Melina Francis | Freelancer Resume

Medical Office Administrator / Medical Billing and Coding Specialist Detail oriented and quality focused professional trained in medical administrative support. Successful track record of handling complicated assignment and administrative/clerical requests. Highly experienced in posting, deposits / payments and reconciling accounts with a high degree of accuracy. Offer solid foundation in software applications, database management, and data entry; proven ability to readily master new technology. Dedicated to maintaining strict patient & Provider confidentiality. My Values My Priorities: Trust, Truth, Commitment, Accountability, Results Client Experience: Integrity (Mine), Respect (Others), Friendly (Community), Value creation (Passion) KEY SKILLS:  Confidentiality.  ICD-9+10 & CPT -10.  HCPCS.  MS Office.  Medical Terminology.  Medical Transcription.  Medical Billing.  Medical Insurance.  Online Claim Submission.  Medical Software (EZ Claims, WRS, Kareo, Athena Health, AdvanceMD, Eclipse & Anzio).  Scheduling Patients.  Verifying Benefits and Eligibility.  Banking.  Placing an Order for Office Supplies. What I do: Insurance Verification Process: Check Eligibility Verify coverage on all Primary and Secondary Insurance Check Benefits for both in Network & out of Network services Obtain Authorizations if needed Contact patient if information such as Referrals or additional Medical Records needed Obtain referral from PCP Explain the benefits to the patient Appointment Scheduling: Obtain all required information on the Call sheet/ Face sheet Enter Patient Demographics in the Billing software Schedule the patient in the available slot on the scheduler Confirm appointment 24 hours prior to the patient visit Clean Claims Creation: Getting the claims accepted, on the first submission! It is the most crucial juncture in the billing cycle. The key details, that are needed to get your insurance claims processed are entered here, and includes, the face sheet of the patient, physician details, information about the insurance coverage of the patient and billing information. It plays a vital role in medical billing management. Well versed with internationally recognized and followed, medical coding systems such as, HCPCS, CPT, ICD-9. Helps the providers get medical reimbursement a whole deal faster! Entering the billing details of the patient in the Billing software Entering Referring/ Rendering provider’s information Entering the primary payer & Secondary payer’s information Entering The correct diagnosis codes & procedure codes for the service dates Adding modifiers if required Entering the required billed amount for each procedures Creating Clean Claims in a timely manner Working on Rejections: Claims that do not meet the specific data requirements or the basic format necessary will be rejected, according to the Centers for Medicare & Medicaid Services (CMS). Rejected claims will not be processed because they are not considered to have been “received” by the payer, thus do not make it into the adjudication system. This may sound complicated, but it really isn’t. Correcting Errors and resubmitting on a daily basis Print and mail claims if not set up for Electronic Data Interchange Accounts Receivables Process: Any claims which remain unpaid for various reasons. These claims are routinely followed up on a monthly basis. The reasons for rejections include: Authorization Issues Referral Issues Medical Necessity and Medical Records requests Non-Participation with Insurance Network Terminated Insurance Coordination of benefits Wrong Diagnosis Inclusive Procedures Partial Payments Out-of-network claim status and deductibles EDI Rejections Letter of Protection from Attorney cases No status and No claim on File Workers' Compensation PIP case Maximum Reimbursement: Claims are followed up systematically and quickly. Claim follow-up is handled utilizing our electronic clearinghouse, insurance websites and direct contact via telephone. I diligently pursue the claims for maximum reimbursement and appeal the denials. Aggressive Follow-up: All unpaid claims are aggressively pursued daily. Expert at getting through to the insurance companies to dispute improper denials and slow payments. Claim Appeals: Denials and rejections are always handled by an appeal. Once the denial is evaluated, I utilize the appeal process to handle incorrect claim denials. Claims are never written off without being appealed first. The Follow-Up Process: Use various Insurance company websites and internet payer portals tp check on the status of outstanding claims Automated Claims Follow-Up (IVR) Insurance Company Representative – If necessary calling a "live" Insurance company representative will give us a more detailed reason for claim denials when such information is not available from either websites or Automated phone systems. Claim Correction and Resubmission done when required Attached Additional Documentation if required Appeal if Needed with Medical records or Proof of timely Filing Bill patients for Deductibles, Co-pays, Co-insurance Bill Secondary with Primary payer’s Payment information In cases where partial payments are made, necessary investigation and analysis is initiated, after which corrective steps are taken. Payment Posting: Involves posting and deposit functions and reconciling posting activities with deposits. The payment posting process effects many other functions of the medical office and can have a major impact on patient satisfaction, efficiency, and overall financial performance. Read EOBs/ ERAs accurately Enter the payment details for a each line item from EOBs accurately in the Billing Software Transfer Patient balances Create Deposit Batch on a daily basis Review Auto posting Upload EOBs in the Billing Software Patient Collection: Providing patients with the best possible customer service to answer their questions, interpret their EOBs, and work with their insurance companies to get their claims resolved. Printing statements for patients for Deductibles, Co-pays, Co-insurance, Non- Covered Services & COB updates Setting up Payment plans for huge payments Discuss Courtesy on patient’s that cannot afford Sending friendly reminders of the payment owed Issue No balance statement when payment collection is completed Medical Billing Reports The Accounts Receivable Aging Report The Key Performance Indicators Report The Top Carrier/Insurance Analysis Report Provide posting by Procedure codes/ Providers Create Report on weekly & monthly basis Mission: To offer services that would reimburse our Health Care providers 100%. To shoulder responsibilities for the benefit of the concern and will perform the duties assigned to me and the team to the entire satisfaction with passion.