Medical Billing Specialist - ENT Illinois - Park Ridge, IL
(2024-11)
- Scrub claims to ensure accuracy and compliance before submission to insurance providers.
- Post insurance and patient payments, reconciling accounts for accurate financial records.
- Conduct claims follow-up, identifying and resolving denials or discrepancies to maximize reimbursement.
- Communicate with insurance carriers and patients regarding claim statuses, payment issues, and eligibility verification.
- Answer incoming calls, assisting patients with billing inquiries, payment options, and insurance-related concerns.
- Maintain detailed records of transactions, payments, and claim resolutions in compliance with industry regulations.
Collections Specialist – AM&D - Philips (formerly Biotel Heart) - Chicago, IL
(2019-11 - 2024-10)
- Contact patients and insurance carriers to resolve claim denials related to demographic discrepancies or coverage issues.
- Verify patient eligibility and benefits for durable medical equipment (DME) to ensure accurate billing and reimbursement.
- Review and correct clerical errors on patient claims, ensuring up-to-date insurance coverage based on weekly work logs.
Senior A/R Representative - Change Healthcare/McKesson - Wheeling, IL
(2008-08 - 2019-10)
Proficient in healthcare and insurance billing, with expertise in customer service and financial reconciliation. Highly organized, detail-oriented, and able to multitask in a fast-paced environment. Strong written and verbal communication skills, with a proven ability to collaborate effectively across teams.
- Manage insurance verification and medical record-keeping to ensure accurate claim submissions.
- Oversee A/R billing procedures, including resolution of denied claims and conflict resolution with insurance carriers.
- Conduct follow-ups on outstanding A/R across all payers, ensuring timely reimbursement and account resolution.
- Handle all insurance correspondence, working closely with carriers and patients to maximize payments and identify potential account issues.
- Process EDI transactions and ERA files, reconciling carrier submissions, edits, and rejection reports.
- Research and resolve accounts listed on Delinquent Insurance Reports, Collection Ledgers, and Government Payer reports, making informed decisions to optimize reimbursement.
- Consistently meet productivity standards and KPI goals while identifying trends and reporting them to management.
- Work on special projects as assigned, demonstrating strong analytical and problem-solving skills.
