Experience

Family and Medical Counseling Service Inc.

• United States
• Medical Practices
• 1 - 100 Employee

• Billing Coordinator

  • Apr 2018 - Present

• Billing Supervisor

  • Apr 2014 - Apr 2018



Inner City Family Medical Services

• Washington D.C. Metro Area

• Medical Billing Specialist

  • Jan 2014 - Mar 2014

  · Input 50-60 charges into the agency database and I cautiously verified the Eligibility and Insurance Benefits. · Verify the accuracy of the billing data and review the personal information (name, address, DOB) to correct the errors. · Run the agency critical reports; edit the reports to identify common errors that include: non- billable charges and claims held for authorization. · Communicate with D.C. Department of Mental Health, Medicare, and insurance companies about the billing, authorization, and to link patients. · Reconcile, collect, re-bill or adjust the account receivables and update the database with correct information to inform the manager. · Research the denied claims and I dispute the denied claims with creating and issuing the Appeal letters. · Review the purchase orders, charge slips, and hospital documentation to reconcile validity of the information. · Process the electronic medical billing through the EZ Claim software. Show less



Providence Hospital

• Hospitals and Health Care
• 700 & Above Employee

• Denial Management Analyst

  • Mar 2009 - Jun 2013

  • Analyzed all of the accounts assigned, investigated the technical rejections, identified the appropriate appeal strategies and took steps to appeal the technical denials and documented the agency files.• Created appeal letters and verbally communicated with the payers. Use the supporting documents obtained from Admitting, Case Management, HIM, and other departments to build cases that support proper reimbursement.• Recognized and managed the account resolutions that revolved the open issues accurately and completely.• Coordinated the activities and scheduled the multiple educational sessions for the physician and staff.• Evaluated the accuracy of the provider charges that included the dates of service, procedures, level of care, locations, diagnosis, patient identification, credentialing, and provider signatures to discuss with D. C. Department of Health Care Finance, Medicaid, or insurance companies if required.• Monitored and ensured the timely and accurate charges of the submissions through electronic charge capture that includes Billing and Account receivables (BAR) system and clearing house.• Utilized the Denial Management software and tools to analyze the denial data for the monthly reporting to the manager.• Communicated and assisted the 15+ Physicians and the Director and Assistant Vice President of Practice Management with the physician billing.• Served as the liaison between the clinics, clinical staff, management, and the third party payers to resolve billing and reimbursement accuracy.• Remained up-to-date with all insurance requirements, including details of patient financial responsibilities, fee-for-service and managed care plans. Show less

• Physician Billing Representative

  • Sep 2007 - Mar 2009

  • Reviewed and interpreted the payer remittance to determine appropriate actions taken for the 500+ denied claims.• Reviewed and corrected all of the EDI clearinghouse rejections from the insurance carriers for the appropriate and possible resubmission.• Contacted the payers for the status of the unpaid claims and maintained the knowledge and understanding of third party payer regulations for the MCO’s, Medicare, and Medicaid’s accounts to explain to the 300+ Doctors if requested.• Submitted the claims to the payers and responded to the billing inquires and created the appeals for the denied claims.• Corrected and/or updated the patient registration data and analyzed the outstanding account balances to determine next plan of action. Show less



The Catholic University of America

• Higher Education
• 700 & Above Employee

• Student

  • Aug 2010 - May 2012

  Health Information Technology Certificate Health Information Technology Certificate



Capitol Hill Medical Clinic

• Washington D.C. Metro Area

• Medical Biller

  • Aug 2002 - Sep 2007