Medical Claims Processor - Ensemble Health Partners - Remote
(2024-12 - 2025-11)
- Reviewed EOBs and adjusted commercial insurance claims according to payer policies and regulatory guidelines.
- Researched and resolved claim denials, discrepancies, and reimbursement issues appeals and other.
- Applied knowledge of ICD-10, CPT, and HCPCS coding systems to ensure accurate claims processing.
- Managed high-volume workloads while maintaining productivity and quality (KPIs) standards.
- Worked with UB-04 and CMS-1500 claim forms and Revenue Optimization team workflows.
- Utilized claims processing software and Microsoft Office applications to track and document claim activity.
- Investigates and follows-up on unresolved Veterans' Affairs claims and its affiliates.
Customer Service Representative - ResultsCX - Remote
(2024-04 - 2024-11)
- Assisted customers with healthcare-related inquiries and technical support requests.
- Resolved customer concerns efficiently through phone and system-based support.
- Adapted communication styles to provide exceptional customer experiences.
- Used multiple systems simultaneously to research and deliver real-time solutions.
- Collaborated with team members to achieve departmental performance goals.
Billing Specialist - Blue Cross Blue Shield of Kansas City - Remote
(2023-11 - 2024-03)
- Managed revenue cycle functions including claim billing, denial resolution, payment posting, and accounts receivable follow-up. To achieve daily and monthly key performance indicators (KPIs).
- Investigated claim denials, appeal denials and corrected clearinghouse rejections for resubmission.
- Reviewed EOBs and patient records to ensure coding accuracy and billing compliance.
- Worked extensively with ICD-10, CPT coding, Epic PM/EHR software, Excel, Outlook, and Microsoft Office applications. Work closely with Revenue Optimization team to support reimbursements.
- Maintained billing accuracy while meeting productivity standards.
- Investigates and follows-up on unresolved Veterans' Affairs claims and its affiliates
Medical Records Specialist I - CIOX Health - Remote
(2023-03 - 2023-07)
- Processed release of information (ROI) requests accurately and within required turnaround times.
- Ensured compliance with HIPAA regulations and company policies regarding patient information.
- Organized, filed, retrieved, and digitized patient health records and documentation.
- Entered and updated patient information in Electronic Health Record (EHR) systems (MIDAS/Cerner/AS400).
- Maintained confidentiality while delivering high-quality customer service.
Medical Records Specialist - CIOX Health - Remote
(2022-06 - 2022-09)
- Processed release of information requests while ensuring HIPAA compliance and data accuracy.
- Retrieved, scanned, transmitted, and maintained patient medical records according to established procedures.
- Protected patient confidentiality and ensured only authorized disclosures were completed.
- Experience working with electronic health records (EHR) systems (MIDAS/Cerner/AS400).
Medical Biller - Pandya Medical Center - Remote
(2020-05 - 2022-06)
- Verified insurance eligibility and benefits through insurance carrier portals.
- Managed revenue cycle functions including claims processing, denials, EOB review, and AR follow-up.
- Processed electronic and paper insurance claims and maintained billing documentation.
- Performed electronic and manual cash posting and maintained revenue tracking systems.
- Utilized ICD-10, CPT coding, Athena Microsoft Office (Excel, Word, and Outlook).
Medical Billing Specialist - Pro-GeneX Laboratories - Remote
(2020-05 - 2022-06)
- Prepared, reviewed, and submitted electronic and paper insurance claims. Revenue Cycle processing aged claims.
- Managed claim denials, appeal denials, payment posting, rebilling, and insurance follow-up activities.
- Verified insurance eligibility and monitored claim statuses using online payer resources.
- Submitted appeals with supporting documentation for denied claims.
- Processed secondary and tertiary insurance billing while maintaining HIPAA compliance.
- Utilized ICD-10 and CPT coding knowledge to ensure billing accuracy.
Release of Information Specialist - ScanSTAT Technologies - Remote
(2019-11 - 2021-02)
- Processed medical record release requests using ScanSTAT software.
- Reviewed medical records, forms, and authorizations to ensure compliance and accuracy.
- Maintained confidentiality and compliance with HIPAA regulations.
- Organized records and completed ROI requests in a timely and efficient manner in electronic health records (EHR) systems (MIDAS/Cerner/AS400).
- Assisted in resolving HIPAA-related release issues.
