problems.Utilize my troubleshooting and problem-solving skills to come up with solutions.Position value-added solutions to customers and close sales.

Coordinated and processed requests for new and refill shipments. Provided explanation of specialty services to new customers.Transferred and escalated clinical questions and issues to the staff pharmacist for resolution. Assisted with administration and operations duties as required. Maintained accurate and complete documentation of required information that met risk management, regulatory, and accreditation requirements. Contacted patients, physicians’ offices, or third-party vendors to respond to inquires or to notify them of investigation results and planned adjustments.