Experience

sleeptech

• United States
• Home Health Care Services
• 1 - 100 Employee

• Medical Insurance Biller

  • Jan 2023 - Present

  Clackamas County, Oregon, United States



Foothills Medical Supply

• United States
• Hospitals and Health Care
• 1 - 100 Employee

• DME Billing

  • Jan 2023 - Present

  United States



WRINKLE RESPIRATORY & DME, INC

• United States
• Medical Equipment Manufacturing

• DME Billing

  • Jan 2023 - Present

  United States



Carelon Global Solutions

• United States
• IT Services and IT Consulting
• 700 & Above Employee

• Medical Claims Specialist

  • Sep 2021 - Dec 2022

  * Apply medicare, medicaid billing guidelines to achieve maximum reimbursement. * Detail knowledge of medical coding; ICD-9, ICD-10, CPT and HCPCS codes. * Confirm coverage and work with private payers, commercial payers, Medicaid, and Medicare for reimbursement of provide medical services. * Research medical records, compliance requirements and explanations of benefits to resolve accounts payable for Medicare, Medicaid and commercial insurance. * Maintain strict… Show more * Apply medicare, medicaid billing guidelines to achieve maximum reimbursement. * Detail knowledge of medical coding; ICD-9, ICD-10, CPT and HCPCS codes. * Confirm coverage and work with private payers, commercial payers, Medicaid, and Medicare for reimbursement of provide medical services. * Research medical records, compliance requirements and explanations of benefits to resolve accounts payable for Medicare, Medicaid and commercial insurance. * Maintain strict confidentiality/privacy of patients' protect health information in accordance with HIPAA regulations. * Assist in educating new hires in HIPPA laws and training. * Assist with special reports of tracking problem medical claims according to HIPPA guidelines. * Adhere to strict HIPAA guidelines for handling and processing sensitive information within these claims. * Review documentation, analyze reject claim data, justify CPT & HCPCS codes and pay CMS-1500 and UB04 claims. * Obtain and enter demographic, clinical, income information into the computer system, efforts ensure compliance with HIPAA. * Review and resolve claim appeals according to policy guidelines. * Review multiple radiology reports from different clinics/hospitals and diagonals them. * Work all identify Medicaid requirement edits through the electronic billing system. * Resubmitted correct claims and appeals to insurance companies within timely filing. * Verify documents and coordinate health care coverage for patients, including eligibility of benefits. * Coordinate with interdisciplinary team members to ensure MDS complete accurately and timely for submission and subsequent reimbursement. * Verify patient insurance coverage, obtain authorizations as necessary, prepare patient estimate payment prior to surgery date. * Locate and process RTP's that occur on appeal claims. * Find and process all IME denials and RTP's including the manual rebilling that is required on almost all IME claims. Show less



Crowne Plaza® Hotels & Resorts

• United States
• Hospitality
• 700 & Above Employee

• Event Management Specialist

  • Apr 2019 - Aug 2021

  Philippines Served as Event Management, Banquet Operation and Food & Beverage service. We are in charge of the hotel's events and activities.