I have comprehensive experience across healthcare payer services, medical billing, and specialty prior authorization. I articulated policy details, coverage, eligibility, and benefits to providers while verifying whether practices and facilities were In-Network (INN) or Out-of-Network (OON). I processed claims, addressed issues and denials, and maintained strict compliance with insurance policies and legal regulations including HIPAA. Additionally, I facilitated claims submission to internal and external parties, responded to providers’ inquiries regarding members, and assessed CPT/ICD-10 codes to determine authorization requirements, delivering approval dates and pertinent information to all stakeholders. In medical billing, I executed payment postings and adjustments, monitored outstanding claims and payments, produced patient bills and statements, validated patient insurance eligibility and benefits, and prepared and submitted complete claims to insurance providers while managing the full cycle of claims, denials, and appeals. I also encoded diagnoses and procedures using ICD-10 and CPT coding systems. For dermatology services specifically, I reviewed and processed prior authorization requests, collected necessary clinical information and medical records, monitored request status and resolved issues, coordinated with providers and their offices regarding upcoming appointments, and submitted requests to various insurers to ensure timely access to care.
Verified
