Billing Specialist Resume

PROFESSIONAL SUMMARY

Self-directed healthcare technology professional with extensive knowledge of insurance plan benefits, medical billing and claim processing. Strong customer service and problem-solving skill with the ability to manage multiple tasks and stay organized. Proven ability to communicate well with professional staff and clients in my position with Blue Cross Blue Shield Prudential Healthcare, and Global HealthCare Alliance...

ACCOMPLISHMENTS

Insurance verification/follow up and Precertification, Data Entry, and knowledge of MEDISOFT Billing Software.
Proficient in Microsoft Office applications such as MS Outlook and MS Word,
Distribution of claims to the payers for prompt, efficient reimbursement...
Maintained knowledge of contract guidelines related to packaging of services for proper billing to third party administrators.
Ensured claims were mailed out to payers with sufficient documentation, i.e. attachments, stamps, EOBs and proper postage...
Identified and pro-actively resolved claims issues with internal and external customers. .
Knowledge of current medical insurance ICD-9 and CPT coding.
Team player with excellent problem-solving and effective listening skills.
Processed and adjudicated commercial and Medicare claims.
Researched and reviewed high-dollar claims.
Medical billing and collections.
Reviewed Appeals and Grievances.

PROFESSIONAL EXPERIENCE

Confidential 05//2010-9//2010
Billing Specialist

Performed all functions required to ensure accurate and timely submission of medical claims from providers to various health plans for expeditious reimbursement
and provider satisfaction.
Maintained knowledge of package protocols for assigned area of specialization:
Physician Office Services, Outpatient Facility Services, Inpatient Facility Services
and/or Claims Pending for Package.
Medical billing and collections.

Confidential Texas 10//1998-03//2009
Senior Customer Advocate II
Special Project Team

Provided guidance to customer - members when determining what products would best suit their needs.
Reviewed, adjusted and finalized claim/appeals
Medical benefits verified and quoted, ID cards, Primary Physician updated.
Proficiency in handling telephone and/or written inquiries.
Researched, adjusted, update, and verified customer/member accounts on a daily basis.
Claim processed and adjudicated
Medical billing.

Confidential 11/1991-06/1998
Customer Service Representative
Corporate Travel Assignments

Handled telephone and/or written inquiries.
Initiated and coded adjustments transactions to correct and resolve inquiries.
Obtained required or missing information via correspondence or telephone.
Processed Medicare and commercial claims.
Ability to recognize member as not only a customer but an individual whose health status/preference are unique.
Ability to show flexibility in dealing with customer needs including where there are deviations of normal practices, procedures or benefit structure.

EDUCATION

Medical Billing and Coding/MEDISOFT/2010
Word Perfect/Basic Computer Skills

SKILLS

Microsoft Word 2003-2007
Medical Terminology and Anatomy
Analytic and Organizational
Verbal and Written Communication
Data Entry
Typing-40WPM

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