Experience

Trinity E.M.S. Inc. a division of PRIDEStar EMS

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

• Senior Billing Specialist

  • Sep 2020 - Present

  * Complete’s daily billing charges * Completes daily deposit of EFT payments from insurance companies, paper checks and credit card payments received via payground portal. * Patient Registration / Insurance Verification * Tracks missing face-sheets by calling the facility to request current patient information on file. * Manually enters patients demographics into our billing systems to run daily eligibility checks for each patient transport. * Customer Service Calls to patients, insurances, and attorneys offices * Billing for BLS, ALS, Level-1, Non-Emergent Transports and Chair Van Services to and from Facilities or patient homes. * Submits claims electronically / CMS 1500 Form * Experience with Zoll - RescueNet Software * Experience with Easy Print Software - Medicare EOB electronic access. * Experience with Office Outlook 365 * Follow-up on insurance denials * Submits Insurance Appeals, Attorney Demand Letters and Patient Letters * Works A/R’s that are 30 to 60 days still outstanding in our system. * Call Blue Cross & Blue Shield regarding all transports that’s are not paid within 60-90 days to collect claim status check as we are a non-contracted provider and BCBS will issue payment to the subscribers, so once verified we submit a private-pay patient invoice to collect revenue. * Issues insurance refunds / Retraction / Take-back request and patient refunds. * Completes system contractual’s when needed as EOB and Billing system don’t correlate with one another. * Completes Attorney's Request for Medical Record’s/Bill’s (Chartswap) * Submits secondary claims and attaches Medicare EOB’s that don’t crossover electronically. * Access to all insurance payers via website portals to verify claim status check, resubmit a corrected claim or to complete an appeal - upload your documents using PDF files to help collect revenue faster on denied claims. * Maintains Patient Confidentially - HIPAA * Works Remotely 4 days a week. In office 1 day out of the week. Show less



Lowell General Hospital

• United States
• Hospitals and Health Care
• 700 & Above Employee

• Certified Professional Coder

  • Mar 2013 - Jun 2020

  *Proficient in electronic professional claims submission for Medical Oncology, Hematology, Diabetes Management, PCP Practices, Inpatient Care, Emergency Room Visits, OB-GYN Surgical Procedures, Psychiatry, Vascular Disease, Palliative Care and Centers for weight management. *Works Remotely - Part Time / In Office Part-Time *Zoom meetings / Conference calls *Coding for all inpatient, outpatient, observation, emergency room, office visits, urgent care, telemedicine visits, surgical procedures, tests and injections. *Performs assignment of codes , verification of completeness and tracking of code variations from physician specified encounter information. *Excellent customer service, communication and organizational skills by interacting with hospital personnel, providers and various hospital departments. *Transitioned from ICD-9 to ICD-10, courses provided by Lowell General Hospital. *Experience with ICD-10/CPT Coding, dispute resolution and insurance follow-up. *Uses appropriate medical terminology. *Reconcile work duties, very dependable and reliable. *Collected payments / Processes payments *Completed A/R’s / Works denials *Customer Service calls to patients and insurance carriers. *Manual entry for paper slip charges *Experience with the following software systems: AthenaNet - Electronic Billing Software (Cloud based program), Emdeon for referrals & Eligibility, MMIS-Portal Mass-Medicaid, EMR: Eclinical /PowerChart/Meditech, Passport OneSource, Quick Pay Portal to help patients pay their bill online. *Microsoft office / Outlook facility emails *Copy machine / Fax Machine / Scan PDF files *Continued Education for CBCS Certification *Follows federal, state and local legal guidelines along with confidentiality. Show less



SEPULVEDA & ASSOCIATES, PC

• United States

• Medical Billing And Coding Specialist

  • Oct 2005 - Feb 2013

  * Post daily checks from all insurance payers to patient accounts in NDCLytec billing software system. * Reconcile the practice day sheet in NDCLytec practice management software and prepares the practice day sheet for daily bank deposits. * Reconcile rejected explanation of benefits (EOB) or statement of account (SOA). * Calls all insurance company’s to verify claim status of unpaid charges that are in the pipeline and not paid within 60 days from the date of service for all insurance payers with filing deadlines of 60 to 90 days. * Responsible for sending all primary claims by electronic submission and bills secondary insurance claims on paper which is a CMS 1500 form that do not interface/crossover electronically by medigap or supplemental insurance carriers. * Experience with the following software used: NDCLytec 2011 Electronic Billing Software, PowerChart - Cerner/Cirtrix Access Gateway (LGH-Main) MD portal & Meditech MD Portal (Saints Campus). EMR - Springcharts Software / Emdeon clearing house / MS Word, Excel, Power Point Presentation, MS Outlook And Office support. * Many years of Medical Billing Experience with ICD-9/CPT Codes, Commercial Insurances, Medicare Part B, Mass-Medicaid, Third Party Billing (TPL), HMO’s, PPO’s, POS’s, Worker’s Compensation, Auto-Related Cases/Insurances, Accounts Receivables and payables. * Responsible for timely, accurate claim submission and payments to maximize reimbursement. * Prepares patient statements for the first business day of each month and answers any customers service calls that may relate to the professional billing operation. *Experience with all aspects of E/M, procedural and diagnostic coding for Internal Medicine and Nephrology. * Educating all staff members within the office of any and all new changes to the billing rules and regulations. * Answers all incoming calls and completes all necessary data entry related to billing. * Schedules patient appointments and collects patient-copays. Show less