Senior Financial Clearance Analyst at NYU LANGONE Health (2024-08 – Present)
- Performs medical necessity review for applicable services to ensure diagnosis is covered under insurance carrier clinical bulletin policy for outpatient appointments as scheduled
- Determines patients' benefit level based on in-network or out-of-network benefits
- Identifies non-par plan status and follows appropriate out of network workflow based on service and payer type, calculates and communicates patients' estimated out of pocket hospital financial responsibility pre-service for scheduled or prospective services utilizing the Epic Estimator tool or International Calculator
- Understands performance measures and is accountable for meeting monthly target goals as determined based on service and payer
- provide coding, financial and/or operational reports, and provide feedback to providers to improve documentation to maximize revenue and reduce denials
- Review and train practices on local and national coding and reimbursement policies including payer coding guidelines
- Monitor reports and assigned work queues, ensuring coding, charge submission and accounts receivable follow-up is occurring on a timely basis
- Perform charge reconciliation to validate all revenue is captured
- Review unbilled charge reports and follow up with physicians and/or practice management for unbilled services
- Works collaboratively with and acts as a liaison with a variety of internal departments within NYULH, external business partners, external departments, and NYULH's contracted payers
- Works independently, takes initiative, and escalates to leadership appropriately
Medical Billing and Coding Specialist at NYU LANGONE FGP Ophthalmology (2021-07 – 2024-08)
- Accurately assigned CPT, ICD-10, and HCPCS codes to medical procedures and diagnoses, ensuring precise documentation for billing purposes
- Processed insurance claims and resolved billing discrepancies to maximize reimbursement
- Reviewed patient medical records for accuracy and compliance with payer and regulatory guidelines
- Managed accounts receivable, including payment posting and follow-up on denied or unpaid claims
- Maintained adherence to HIPAA and patient confidentiality regulations
- Reviewing and extracting appropriate CPT, ICD-10CM, and/or HCPCS based off of documentation
- Responsible for pre authorizations, approvals and denial claims for all surgical procedures
- Determine reasoning for denied claims, resubmit documents, verify insurances utilizing insurance portals
- Monitors intake work queue for timely intake completion
- Assist patients with payment assistance programs for surgical procedures that are not covered by insurance
- Diagnostic and procedural inpatient coding for all ophthalmic procedures
- Review, analyze, abstract, code, or index patients' medical records
- Order specialty medications for in office procedures, create and track all medication logs on excel sheet
- Apply knowledge to identify diagnoses and procedures documented in the medical record
- Apply knowledge of the ICD-10-CM and CPT-4 coding system to translate identified diagnoses and procedures to codes for accurate reimbursement and data
- Ensures that appropriate procedure and diagnosis coding is utilized in the pre-certification and verification process and questions physicians, if appropriate, to ensure accuracy and completeness of information
- Performs other related duties as needed by providers and supervisors
- Maintains cooperative and professional relationships with physicians, nurses and office and clinical staff
- Types routine material such as forms and letters, envelopes, etc. Types materials neatly, accurately and according to instructions
- Works independently, takes initiative, meets all deadlines and demonstrates leadership
- Trains less senior staff
Medical Secretary II at NYU LANGONE FGP Ophthalmology (2019-04 – 2021-07)
- Greet and check in patients
- Responsible for all Insurance verifications prior to patients appointments and authorization approvals
- Scan all necessary documents (insurance cards, lab requisitions, etc.) into the intake system
- Assist patients with kiosk and questionnaire
- Represents physicians by screening incoming practice calls; triages calls and handles calls efficiently and accurately
- Epic Registration
- Update physicians schedules
- Arrange referrals to other health care providers; scheduling appointments for consultations
- Confirm authorizations and insurances for patients
- Handled co-payments
Front Desk Supervisor at Union Square Eye Care (2017-08 – 2019-04)
- Oversea less senior staff/train new hires
- Greet and check in patients
- Represents physicians by screening incoming telephone calls; recording and transmitting messages
- IFA data entry software, Athena Scheduling
- Arranged referrals to other health care providers; scheduling appointments for consultations, x-rays, lab tests, MRI's, CT scans, Medical records, etc
- Confirm authorizations and insurances for patients
- Handled co-payments, claims and insurance clearances
Front Desk Manager/Auditor at Bio Fitness Center (2016-05 – 2017-06)
- Acknowledged and greeted guest upon arrival
- Open/closed facility
- Registered clients and trainers on data entry
- Oversee maintenance of the reception and waiting area
- Bookkeeper, coordinated customer payments, cash wrap, night auditing
- Provided information regarding facility and payment options
- Generate operational and managerial report
Medical Administrative Assistant at East Side Diagnostic Clinic (2013-03 – 2016-06)
- Check in Patients, schedule appointments, answer phone calls
- Organize and track files, fax and printed documents
- Assisted with physical therapy
- Prepare room for physician
- Medical billing and filing
- Confirm authorizations and insurances for patients
- Handled co-payments
