Alina Riaz

PROFESSIONAL EXPERIENCE May 2013June 2016  Proficiently managed Commercial, Medicare (MCR), and Medicaid (MCD) denials, as well as paper submission denials, insurance claim-specific letters, and appeals.  Possess comprehensive understanding of eligibilities, Medicare, Medicaid, and Health Maintenance Organization (HMO) plans.  Thoroughly well-versed in ICD-10, Local Coverage Determinations (LCD), and Common Procedural Terminology (CPT) code conflicts as per Correct Coding Initiative (CCI) guidelines.  Proficiently produced and submitted claims to insurance companies using meticulously coded data.  Profoundly knowledgeable about Electronic Remittance Advice (ERA) and Explanation of Benefits (EOB)  Demonstrating swiftness in both electronic and manual payment postings.  Effectively liaised with insurance companies, healthcare providers, and patients to ensure successful claims reimbursement.  Diligently reviewed and appealed unpaid and denied claims, optimizing claim reimbursement rates.  Demonstrated adeptness in managing collections for unpaid and under-reimbursed claims.  Successfully handled both professional and institutional claims. Alina Riaz Senior Medical Biller and Coder Quality of work is directly related to the quality of a Person’s Character --Lahore, PK ABOUT ME Experienced Senior Medical Billing and Coding Specialist with over 11 years of expertise in overseeing the complete RCM process, from scheduling to Practice A/R management. Proficient in handling various EHRs and EMRs, utilizing Microsoft Office proficiently, and navigating insurance portals. Committed to pushing the limits of RCM to elevate my clients' practice prominence and foster growth. EDUCATION 2007 Matric (Science)-BISE Lahore 2009 I.Com -BISE Lahore 2011 B. Com -BISE Lahore 2013 M. Com (Sargodha University) COMPUTER SKILLS          Microsoft Office Suite (Word, Excel, Outlook) - Google Workspace Typing Speed of 50 WPM-Knowledge of Insurance Guidelines and Payer Policies Virginia, USof Billing Regulations Understanding and HIPPA Compliance LinkedIn, Twitter, Facebook & Google+ 03 years’ Experience as a Senior Accounts Management Analyst CureMD, Lahore, Pakistan June, 2016Aug, 2018 2 years’ experience as a Senior Analyst Trans Cure LLC, Lahore, Pakistan  Successfully led a dedicated team of up to 6 members to oversee a comprehensive client portfolio.  Took a primary role in addressing denials, managing payments, monitoring claims aging, and handling patient statements for a recently onboarded client.  Converted dictated data into medical coding for a provider specializing in Neurological Surgery.  Responsibility for training new team members on all aspects of medical coding and related procedures.  Generate comprehensive month-end closing reports that provide detailed insights into monthly charges, payments received, and accounts receivable. PROFESSIONAL EXPERIENCE Aug, 2018Sep 2021  As a Team Lead, I effectively managed a team of up to 7 members.  Oversaw billing operations for 4 clients consisting of Cardiology surgeons, handling both professional and institutional billing.  Responsibilities included client management, denials and rejections reduction, monthly payment reconciliation and aging analysis, generating client-specific reports, and overseeing all production-related tasks.  At times, I also took on tasks related to Accounts Receivable (A/R) calling. Alina Riaz Senior Medical Biller and Coder TECHNICAL SKILLS • Familiarity with Medical Billing Software’s (EHR’s and EMR’s) such as ECW, Health Fusion, Next Gen, EPaces, EzDerm, OfficeAlly, Advanced MD, ChiroFusion, CureMD Software, Availity, Waystar, TriZetto, EPaces, Change Health Care, Thera Nest, Mail Chimp and Practice Fusion. • Medical Coding (ICD-10, CPT, HCPCS) • Insurance Claim Submission and Processing • Payment Posting and Reconciliation • Denial Management and Appeals • Accounts Receivable (A/R) Management • HIPAA Compliance and Medical Privacy Regulations • Medicare and Medicaid Billing • Clearinghouse Interface • Insurance Verification and Eligibility • Revenue Cycle Management (RCM) 2.5 years’ experience as a Team Lead Exponere Billing, Lahore, Pakistan Sep, 2021June, 2022 10 Months’ experience as a Production Manager True Care RCM, Islamabad, Pakistan (Worked Remotely)  Served as both a Production Manager and Head of the Transition Team.  Simultaneously managed existing clients while overseeing the seamless transition process for new clients, including prominent specialties such as Dermatology, Chiropractic, Physiatry and Family Medicine.  By successfully managing both existing clients and leading the transition process for new clients, I contributed to enhancing the overall efficiency, growth, and reputation of the organization. ADMINISTRATIVE SKILLS • Data Entry and Accuracy and Record • Documentation Keeping • Customer Service and Patient Interaction • Multitasking and Handling Multiple Clients • Medical Terminology Analysis and Reporting • Financial - ADDITIONAL SKILLS        -Fluent in English Strong Communication (both written Virginia, US and verbal) Adaptability and Flexibility Initiative and Proactive Approach Professionalism and Confidentiality Problem Solver & Critical Thinking Team Collaboration June, 2022Current AR Short Projects Up Work & Fiver  Collaborated with two distinct Cardiologists to comprehensively resolve pending denials and accounts receivable issues within their practices.  Managed the billing of secondary Medicaid claims for an Internal Medicine client through E-Paces, successfully handling a workload of over 300 claims  Executed a concise software training project, ensuring the seamless integration and proficiency of the team with the newly implemented software.  Strategically tackled a focused project centered on pending letters and appeals, effectively expediting claim settlements and enhancing overall reimbursement outcomes.