A Medicare Billing Specialist is responsible for submitting medical claims to the insurance companies and Medicare and Medicaid. The job description entails taking responsibility for the timely submission of technical and professional medical claims. A well-drafted Medicare Billing Specialist Resume indicates the following duties and responsibilities – obtaining referrals and pre-authorizations as required, checking benefits and eligibility for treatment, and hospitalization; reviewing patient bills for accuracy and completeness, preparing and reviewing claims using billing software; checking insurance payment for accuracy and compliance with contract discounts; identifying and billing secondary insurances; researching and appealing denied claims; setting up patient payment plans and updating billing software with needed changes.
Apart from proven work experience, the following skills and abilities are expected – knowledge of insurance guidelines, familiarity with CPT and ICD coding; knowledge of accounting and bookkeeping procedures; proficiency of medical terminologies, and the ability to maintain the confidentiality of patients. While a high school diploma is mandatory, possessing knowledge of business and accounting process is preferred.
Objective : A highly accomplished and solutions-driven Leader with 20 years experience leading departments through startup, change, revitalization, turnaround and accelerated growth in the healthcare arena. Participative business leader well versed and experience in Managed Care and Finance. Proven successes in the following area: Director/Manager level leadership Joint Ventures, Mergers and Acquisitions Decision Support Application Implementation.
Supervised Accounts Receivable Billing/Collection Specialists that were responsible for the entire Medicare, Medicaid, and Managed Care Insurance Company daily issues.
Analyzed AR accounts for accuracy and filing Reconsideration's on denied Medicare/Medicaid Claims.
Submitted, adjusted and voided claims to Medicare/Medicaid.
Negotiated Contracts with Insurance Companies, Secondary/Third Party Billing Performed AR Month End Close, Monthly Reconciliation's, Daily Cash Receipts, and Journal Entries.
Maintained chart of accounts by setting up new accounts including general ledger and Accounts Receivable.
Worked Estate Claims.
Filed reconsideration claims with medical records to Medicare denied claims.
Experience
0-2 Years
Level
Entry Level
Education
MBA
Sr. Medicare Billing Specialist Resume
Summary : Organized Medicare Biller with foundation in records management. Experienced in billing and collection procedures. Advanced medical terminology knowledge. Efficient Medical Administrative Assistant skilled in tackling administrative and patient-oriented tasks in a fast-paced environment. Organized Medicare Biller with the ability to readily adapt to changing environments and demands.
Skills : Verifying Insurances, Collecting From Insurances And Patients.
Description :
Maintained updated knowledge of coding requirements, for both ICD-9 and ICD-10 coding as of 10/01/2015.
Verified patients' eligibility and claims status with insurance agencies.
Prepared patient charts accurately and neatly for the office.
Researched questions and concerns from providers and provided detailed responses when requesting chart notes and documentation to be sent to Medicare for appeals.
Maintained strict HIPPA regulations.
Resourcefully used various coding books, procedure manuals and on-line encoders for the Medicare guidelines in billing for Durable Medical Equipment (DME).
Managed collections claims for unpaid bills against the estates of debtors and Medicare claims/appeals.
Interacted with providers and other medical professionals regarding following Medicare guidelines for testing on oxygen and CPAP/Nebulizer use and follow up on the use of the equipment.
Experience
10+ Years
Level
Senior
Education
GED
Jr. Medicare Billing Specialist Resume
Objective : To grow within a company in which can absorb all the needed skills, knowledge, and experience needed to be successful. To obtain all that is needed and more in order to climb the business ladder. Hardworking, reliable, and optimistic, detail orientated, and a self-starter with good character.
Skills : Customer Service, Administration, Billing, Case Management.
Description :
Processed Medicare and managed care plan billing for skilled nursing facility claims using LTC EMR systems.
Followed up on claims using NGS portal and managed care sites.
Reviewed cash receipts.
Responsible for Insurance follow up.AR management using excel spreadsheets.
Calculated billing.
Generated and bill out medical claims.
Contacted with patient/resident, facility office manager and insurance carriers.
Experience
2-5 Years
Level
Junior
Education
B.A
Medicare Billing Specialist I Resume
Objective : Long term employment with upward mobility in a Medicare Billing Specialist professional environment. This includes administering medications such as acetaminophen, ibuprofen, corticosteroids, steroids, sedatives and tranquilizers or pain relievers.
Skills : Acumen, Availity, Health Fusion, Intergy.
Description :
Provided customer service to Medicare patients.
Maintained up-to-date knowledge of Medicare rules and regulations.
Assisted patients in person and via telephone.
Managed quality communication, patient support and representation for each patient account.
Contacted insurance providers to verify correct information and get authorization for proper billing codes.
Successfully handled 50 to 70 bills per day.
Investigated and resolved patient inquiries and complaints in a timely and empathetic manner.
Attended local Medicare meetings for additional training Cross-trained and provided back-up for other insurance billing.
Verified payments done by insurance companies were accurate and according to contract guidelines.
Experience
2-5 Years
Level
Junior
Education
Bachelor's
Medicare Billing Specialist II Resume
Headline : Provides direct back up support for Premium Billing and Dunning processes. Assists with questions and complex issues relating to employer group payments.
Skills : Management, Organizing.
Description :
Enters and monitors billing discrepancies for both active and terminated groups. Documents the status or retrieval of dollars relating to same.
Adjusts customer accounts by entering discretionary billing items, requesting rebills and updating billing entity records.
Performs monthly analysis of the Billing Aging reports to identify miscellaneous open invoices or balances. Determines the disposition and takes the necessary action to resolve the aging or relieve the receivables.
Reviews the Dunning Reports and Notices for all lines of business.
Compiles and generates spreadsheets capturing key data for the dunning process.
Creates pivot tables, modifies spreadsheets and formats the data within to achieve the analytical goals of the Billing/Configuration Team.Upon request, completes regulatory forms for employer groups.
Researches accounts, provides decisions and rationale on individual customer complaints regarding premium billing and dunning.
Experience
5-7 Years
Level
Executive
Education
Bachelor's
Medicare Billing Specialist III Resume
Summary : To further enhance skills as a professional as well as obtain a Medicare Billing Specialist position that allows future Career Development.
Skills : Billing, Management.
Description :
Makes sure claims are coded correctly and that any corrected claim is submitted and received by the insurance carrier.Bill Medicare claims electronically, for inpatient and outpatient services.
Analyzes clean, error, rejected and denied claims through Cirius software.
Identifies late charges, add charges through DDE, corrections to RTP claims through DDE.
Appeals unpaid and denied claims, handling collections on unpaid and underpaid accounts.
Manages the facility's Accounts Receivable reports.
Identifies RAC accounts for appeals.
Works individual split of accounts from Collect Logix collection system.
Receives inbound and places outbound calls to/from insurance companies to collect outstanding funds.
Experience
7-10 Years
Level
Management
Education
Certification
Asst. Medicare Billing Specialist Resume
Objective : Familiar with commercial and private insurance carriers. Seeks a position of increased responsibility and authority. Skill Highlights HIPAA compliance Electronic Medical Record (EMR) software Medical billing software ICD-9 coding Strong work ethic CPT and HCPCS coding Team player with positive attitude Internal medicine billing Knowledge of HMOs, Medicare and Medi-Cal.
Skills : Supervisory, Customer Service, Microsoft Office.
Description :
Projects image of GHP's dedication to professional excellence.
Demonstrates proficiency in computer operations including software applications in desktop publications, as well as presentation, spreadsheet and network applications.
Demonstrates the ability to work in a multi-task environment where there are pressures of production schedules and deadlines.
Demonstrate skill in mathematics/statistical analysis.
Demonstrates strong writing and verbal presentation skills.
Demonstrates the ability to influence others and work collaboratively in order to produce results across multiple functional teams
Enters details such as payments, account information and call logs into the computer system.
Experience
2-5 Years
Level
Junior
Education
Associate
Associate Medicare Billing Specialist Resume
Headline : To obtain a part-time, on-call or seasonal job in your organization where can perform to the best of potential.
Skills : 10-Key, Typing, Phones, Data Entry.
Description :
Monitors the billing and collection processes to ensure days in accounts receivable are in compliance with MW financial policy standards
Performs accounts receivable and revenue analysis
Responsible for training and communicating to front desk, providers and clerks any practice management system updates and changes. Acts as billing and coding resource for training and education
Reviews monthly self-pay accounts and makes recommendations to CFO for bad debt write offs
Responsible for escalated issues identified within practice management system
Responsible for auditing data within practice management system for accuracy and validity. Recommend process improvements based upon audit results.
Discusses patient accounts, process and post payments, (as applicable)
Processes refunds as directed from CFO
Experience
5-7 Years
Level
Executive
Education
Nursing
Lead Medicare Billing Specialist Resume
Summary : To obtain a Medicare Billing Specialist position as a where an understanding of advanced medical processes and excellent skills in medical assisting will help the operations of this healthcare facility.
Skills : Management, Organizing.
Description :
Edits and performs maintenance on Medicare claims in within Alpha split.
Reviews patient accounts using Meditech software.
Ensures billing quality in order to achieve maximum benefits to the hospital as well as the patient.
Reviews balances on accounts.
Works with patient's to obtain correct history and insurance information to process claims correctly.
Submits medical records to Medicare, Medicare Railroad, and Medigold when requested as proof of treatment or documentation.
Ensures compliance with Medicare rules and regulations while submitting claims.
Attends training seminars and weekly meetings.
Verifies patient Medicare eligibility through Medicare's online system.
Experience
10+ Years
Level
Senior
Education
Associates
Medicare Billing Specialist Resume
Summary : Experienced Medical Office Specialist with strong analytical and organizational skills as well as effective communication, interpersonal and customer service skills. Experienced in Medical Office Practices including Front Office/Reception duties, Billing, Account Receivables and Accounts Payable with applied knowledge of general accounting principles.
Skills : Management, Organizing.
Description :
Provides related weekly, monthly and year end reports of audit findings and generate reports per state and federal regulations
Processes claims for contract payers
Resumes the role of lead contact and acts as liaison for new satellite offices
Provides requested ad hoc reporting to management
Keeps abreast of state and federal billing requirements and regulations
Responsible for the maintenance of patient confidentiality and adherence to Patient Rights and Responsibilities, as issued in the New Hire Orientation
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