1. Professional Overview
Detail-oriented and reliable Medical Billing Specialist with hands-on experience handling Medicare, Medicaid, and commercial insurance claims. Skilled in end-to-end revenue cycle management—from claim creation and submission to payment posting and denial resolution. Experienced in working with multiple billing platforms and communicating directly with insurance providers to resolve claim, appeal, and authorization issues. Adept in both medical and behavioral health billing, with additional training in Utilization Review support.
2. Skills & Expertise
Medical & Behavioral Health Billing
Medicare, Medicaid & Commercial Insurance Claims
Primary & Secondary Claim Creation
Payment Posting & Reconciliation
Claim Denial Management & Appeals
Insurance Follow-ups & Claim Status Calls
Prior Authorization & Appeals Tracking
Utilization Review Support
HIPAA-Compliant Documentation
3. Tools & Billing Platforms
Office Ally
Tebra
AMD
Optimantra
4. Work Experience Description
Medical Billing & Claims Specialist
Submitted accurate claims to Medicare, Medicaid, and commercial insurance plans
Created and processed both primary and secondary insurance claims
Posted payments and adjusted accounts across multiple billing platforms
Identified, analyzed, and resolved claim denials to maximize reimbursements
Communicated with insurance companies for claim status, appeal updates, and prior authorization follow-ups
Handled billing for both medical and behavioral health services
Trained to assist the Utilization Review department with authorization and documentation processes
