Hi! I am a Medical Biller with 7+ years of experience helping DME providers and multi-specialty practices (Internal Medicine, Family Medicine, and Physician Assistants) streamline the billing process. Demonstrated proficiency in prior authorization, claims submission, payment posting, and denial management to ensure maximum reimbursement.
Payment Posting & Denial Specialist: extensive experience in high-volume payment reconciliation (Manual/Electronic) and multi-payer denial resolution. I specialize in identifying denial trends and optimizing account accuracy for Medicare, Medicaid, and MCOs to ensure seamless revenue flow.
Prior Authorization Specialist: Expert in navigating MCO and Commercial payer requirements to secure medical authorizations. Proven track record in auditing clinical data for medical necessity, managing the full submission-to-approval lifecycle, and resolving complex denials through targeted appeals.
Claims Submission Specialist: Dedicated to maintaining high clean-claim rates for multi-specialty outpatient services. Expert in identifying and correcting ICD-10 and CPT/HCPCS coding errors before transmission. Proficient in managing the end-to-end electronic submission process for CMS-1500 and UB-04 forms, ensuring timely payer acceptance and reduced rejection rates.
Tools: Brightree, eClinicalWorks (eCW), Availity, Carelon, Carecentrix, Cigna, ePACES, Fidelis, HealthFirst, Humana Tricare, Optum, UHC
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