Detail-oriented Revenue Cycle Management (RCM) professional with nearly five years of experience supporting U.S. healthcare providers in medical billing operations, medical coding, prior authorization, charge entry, claim scrubbing, and electronic claims submission. Skilled in ensuring claim accuracy, maximizing clean claim rates, and supporting efficient reimbursement through strong knowledge of insurance guidelines, CPT, ICD-10-CM, and payer requirements.
Experienced in working with commercial insurance, Medicare, Medicaid, and managed care plans while utilizing multiple Electronic Health Record (EHR) systems and billing platforms. Recognized for exceptional attention to detail, strong analytical thinking, and the ability to quickly adapt to new healthcare technologies and workflows.
Currently pursuing the Certified Coding Specialist (CCS) credential through AHIMA while continuously expanding expertise in claims follow-up, denial management, EOB/ERA analysis, and revenue cycle optimization to advance into Accounts Receivable and Revenue Cycle Management roles.
CORE COMPETENCIES
* Electronic Claims Submission
* Prior Authorization
* Revenue Cycle Management (RCM)
* Medical Billing
* Medical Coding (ICD-10-CM, CPT)
* Charge Entry
* Charge Scrubbing
* Insurance Eligibility and Benefits Verification
* Claims Processing
* EOB & ERA Interpretation
* Claims Follow-up
* Denial Management Fundamentals
* Medicare & Commercial Insurance
* HIPAA Compliance
* Documentation Review
* Medical Records Management
* Provider Communication
* Patient Scheduling
* Data Entry Accuracy
* Microsoft Excel
* Google Workspace
PROFESSIONAL EXPERIENCE
Medical Billing Specialist - Gastroenterology Clinic
May 2022 – June 2025
Responsibilities:
* Maintained accurate patient demographics and insurance information.
* Obtained prior authorizations for diagnostic procedures and specialty services.
* Reviewed documentation for coding and billing compliance.
* Assigned ICD-10-CM and CPT codes based on provider documentation.
* Worked with providers to resolve documentation discrepancies before claim submission.
* Performed charge entry and claim scrubbing to ensure billing accuracy.
* Submitted electronic claims to commercial and government payers.
* Assisted in resolving front-end claim edits to improve clean claim rates.
* Supported revenue cycle operations while maintaining HIPAA compliance.
* Utilized multiple EHR and practice management systems for daily billing workflows.
Patient Coordinator Assistant - Bariatric Surgery Clinic
November 2021– May 2022
Responsibilities:
* Managed inbound and outbound patient calls while providing excellent customer service.
* Scheduled appointments and maintained accurate patient records.
* Verified insurance eligibility and obtained prior authorizations.
* Coordinated pre-surgical requirements for bariatric surgery patients, conducted follow-ups, and updated the supervisor on patients cleared for surgery scheduling.
* Responded promptly to patient and provider inquiries via email.
TECHNICAL SKILLS
* ModMed/Epic/Office Ally/Availity, Tebra
* AT&T, Ring Central, 8x8
* Asana/TCW
* Google Sheets / Docs/ Slides
* Google meet/MS Teams /Outlook/Slack
TRAINING
* HIPAA for Healthcare Workers
* RevConnex Medical VA & RCM Academy
- Claims Follow-up
- Denial Management
- EOB & ERA Analysis
- Tebra Medical Billing Training
CERTIFICATIONS
* AHIMA Certified Coding Specialist (CCS) (In Progress)
* Certified Industrial Engineer
* Lean Six Sigma Yellow Belt
EDUCATION
BS industrial engineering
Columban College-Barretto
Verified
