Medical Billing Specialist • Customer Service

Overview

Looking for full-time work (8 hours/day)

at $9.00/hour ($1,584.00/month)

Associates degree

Last Active

December 26th, 2024 (today)

Member Since

December 7th, 2022

Profile Description

Medical Biller
Healthcare Coding Integrity (HCI)
April 2021- February 2024
-Perform posting charges
-Ensure patient’s information is accurate and up to date
-Perform completion of claims to payers-Conduct duties in a professional and timely manner
-Submit billing data to appropriate insurance providers-Process claims and resolve denials to ensure maximum reimbursement-Follow up unpaid claims to appropriate parties and payers
-Review remits and payer correspondence and escalate any identified issues to appropriate areas for review and response to expedite claim resolution
-Insurance verification, authorization and appeals
-Analyze EOBs and remits

Highmark-HNAS, Supervisor
Concentrix
January 2018-April 2021
-Managed team performance for Highmark-HNAS LOB and Compcare Authorization Department
-Took escalated calls from both members and providers-Accepted incoming calls from both members and providers for eligibility, benefits and claims questions for PPO and EPO plans
-Make outbound calls to providers and member’s network to help member’s claim to be processed and paid-communicate with the providers what needs to be done for their claims: need corrected claim, diagnosis is not supported, procedure was considered not medically necessary so appeals need to be submitted, no authorization was requested, needs medical records.

Cigna, Supervisor
Concentrix
December 2016- January 2018
-Managed team performance
-Accepted incoming calls from providers for eligibility, benefits, and claims questions for OAPand HMO plans
-Took escalated calls

Cigna, Subject Matter Expert
Concentrix
August 2016 - December 2016
-Accepted incoming calls from providers for eligibility, benefits, and claims questions for OAPand HMO plans
-Took escalated calls-Answered CSR’s questions about their calls

Cigna, Customer Service Representative
Concentrix
December 2014- August 216
-Accepted incoming calls from both members and providers for eligibility, benefits, and claimsquestions for OAP and HMO plans

Top Skills

Customer Support » Phone Support

Experience: 5 - 10 years

I was on a customer service for more than 6 years handling inbound calls from members and providers.

Customer Support » Insurance » Medical Insurance

Experience: 5 - 10 years

I worked for US medical insurance companies for more than 6 years. 2 years as customer service advocate and 4 years as supervisor

Professional Services » Medical Services » Medical Billing

Experience: 5 - 10 years

With my experience working on medical insurance companies, I helped providers on how they bill their claims and explain to them what needs to be done to have it paid or adjusted. I worked for few medical insurance companies so I am knowledgeable on how they processed claims, authorizations and appeals. And also, I am familiar on their medical policies.