favorite
favorite
hide
unhide
flag

Posted

print

Medical Billing / Claims Follow Up Specialist - Experienced (Tucson)

available afternoons
available mornings
education completed: associates

My name is Steve. I am an experienced medical biller with extensive background in claims follow up searching for a full-time position. I have background working with both physician and facility/procedure claims (HCFA and UB04). I am a dependable hard working person who is able to make a positive impact reducing your aging denied and unpaid claims.

I learn any system quickly and perform effectively the duties needed for your business to achieve your goals. I have experience working with commercial payers along with AHCCCS and Medicare. I have been responsible for increasing revenue for providers and reducing aging claims A/R. I am capable of adjustments; contacting insurance companies on claim denials and underpayments; pulling A/R reports; filing grievances / appeals; resubmitting corrected claims; charge entry; CPT-4, modifier, and HCPC code review and application; outstanding claim resolution; report generation; contract review, negotiations, and maintenance. I also have worked with data entry if needed.

I have worked in multiple specialties including surgical, internal medicine, radiology, hospital, Ophthalmology, ambulatory surgery, and behavioral health. I work with a sense of urgency in everything I do. I follow through from start to finish.

I would be willing to submit my full resume for review if you are interested. I will only respond to local inquiries in the Tucson area. I have good references and work history. When responding, please give me some detail of your opening so I know this is not a phishing or scam attempt, otherwise, I will not respond.

I have attached some of my qualifications below:

11/13/2018 – Present

Biller / Collector
 Billing of inpatient claims to insurances using SSI
 Correcting claims and resubmitting to insurance payors for payment
 Following up on claim denials and underpayments with insurances
 Obtaining medical records and review for claim submissions
 Review UB-04 claims for correct and accurate submissions
 Identified denial trends to report to corporate affecting A/R
 Submitted adjustment requests for correct contractual adjustments
 Writing and filing appeals for denied and underpaid claims
 Oversee all AHCCCS and Title 36 billing and follow up
Reviewed contracts for correct reimbursement and contractual guidelines
Training staff in effective appeal development

7/13/17 - 6/8/2018 Tucson, AZ
Revenue Cycle Analyst
 Claim review, claim entry, and billing of claims into Avatar system
 Claim follow up and A/R reduction
 Initiate all claim submissions RHBA and denials service providers
 Void / Edit claims in Avatar, Emdeon, and insurance portals
 Develop Excel spreadsheet record of all voids and recoupments
 Initiate all check vouchers and requests
 Report development of eligibility and billing account receivable
 Produced weekly unbilled and billing error reports
 Reviewed and resolved daily billing errors

9/19/2014 - 5/15/2017 Tucson, AZ
Billing Office Manager Surgical Practice
 Daily payment and charge reporting to 5-6 physicians
 Managed all day-to-day operations of Business/Billing Office
 Filed appeals / grievances with commercial, AHCCCS, Medicare
 Overseen PMS (Nextgen) system updates and conversions
 Coordinated all staff functions and directed daily responsibilities
 Contract review and negotiations of rates with insurance companies
 Managed and overseen duties of 5 billing office staff members
 Monthly Metrics and A/R reporting to physicians
 Responsible for Interviewing, hiring, directing, training, and disciplinary duties
 Development of policies and procedures of Business Office
 Responsible for reducing Aging A/R over 90 days from 32.4% to 8.55%
 Restructured office functions and improved efficiency of billing office
 Increased revenue by 14% during 2015 and 7% in 2016


7/14/2013 - 2/19/2014 Tucson, AZ
A/R Biller
 Billed Hemodialysis claims
 Worked credit balances
 Verified billing information accuracy
 Developed and Filed all claim appeals
 Designated to work complex claim denials and issues
 Developed filing system for billing office

11/13/2018 – Present Sonora Behavioral Health Hospital 469-8700
Biller / Collector
 Billing of inpatient claims to insurances using SSI
 Correcting claims and resubmitting to insurance payors for payment
 Following up on claim denials and underpayments with insurances
 Obtaining medical records and review for claim submissions
 Review UB-04 claims for correct and accurate submissions
 Identified denial trends to report to corporate affecting A/R
 Submitted adjustment requests for correct contractual adjustments
 Writing and filing appeals for denied and underpaid claims
 Oversee all AHCCCS and Title 36 billing and follow up


12/5/11 - 04/19/13 Tucson, AZ
Biller / Claims Follow-Up / Collector
 Audited claims for correct diagnosis, CPT, HCPCS, Modifier usage and correct reimbursement
 Acted as contract consultant for ASC and practice management staff
 Performed follow-up on Practice Management Claims (Surgical, Podiatric, Ophthalmology)
 Performed claims follow-up duties for surgery center
 Reviewed EOB denials and partial payments
 Overseen and coordinated special projects in practice management
 Worked Medicare, Commercial, AHCCCS, and Workman Compensation
 Reduced A/R for practice management account from 24% to 6% for accounts at 90 days plus



6/7/11 - 12/2/11 Tucson, AZ
Billing Specialist
 Conducted Electronic Edit resolution for Central Business Office
 Identified and resolved all EDI Edits and Payer Rejections
 Corrected and edited Financial Status Codes (FSC)
 Developed Daily Billing Reports from GE / ETM Centricity system


9/22/08 - 5/31/11 Tucson, AZ
Claims Review Auditor
 Conducted reviews of facility UB-04 claims and EOB's for underpayments/descrepancies
 Reviewed commercial contracts between providers and payors
 Determined correct payment amounts for claims according to contracts, fee schedules, stop-loss calculations, DRG, and Carve-Out rates
 Developed all appeals and performed follow-up for claim underpayments
 Verified correct usage of modifiers, CPT Codes, and Revenue Codes

  • it's ok to contact this poster if you are a potential employer or other principal. Principals only. Recruiters, please don't contact this job poster.
  • do NOT contact me with unsolicited services or offers

post id: 6930666791

posted:

updated:

best of [?]