I have excellent skills with billing, creating procedures to make billing and payments as simple as possible encompassing procedure code/modifier sets, and billing Medicare across all regions.
- Billing insurance including; Medicare, Medicaid, HMO, PPO, Indemnity, Worker’s Compensation plans, and hospitals.
- EMR/billing systems, electronic and paper claims submission. Primarily billing DMEPOS procedure codes, modifiers, and ICD-9/ICD-10 diagnosis coding.
- Processing and submission of all Preauthorization, Precertification and Predeterminations via internal and external software portals, and by mail. Gathering all of the information necessary to ensure that the submissions get authorized the first time.
- Ensure that all Explanation of Benefits (EOB) received are accurate and properly reflect the contractual obligation for payment and 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.
- Compiling the necessary supporting documentation for multi-level appeals to Medicare, Medicaid, and private insurances when necessary to ensure proper payment will be the final result.
- Fee schedule management for all insurance contracts and self-pay patients utilizing self-created Microsoft Access databases, Excel spreadsheets, and proprietary patient management software to quickly and easily verify all procedures are billed properly.
- Advising patients of their eligibility status, benefits as it applies to their treatment, deductibles, co-pays, total treatment cost, and their total estimated payment responsibility.
- Assisting patients navigating their specific insurance plan benefit requirements. Expert at handling out-of-network benefits. Determining the required information necessary to submit a clean claim, and advising patients of authorizations and denials.
- Keeping up-to-date on insurance regulations and policies for 12 Medicare Regions, individual plans nationwide, and policies received via email notifications, insurance database research, and internet website searches.
- Professional communication over phone and email with patients, physicians, insurance companies, lawyers, accountants, and co-workers.