Medical Billing-Team Lead - Integrated Home Care Services - Miramar, FL
(2024-04 - 2026-07)
- Assist with New Hire Onboarding process
- Train on DME (Durable Medical Equipment) billing software such as Brightree, (EHR) NextGen systems and Microsoft Office Suite (Excel, Word), Medtrac systems
- Daily auditing & quality assurance reports
- Verified insurance eligibility and obtained prior authorizations to ensure coverage for equipment and supplies
- Prepare and submit appeal letters with supporting documentation (payer forms, medical records, prior authorization details, clinical justification)
- Oversee all claims for Medicare, Medicaid, and various commercial insurance plans
- Resolved billing inquiries, explained account balances, and managed claims processing
- Responsible for managing appeals to ensure proper reimbursement and avoid Timely filing
- Review denied claims and determine appropriate appeal strategy based on payer guidelines
- Collaborated with other management and other department team members to resolve complex issues or improve processes
- Managed the end-to-end billing cycle for durable medical equipment, including order confirmation, claim submission, payment posting, and denial management
- Responded to other departments (Collections, Posters, Accounting etc.) for patient billing inquiries
- Handle all billing inquiries, disputes, and appeals, ensuring timely and efficient resolution
- Analyzed claims payment to ensure accuracy and reconcile any discrepancies identified in Explanation of Benefits (EOBs)
- Obtains and maintains a basic understanding of third party billing requirements as assigned, including federal, state and commercial payers
- Responsible for account receivable, investigates and reviews claims based on the productivity standards set by management
- Process all HCFA-1500 claims through the related billing system, working the related claims scrubber in a timely and efficient manner; performs all associated duties in order to ensure the completeness and accuracy of all claim information, facilitating maximum reimbursement
- Reviewed medical records and patient documentation to ensure all required information was included before submitting claims
- Submitted electronic or paper claims to primary, secondary, and third-party payers
- Assist with escalation calls (Patients, Hospitals, Doctor's office, Case managers, Health plans)
- Manage complex denial resolution and appeal strategy across medical necessity, authorization, coordination of benefits, and timely filing, and drive denial trend analysis
- Work closely with the accounting department to ensure accurate financial records
- Processed orders, returns, and exchanges efficiently, maintaining accurate records in the company's CRM system. (DME, CPAP, Oxygen and Ostomy, Wound Care supplies)
- Analyze daily aging of insurance accounts via the billing system to determine appropriate follow up for non- payment and delayed payment accounts, as well as to ensure compliance with all Federal, state, insurance payer and St. Luke's Network policies
- Analyzes denied claims and investigates the reasons causing the denial and takes the necessary action to resolve the denial and/or resolution of the account
- Seeks resolution to problematic accounts and payment discrepancies with optimal goal of receiving accurate payments and maximum reimbursement
- Verified patient insurance coverage and benefits, updated patient records, and processed payments
Medical Biller - Integrated Home Care Services - Miramar, FL
(2019-06 - 2024-04)
Customer Service - Integrated Home Care Services - Miramar, FL
(2018-05 - 2019-06)
Case Manager - Change Healthcare - Weston, FL
(2017-04 - 2018-04)
- Acts as liaison between the member and our teams to promote effective communication
- Maintained close contact with the members throughout the entire process of enrollment in State Programs
- Conduct regular meetings with clients to review progress, mental health stability, appointments, and discharge readiness
- Access member's PHI to provide accurate information for assistance, in accessing member's account information and for enrollment purposes
- Ensures all documentation are accurate and compliant with GHS standards, Florida State and Federal Regulations
- Assists members with options for needed programs/services in their area (transportation, translations, prescriptions discounts, Medicare Savings Program and other (State Programs)
- Support clients with completing redetermination forms, SNAP applications, and other essential documents
- View all incoming documents requested for accuracy prior to submitting to State
- Coordinate and assist with referrals for medical care, entitlements, transportation, education, employment, legal assistance, and more
Supervisor-Medical Records - LaVan & Neidenberg Law office - Plantation, FL
(2013-05 - 2017-04)
- Manage and train a team of medical records employees, including medical coders and health information technicians. This involves assigning tasks, monitoring performance, and providing guidance
- Prepare reports and compile health statistics for upper management and administrators to assist with evaluating department performance
- Oversee all procedures to ensure the accuracy, confidentiality, and security of medical records, in compliance with laws like HIPAA
- Regularly audit records for accuracy, completeness, and proper storage
- Manage the organization, retrieval, and release of patient records, including responding to requests from third parties
- Work with healthcare providers and IT staff to ensure the proper flow of information and resolve any issues
- Collaborate with attorneys, paralegals, and other team members to ensure accurate and timely records reviewed
- Implement and enforce policies and procedures to ensure that all patient records are accurate, complete, and up to date. This includes performing regular audits
- Process requests for medical information from third parties, such as insurance companies, our attorneys, and patients, ensuring all procedures are followed correctly
Supervisor-Customer Service - EMP Medical - Coral Gables, FL
(2012-12 - 2013-04)
- Managed and developed a team of customer service agents/representatives
- Provided daily guidance, coaching, and performance feedback
- Delegating tasks, managing workload, scheduling, and ensuring efficient operations
- Conduct performance reviews, provide coaching and feedback
- Monitored performance metrics like customer satisfaction (CSAT) and average handling time
- Facilitated training sessions for new hires and provide ongoing professional development for existing staff
- Handled escalated customer issues, consistently achieving high resolution rates and maintaining a positive brand image
- Collaborated with other departments to address customers concerns and ensure seamless coordination
- Collaborated with other management and other departments to resolve complex issues or improve processes
