Michael D. Caira Email & Phone Number

Brookline, Ma

Took care of billing for Blue Cross/Blue Shield - MA & Beacon Health Strategies via: paper claims, direct data entry, and electronic billing.Submitted denied or underpaid Beacon Health Strategies claims for adjustment online to obtain proper payment.Billed Secondary claims via paper & direct data entry.Posted payments from prior months that were never recorded.Posted: cash, check, and credit card payments to self-pay accounts.Met with clients about self-pay bills, and corrected any errors.

Greater Boston Area

Posted payments from Medicare B & Medicare A for 5 Mental Health Hospitals for the State of Michigan.Audited others work, and returned it to them for correction prior to posting.Removed $0.00 charge items from the database.

Charlestown, Ma

Verified information on scanned invoices so that they could be paid.Printed & referred problem invoices so that they could be researched, and paid manually.

Waltham, Ma

Did Monthly Aging Services Access Point (ASAP) billing using the Healthwyse billing system. * Did both paper and electronic Mental Health billing using Therapist Helper. * Used Claims Connect to bill Medicare B claims. I would then check the reports generated the next day to verify that all of the claims went through, and corrected any errors on rejected claims. * Did manual crossover claims from Medicare B to secondary payors that did not cross over automatically from Medicare B. * Used MassHealth's Eligibility Verification System (EVS) to verify patient eligibility for 400 patients per month in the: Mental Health, Home Health, and Group Adult Foster Care programs. * Used MassHealth's Virtual Gateway to enter claims, and print out. Weekly payment reports. * Did Direct Data Entry of claims into the following systems

Did billing & follow-up for: Network Health, BMC HealthNet Plan, Neighborhood Health Plan, and Tricare/Champus. Used Meditech system to track payment progress.Transferred co-pays from insurance to self-pay.Referred claims for write-off to Billing Manager.Checked REV's system to verify: Medicaid Eligibility, Claim Status, and Primary Care Clinician Information.Researched outstanding Medicaid balances on SDK system. Unbilled claims were sent to Medicaid. If the patient had other insurance, then balances were transferred, and the claims were billed to the proper carrier. Finally, if claims were paid, but still showed a balance, then those were given to the billing manager for write-off.Verified Primary Care Clinician information for Meditech claims, and updated the patient's record accordingly.Did Medicare A to Medicaid manual crossover billing.

Used Epic Medical Billing system to resolve behavioral health denials, usually by printing corrected paper claims for resubmission. * Went online to determine Eligibility Information, and claims information from the following carriers: BC/BS, CIGNA, United Behavioral Health/PacifiCare, Beacon Health Strategies, and Neighborhood Health Plan. * Sent a weekly report to the Authorization Resolution Department of claims that needed: authorizations, authorization updates, or other corrections from the provider of service. * Work with other claims representatives, and the treatment sites answering any questions related to behavioral health claims. * Resolve complicated cash-posting issues related to behavioral health payments.

Sent in Medicaid Applications to help qualified patients obtain Medicaid Benefits.Interviewed patients to obtain relevant information, and to have them sign the applications.Did follow-up phone calls to Insurance Companies on overdue accounts.

Print paper claims for: Early Intervention, Mental Health, and Lactation Education.Voided & Rekeyed charges that were billed to the wrong insurance carrier(s).Billed and did follow-up on Home Health & Group Adult Foster Care, (GAFC), claims.Trained new Biller in: Mental Health, Home Health, and GAFC claims.Handled special billing claims such as Co�rdination of Benefits, and any Manual Claims necessary for Early Intervention.Created Educator Service Plans for Early Intervention clients with Medicaid, or a Medicaid HMO.Worked with billing people doing charge entry, and Insurance changes in: Early Intervention, Mental Health, and Lactation Education to solve Insurance issues.Ran REV's Eligibility for Medicaid & Medicaid HMO clients.Verify Medicaid Coverage thru REV's.Make sure that all charges that need to be billed to the Department of Public Health, (DPH), for Early Intervention have been billed.Follow-up on DPH pended claims.

Did follow up phone calls on overdue accounts and adjustments. * Submitted electronic claims to MBHP, and did resubmissions of any outstanding claims. * Pulled backup on claims requiring adjustment or write off. * Filled in as necessary for other account representatives who were out on leave of absence. * Did projects as assigned by the Supervisor and Manager.

High School Diploma, College/University Preparatory And Advanced High School/Secondary Diploma Program

Activities and Societies: Newton North Concert Choir Bacon House Council

Bachelor Of Science In Business Administration, Management

Activities and Societies: Northeastern University Chorus - Served as Concert Manager for 1 year.