Reimbursement Specialist Resume
Summary : Qualified for any position that comes my way. sharp and eager and willing to learn new things to pursue a professional career. Eager to work in a fast pace environment where skills and talents to the best of ability.
Skills : A challenging Medical Billing position with diverse job responsibility to provide the opportunity to build on.
- Conduct benefit investigations, verify insurance benefits for patient and physicians' office and submit and obtain prior authorization as required by payer.
- Obtain recertification for cases requiring extended treatment/coverage beyond the expiration of original approval Accurately enter and maintain data as required in client database and patient files and utilize the client database to monitor outstanding items on each client case file.
- Ensure files are complete so the team can determine the current status.
- Participate in conference calls with Client Sales Representatives, client management and physicians' offices regarding the status of cases, drug orders and status of alternative funding.
- Provide coordination of order for a product, a shipment of product, and therapy initiation with pharmacy and patient.
- Participate in Call Center Activities, triage and respond to incoming calls from patients, insurance companies, physicians, Sales Reps, pharmacies, and home care agencies.
- Identify and report events as required by the REMS requirements for specified medication.
Sr. Reimbursement Specialist Resume
Summary : Exhibited sharp analytical abilities toward inputting monthly budgets for residence funding from providers and mental health facilities, along with submitting bills to accounts payable and managing and distributing resident allowances.
Skills : Detail Oriented, Cash Handling, Organizational Skills, Multi-Tasker, Customer Service Skills, Clerical, Microsoft word, Microsoft excel, Microsoft outlook.
- Perform initial assessment to determine patient's need for home care services and provide information to clinical team.
- Identify payer sources, verify benefits, negotiate rates and obtain authorization for services.
- Ensure accounts are paid in accordance with terms of contact and notify management team of any potential problems with payer source.
- Document and maintain patient files to comply with company policy, legal requirements and regulatory mandates.
- Payroll and Data Entry Clerk Maintain admission and billing data for 375- 400 patients and payroll information for 18 clinical professionals in the local office using CaseMatch software.
- Verify completeness and accuracy of information maintained in database for consistency with company policies, legal requirements, and Federal healthcare regulations, including HIPAA.
- Compile and distribute compliance documentation as requested by management and operations staff.
- Collect data from internal and external sources to respond to requests for information, obtaining appropriate approval and maintaining log of requests.
Bachelor Of Science
Jr. Reimbursement Specialist Resume
Objective : As a detail oriented individual with 18+ years' experience in healthcare accounts receivable, Looking to secure employment with a reputable organization providing growth and stability. Well known and highly regarded for attention to detail and vast ability to adapt to changes while providing high quality output.
Skills : Detail Oriented, Keyboarding, Medical Terminology, Medical Terminology, MS Office, Outlook, Research, Team Player, Team Player, Computer Skills.
- Accurately and timely post all cash, checks, credit cards, and electronically transferred funds to customer's accounts.
- Researches and corrects reconciling items from various bank accounts and coordinates with various internal and external personnel to correct any errors discovered in research.
- Creates, enters, and posts adjusting entries to clear outstanding reconciling items.
- Research incoming payments for adequate information to ensure appropriate allocation and account reconciliation.
- Research, audit, approve, and process patient refunds, ensuring that overpayments are identified within timely manner and processed according to policy.
- Led and managed successful conversion from paper batch posting to CashPro imaging.
- Played vital role in conversion to GE Groupcast practice management system, ensuring timely and accurate acceptance of electronic remittance advice from health plans.
- Responsible for obtaining banking reports from on-line banking web services, reconciling monthly statements, and distributing reports as necessary.
Bachelor Of Science
Jr. Reimbursement Specialist Resume
Objective : Proven ability to utilize inspiring leadership, personal drive, creative vision, and analytical skill to yield successful delivery of both team and individual goals, actively contributing to organizational growth.
Skills : Motivated Team Member And Independent Worker With Aptitude.
- Utilizing and understand provider guidance and eligibility processes, in order to make necessary updates to various internal systems required for enrollment into Express Scripts Prescription Drug Plan.
- Serving as first point of contact for internal clients and members during the enrollment process.
- Making outbound and receiving inbound calls from physician offices, patients, and potential clients including correspondence regarding member eligibility.
- Make independent judgements in order to respondtoncomplex or critical issues.
- Work collaboratively with eligibility system analysts, eligibility associates, eligibility managers, and account managers to provide seamless support to our clients.
- Identify and escalate repetitive questions and/or problems so that corrective action can be pursued and expedited.
- Maintain accurate and complete documentation of all contacts to continually improve the process and reduce potential legal concerns or payouts.
- Complete other projects and additional duties as assigned.
Lead Reimbursement Specialist Resume
Headline : To demonstrate strong leadership, creative thinking and unparalleled determination. Flexible and versatile - able to maintain a sense of humor under pressure are traits.
Skills : Microsoft Word, Mircrosoft Excel, Alora Software, Internet Research, Spreadsheets, Spanish Translator.
- Support practice management by handling administrative responsibilities required to keep accurate records of patient information.
- Gather and verify insurance details for specific diagnosis and procedures being rendered to patients; provide information to physician.
- Utilize high level of knowledge/expertise in billing and reimbursement to accurately log medical records.
- Maintain positive relationships, collaborate with departments, payers, and business partners to protect the interests of the company and its customers.
- Reduce/eliminate rejected claims by reviewing medical documents to ensure patient insurance covers treatments being rendered.
- Verify patient insurance benefits and eligibility by making outbound calls to various insurance companies.
- Address compliance-related matters proactively by verifying CPT, ICD9 and diagnosis codes are accurate and current, per regulation standards.
- Review appropriateness of CPT, ICD9 coding prior to submitting for billing of claims.
CPT In Verification
Reimbursement Specialist III Resume
Summary : More than 20 years of experience in accounting and financial management in both business and medical fields. A financial professional who is a self-starter and capable of effectively functioning with minimum supervision. Known for taking initiative and skilled at meeting challenges and deadlines. A team player who is highly attentive to detail and produces quality results.
Skills : Passport, AS/400, Epic, DataArk, MITS, Meditech, Concuity, Epremis, Alpha Collector, Pulse, Dar, Claim IQ, Isynergy, ETM.
- Accounts receivable management for a Joint Commission accredited durable medical equipment company.
- Currently responsible for all aspects, including insurance and patient billing and collections, processing of payments, payment disputes, reconciliations and adjustments, management of hardship program, financial reporting.
- Responsible for review of claims prior to billing to ensure accuracy and completeness and that all documentation requirements have been met.
- Assist in collection of accurate documentation when necessary.
- Medicare specialist responsible for billing of claims and filing of appeals through ALJ level with an over 80% favorable decision rate.
- Assist in ensuring that all Medicare Supplier Standards requirements are met.
- Maintain insurance contracts and fee schedules.
- Experience in all aspects of business including the entire order entry process, intake, qualifying, document collection, patient services, shipping, outside sales support, and accounts payable.
Reimbursement Specialist II Resume
Headline : Seeking a position where able to use experience, skills and abilities to provide expertise toward actively supporting a progressive organization while optimizing operational performance.
Skills : Medical billing , CMS1500, Eligibility, Allscripts CTRIX, Microsoft Outlook, Microsoft Word, Medical office procedures,.
- Collects and reviews all patient insurance benefit information, to the degree authorized by the SOP of the program.
- Provides assistance to physician office staff and patients to complete and submit all necessary insurance forms and program applications.
- Completes and submits all necessary insurance forms and electronic claims to process the claims in a timely manner as required by all third party payors.
- Researches and resolves any electronic claim denials.
- Researches and resolves any claim denials or underpayment of claims.
- Effectively utilizes various means for collections, including but not limited to phone, fax, mail, and online methods.
- Provides exceptional customer service to internal and external customers; resolves any customer requests in a timely and accurate manner; escalates complaints accordingly.
- Maintains frequent phone contact with provider representatives, third party customer service representatives, pharmacy staff, and case managers.
Reimbursement Specialist I Resume
Objective : Highly regarded Credit and Reimbursement Analyst with 15 + years experience in credit, collection, and receivables management. Proven ability with devising business strategies pertinent for advancing client services and increasing corporate revenue stream.
Skills : A/R Management, General Ledger, Revenue Enhancements,.
- Identified and explored additional revenue opportunities for hospital-based physician earnings.
- Analyzed financial transactions and provided variance analysis identifying trends, issues, and solutions affecting revenue.
- Responsible for maximizing cash collections through efficient process flows, revenue identification and timely collection of receivables.
- Identified and addressed favorable and unfavorable insurance carrier reimbursement trends used for forecasting.
- Tracked and analyzed key financial and operational business metrics for optimal bottom-line revenue results.
- Created and maintained databases and financial spreadsheets for senior management and physician review.
- Followed-up on outstanding account receivables reviewed medical claims for accuracy, proposed account settlements and managed aging reports, resulting in additional $1.9 million recoveries.
Certificate In Real Estate
Reimbursement Specialist/Analyst Resume
Summary : Investigative and cooperative analyst with a passion for delivering excellence. Adept in research, writing, problem-solving and organizational skills. Expertise in regulatory and policy compliance. Able to interact with people of diverse backgrounds and thrive in fast-paced environments.
Skills : Microsoft Word, Outlook, Excel.
- Researched documentation in SalesForce to determine eligibility for the Bayer Pharmaceutical Diabetes patient assistance program.
- Took inbound calls from healthcare professionals, patients, and sales representatives in regards to insurance inquiries.
- Placed accurate and timely documentation of payer, billing information and patient status within the operations systems.
- Acted as a liaison between the provider and sales representatives to resolve any prior authorizations inquiries or appeals of denials as part of a key account initiative program.
- Conducted research to determine payer landscape in regards to determining coverage of benefits.
- Maintained databases to reflect changes or updates to payer's policies.
- Assisted in the preparation of/or prepared reports as requested by management.
- Aided in the development of reimbursement tools, presentation materials, and program SOPs as requested by the program manager.
Bachelor Of Arts
Reimbursement Specialist/Executive Resume
Objective : A highly organized and detail-oriented Administrative Assistant with over 3 years of experience providing thorough and skillful administrative support. Dedicated and focused; able to prioritize and complete multiple tasks and follow through to achieve project goals. An independent and self-motivated professional with excellent research and writing skills.
Skills : Excellent interpersonal and communication skills. Great customer service, attention to detail, time-management skills, organizational skills, and able to multi-task effectively.
- Supporting a series of branch offices with accounting functions, such as invoicing corporate clients for services rendered.
- Reviewing unpaid accounts to determine status and taking appropriate action to ensure payment.
- Contacting corporate clients regarding reimbursement for unpaid accounts over thirty (30) days or more, by researching and following up on denials and requests for additional information.
- Establish a relationship with account manager's and the facility's accounts payable department to ensure productive billing and collections.
- Review various contracts and policies in order to execute accurate and efficient billing cycles.
- Review payments for cash applications to various account branches within assigned region.
- Research over and underpayments for individual invoices through programs such as Great Plains, Clearview, and Payment Coding Sites.
- Manage accounts over $1 million in revenue each week.
Masters Of Arts
Associate Reimbursement Specialist Resume
Objective : Seeking career-advancing opportunities in an environment affording challenge, growth and rewards based on merit and positive results. An effective team player that is motivated, organized, committed, dedicated, creative, resourceful, customer service oriented, detail oriented, able to handle multiple tasks and stressful situations.
Skills : Excel Spread Sheet , Power Point, Internet, Email, Word Processor, Ecm,magnacre And Many More., Voyager, CMS,Marx, First Trax.
- Provided patient information for use by collection agency, physicians, and Account Manager.
- Effectively communicated with patients, physicians' offices, hospital personnel and all IPMS staff in relation to billing, insurance and general information, to build and maintain positive business relationships.
- Accurately recorded daily ca-sand credit card totals, distributed vouchers and posted EOBs manually and electronically.
- Handled monthly payment reconciliation and collection agency turnover process for HPA.
- Review insurance claims in the billing department and ensure that clients or customers receive accurate reimbursements for their claims.
- Working in this position requires a strong attention to detail and a high level of familiarity with clerical and office processes.
- Responsible for insuring timely and full allowable amount of payment according to contracts of each insurance company.
Reimbursement Specialist Resume
Summary : A motivated Corporate Professional with the drive to excel and grow within a company. Self-motivated individual that works hard as a team player to achieve goals and beat expectations. Various experiences within different professional arenas has produced a well rounded individual with the skills to quickly learn new processes and procedures.
Skills : Bilingual Spanish, Customer Service, Microsoft, Adobe, Photoshop, Lightroom, Medical Terminology, Medical Records, Medical Billing, Administration, Management.
- Took calls from health care professionals, patients, and sales representatives.
- Provided assistance with medical and pharmaceutical reimbursement inquiry requests.
- Provided billing and coding information related to specific product(s)/Hotline (CPT & ICD-9).
- Verified patient health insurance benefits, and conducts general payer research.
- Worked with insurance payers and health care professionals to resolve prior authorization issues and/or appeals and grievances of denials.
- Assisted in the development of reimbursement tools, presentation materials, and program SOPs as requested by the program manager.
- Assisted with reports using MS Word, PowerPoint and MS Excel as requested by the Program Manager.
- Cultivated and managed relationships with key contacts at managed care organizations (Medical Directors, Directors of Contracting, etc.), CMS and medical professional societies.
Medical Billing & Coding