Alexa Grande
Princeton
Summary
Organized Medical Biller thoroughly versed in medical coding, HIPAA requirements, CMS Guidelines, ICD 10, CPT, and HCPCS. Personable, with several years of hands-on experience claiming refunds, reviewing claims, and maintaining billing reports. Accommodating and helpful team player proficient in job-related billing software.
Works quickly with insurance companies including private, commercial, Medicare, Medicaid, and MCOs (versed in the difference between HMO and PPO) within a high-traffic office environment.
Accurate coding, claims processing and managing patient accounts. Aware of the requirements for different insurers in order to ensure a clean claim. Showcased proficiency in medical software systems (trained in three separate ones) and pride in strong investigational skills regarding difficult claims and finding a patient policy with very little information. Skills and commitment to maintaining confidentiality in handling sensitive patient information.
Prepares and distributes statements to customers while maintaining comprehensive, accurate records. Accustomed to answering questions, providing information and resolving concerns. Good communication, organizational and multitasking abilities. Ability to process payments from patients over the telephone.
Skilled in reconciling accounts, identifying discrepancies, and resolving billing issues promptly. Strong attention to detail and numerical accuracy.
Highly-motivated employee with desire to take on new challenges. Strong work ethic, adaptability, and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills. Working knowledge of the pace of a billing office, and how quickly billing situations can change.
Overview
4
4
years of professional experience
1
1
Certification
Work History
Medical Billing Specialist
Advanced Spine And Pain Center
Clayton
10.2021 - Current
- Generated monthly invoices for patients based on services provided according to established fee schedules.
- Maintained detailed records of all billing activities including denials, adjustments, and payments received.
- Monitored aging accounts receivable balances ensuring timely resolution of outstanding balances.
- Conducted research on insurance policies, procedures, and regulations to ensure compliance with all applicable laws.
- Analyzed rejected claims and corrected errors as necessary before resubmitting them for payment.
- Processed credit card payments from patients in accordance with office policy.
- Ensured HIPAA compliance by maintaining confidentiality of all patient information.
- Created and processed claims to third-party payers using specific coding guidelines.
- Verified the accuracy of claim data prior to submission to insurance carriers.
- Updated patient accounts with information obtained from internal departments or external sources.
- Provided customer service support to patients who had questions about their bills or payments due.
- Submitted appeals for denied claims when appropriate according to the insurance company's criteria.
- Resolved discrepancies between insurance companies and patients regarding payment of bills.
- Reviewed patient records for accuracy and completeness of information in medical billing system.
- Initiated collection efforts on unpaid accounts by contacting insurance companies or patients directly via phone or mail.
- Prepared and attached referrals, treatment plans or other required correspondence to reduce incidence of denials.
- Prepared billing statements for patients, ensuring correct diagnostic coding.
- Reviewed and verified benefits and eligibility with speed and precision.
- Contacted patients for unpaid claims for HMO, PPO and private accounts and performed friendly follow-ups to ensure proper payments were made according to contracts.
- Maintained current working knowledge of CPT and ICD-10 coding principles, government regulation, protocols and third-party billing requirements.
- Contacted insurance providers to verify insurance information and obtain billing authorization.
- Analyzed and interpreted patient medical and surgical records to determine billable services.
- Posted charges, payments and adjustments.
- Collaborated closely with other departments to resolve claims issues.
- Identified errors and re-filed denied or rejected claims quickly to prevent payment delays.
- Submitted refund requests for claims paid in error.
- Precisely completed appropriate paperwork and system entry regarding claims.
- Generated financial reports for management review.
- Handled billing, waivers and claims for private and commercial clients.
- Coordinated communications between patients, billing personnel and insurance carriers.
- Reviewed account information to confirm patient and insurance information is accurate and complete.
- Reviewed claims for coding accuracy.
- Submitted appeals using provider portals and phone communication.
- Communicated with insurance representatives to complete claims processing or resolve problem claims.
- Weighed envelopes containing statements to determine correct postage and affix postage.
- Collected, posted and managed patient account payments.
- Investigated past due invoices and delinquent accounts to generate revenues and reduce number of unpaid and outstanding accounts.
- Developed strong professional rapport with vendors and clients.
- Reviewed legal claims for accuracy and issues.
- Entered procedure codes, diagnosis codes and patient information into billing software to facilitate invoicing and account management.
- Answered patient questions to maintain high satisfaction levels.
Education
Health Insurance Specialist Certificate - Medical Office Administration
Johnston Community College
Smithfield, NCSkills
- Medical coding
- Claims processing
- Insurance verification
- Customer service
- Account reconciliation
- Effective communication
- Attention to detail
- Time management
- HIPAA compliance
- Accounts payable
- CPT knowledge
- Patient billing
- ICD-10 proficiency
- Payment posting
- Denial management
- Files and records management
- Medicare and medicaid process
- Collections management
- Claim submission
- Collection calls
- Data entry
- Medical terminology
- Patient collections
- Multitasking and organization
- Teamwork and collaboration
- CPT code modifiers
- Claim review
- Procedure coding
- CMS-1500 billing forms
- Balance reconciliation
- Verbal and written communication
- Authorizations
- Paper claims
- Creating claims for new patient visits, follow up visits, urine drug screens, and in-office procedures such as: TPI, LESI, SNRB, FJNB, FJNA, SIJ, GNB, SCS, EMG, and others
Certification
- Health Insurance Specialist Certificate
Languages
Italian
Limited
Timeline
Medical Billing Specialist
Advanced Spine And Pain Center
10.2021 - Current
Health Insurance Specialist Certificate - Medical Office Administration
Johnston Community College