With extensive experience in health insurance billing, I specialize in ensuring accurate claim submissions, timely follow-ups, and seamless coordination with insurance providers. I am skilled at navigating complex billing systems, optimizing reimbursement processes, and maintaining compliance with industry regulations to facilitate streamlined and effective billing processes.

• Process insurance billing for Medicare, Medicaid, commercial insurance, Worker’s Compensation plans, and hospitals. Experienced with EMR/EHR billing systems, including electronic and paper claim submissions. Focused on billing DMEPOS procedure codes, modifiers, and ICD-9/ICD-10 diagnosis codes.

• Manage the processing and submission of Preauthorization, Precertification and Predetermination requests through both internal and external software portals, as well as by mail. Ensure all required information is collected to secure first-time approval.

• Verify that all Explanation of Benefits (EOB/EOMB) statements are correct and align with the contractual payment terms, ensuring proper billing to the patient.

• Eligibility verification specialist using internal and external software portals, and by telephone.

• Claims review and analysis to ensure that payments are received according to contract, and rectification when the payment is incorrect.

• Advise patients of their eligibility status, benefits as it applies to their treatment, deductibles, co-pays, total treatment cost, and their total estimated payment responsibility.

• Stay current on insurance regulations and policies across 12 Medicare Regions, individual plans nationwide, and updates received through email notifications, insurance databases, and online research.