Tiffany Chapman
Rockingham
Summary
Results-driven Medical Billing Specialist with extensive experience at Optum, adept at appeals and denial management. Expert in medical coding and claims reconciliation, successfully reducing denial rates through strategic payer resolution. Strong analytical skills enhance billing accuracy and compliance, ensuring timely reimbursements and optimized revenue cycles.
Overview
7
7
years of professional experience
Work History
Medical Billing Specialist
Optum
Plano
02.2022 - 03.2025
- Followed up on outstanding accounts receivable across all payers, including self-pay accounts.
- Resolved insurance denials through root cause identification and corrective action implementation.
- Coordinated with insurance carriers and patients to optimize claim reimbursement processes.
- Processed EDI transactions and ERA files, reconciling carrier edits and rejection reports.
- Analyzed delinquent insurance reports to identify trends and enhance billing workflows.
- Assisted with the reconciliation of accounts receivable ledgers at month-end close process.
- Assessed billing statements for correct diagnostic codes and identified problems with coding.
- Maintained detailed records of all billing activities including denials, adjustments, and payments received.
Denial Specialist
Rivera Billing Services
Lusby
03.2020 - 02.2022
- Resolved denied claims through thorough research of payer requirements and preparation of appeals.
- Identified denial trends and collaborated with clinic staff to implement reduction strategies.
- Conducted daily audits on all submitted bills to ensure accuracy and completeness.
- Assessed accuracy of medical codes in patient records for compliance.
- Reviewed medical records to identify diagnosis codes, procedures, and supplies for coding.
- Managed coding across multiple specialties, ensuring precise application of codes.
- Collaborated with physicians to gather additional clinical information for accurate coding.
- Coordinated with billing department to clarify issues related to coding discrepancies.
Medical Biller / Patient Account Specialist III
Greater Maryland Pain Management
Odenton
07.2018 - 01.2020
- Investigated denied claims and processed appeals to secure reimbursements
- Collaborated with patients to set up self-pay arrangements and payment plans
- Audited patient accounts for billing accuracy and claim compliance
- Maintained communication with third-party billing companies for account resolution
Medical Billing Specialist
Greater Washington Orthopedic Group
Rockville
01.2018 - 06.2018
- Managed payment posting, coding, and insurance follow-ups
- Worked on complex insurance denials, securing proper documentation for appeals
- Ensured claims were correctly coded and submitted for timely reimbursement
Education
High School Diploma -
Patuxent High
Lusby, MD05-2007
Medical Billing & Coding Certification -
Penn Foster College
Scottsdale, AZSkills
- Appeals and denial management
- Medical coding (ICD-9, ICD-10, CPT, HCPCS)
- Claims reconciliation and investigation
- Payer resolution strategies
- Data interchange and ERA processing
- Billing and collections in healthcare
- Compliance with HIPAA regulations
- Management of revenue cycles
- Analytical skills for problem-solving
- Regulations for Medicare
Affiliations
American Academy of Professional Coders (AAPC)
Languages
Spanish
Full Professional
References
References available upon request.
Timeline
Medical Billing Specialist
Optum
02.2022 - 03.2025
Denial Specialist
Rivera Billing Services
03.2020 - 02.2022
Medical Biller / Patient Account Specialist III
Greater Maryland Pain Management
07.2018 - 01.2020
Medical Billing Specialist
Greater Washington Orthopedic Group
01.2018 - 06.2018
High School Diploma -
Patuxent High
Medical Billing & Coding Certification -
Penn Foster College