Medical Billing/AR Follow Up/Charge Entry/Denial Management/Payment Posting/Insurance Verification Specialist/Administrative Assistant/HIPAA Certified/Customer Service Representative
Medical Billing & Insurance Verification Specialist with 8+ years spanning Optum Specialty Pharmacy to Premier Medical Billing (PMBA). I help outpatient and specialty practices get paid—accurately and on time—by optimizing clean claims, maximizing collections, and shortening A/R. Strengths include charge entry; ICD-10/CPT/HCPCS validation; eligibility & prior auth; claim submission; denial management & appeals; payment posting; and payer-portal navigation. Known for boosting first-pass approvals and resolving complex rejections/underpayments in high-volume, remote workflows. Calm, collaborative, and HIPAA-strong—I partner with providers, coders, and payers to enhance revenue and patient experience using Tebra, Prompt, SimplePractice, TherapyAppointment,Home State Health, Availity, and major health-plan portals.
EMR/EHR & Practice Management Systems
- Tebra
- TherapyAppointment
- AdvancedMD
- Prompt
- Home State Health
- ClaimMD
- PRAVA PMS
Skills Developed
- Performing charge entry accurately to ensure proper billing
- Analyzing Explanation of Benefits (EOB) and Electronic Remittance Advice (ERA) for claim accuracy
- Processing and reviewing claims to maximize reimbursements
- Ensuring full reimbursement by verifying insurance coverage, patient responsibility, and payer requirements
- Using electronic health record (EHR/EMR) software for documentation, billing, and record management
- Performing account reconciliation and managing accounts receivable efficiently
- Handling denial management by identifying issues and coordinating resolution
- Conducting medical transcription and maintaining accurate patient records
- Operating billing systems and managing claims submission workflow
- Providing excellent customer service and communication with patients, providers, and payers
- Applying problem-solving skills to resolve complex billing and insurance issues
- Navigating Medicare and Medicaid processes accurately
- Performing insurance verification and confirming eligibility for benefits
- Applying ICD-10 coding and billing & collection procedures for compliance and accuracy
- Posting payments to insurance and patient accounts to maintain updated financial records
