CLAIMS SERVICE SPECIALIST Professional Summary Medical Billing Specialist 3 years experience fast-paced, multiple client medical billing company. Researched denied claims submitted appeals. Familiar health billing collections. Advanced knowledge claims processing pre-authorizations. Skills Medical terminology expert ICD-10 (International Classification Disease Systems) Billing collection procedures expert Hospital inpatient outpatient records Inpatient records coding proficiency Outpatient surgery coding specialist HCPCS Coding Guidelines Familiar commercial private insurance carriers Insurance collections procedures DRG PC grouping Understands insurance benefits Research data analysis Close attention detail Adept ulti-tasker Office support (phones, faxing, filing) Excellent verbal communication MS Windows proficient Customer service award Skilled trainer Excellent time management skills Microsoft Outlook, Word Excel MS Office expert Supervisory training Accomplished leader Resource management expertise Knowledge Medicare statutes regulations Work History Claims Service Specialist 10/2013 06/2014 Company Name – City State Filed claims per NextGen system Discussing coverage's liability insured, claimant, body shops. Also spoke lienholders medical providers. Typing data entry Obtaining police reports determine liability claims Reviewing estimates correspondence faxed, mailed, emailed in. Issuing payments scheduling rental reservations insured claimants. Precisely completed appropriate claims paperwork, documentation system entry. Correctly coded billed medical claims various hospital nursing facilities. Verified patients' eligibility claims status insurance agencies. Performed qualitative analysis records ensure accuracy, internal consistency correlation recorded data. Interacted providers medical professionals regarding billing documentation policies, procedures regulations. Accurately posted sent medical claims. Submitted electronic/paper claims documentation timely filing. Claims Specialist 10/2011 07/2012 Company Name – City State Correctly coded billed medical claims various hospital nursing facilities. Meticulously identified rectified inconsistencies, deficiencies discrepancies medical documentation. Diligently filed followed third party claims. Determined prior authorizations medication outpatient procedures. Pre-certified medical radiology procedures, surgeries echocardiograms. Researched questions concerns providers provided detailed responses. Reviewed, analyzed managed coding diagnostic treatment procedures contained outpatient medical records. Researched CPT ICD-9 coding discrepancies compliance reimbursement accuracy. Actively maintained current working knowledge CPT ICD-9 coding principles, government regulation, protocols third party requirements regarding billing. Managed collections claims unpaid bills estates debtors. Accurately posted sent medical claims. Submitted electronic/paper claims documentation timely filing. Performed billing coding procedures ambulance, emergency room, impatient outpatient services. Precisely evaluated verified benefits eligibility. Responded correspondence insurance companies. Identified resolved patient billing payment issues. Confidently adeptly handled claim denials and/or appeals. Evaluated patients' financial status established appropriate payment plans. Reviewed resolved claim issues captured TES/CLAIMS edits clearing house. Examined patients' insurance coverage, deductibles, possible insurance carrier payments remaining balances covered policies applicable. Updated patient financial information guarantee accuracy. Subject Matter Expert 07/2012 10/2013 Company Name – City State Initiated audit process evaluate thoroughness documentation maintenance facility standards. Created maintained computerized record management systems record process data generate reports. Supervised 15+ claims specialist answered work-related questions via chat instant messaging system Took escalated calls providers providing excellent customer service solving claim related problems. Manually reprocessed claims accuracy sent back facilities questions denials non-payment. Cross-trained backed customer service managers. Solved unresolved customer issues. Assumed ownership team productivity managed work flow meet exceed quality service goals. Identified individual development needs appropriate training. Effective liaison customers internal departments. Defused volatile customer situations calmly courteously. Healthcare Agent Education Associate Science Medical Billing Coding Current Central Piedmont Community College City State Coursework Business, Accounting Healthcare Administration Coursework Healthcare Management Coursework Healthcare Administration Coursework Medical Front Office Assisting High School Diploma 10 2007 Skills accounting, benefits, billing, communication skills, customer satisfaction, customer service, customer service training, data entry, focus, insurance, listening, Medical Billing, police, problem resolution, Coding, Read, scheduling, supervisor, Typing, type