MBS & Billing Administrator / Credentialing / Admin Support

I have several years of experience in healthcare administration, mainly focused on managing patient records, billing compliance, and data accuracy. I worked on data management and migration, where I created and updated patient accounts, transferred medical records, insurance IDs, images, and balances from previous systems, and ensured all records were accurate and secure. I also conducted data reviews and quality checks to correct discrepancies, ensuring accuracy, confidentiality, and compliance with data integrity standards.

I collected and verified licenses, certifications, and insurance documents or COI for providers applying to different healthcare facilities across the US, making sure everything was accurate and up to date. We also use NPPES to verify provider information and make sure their NPI details match what’s on file with Medicare and other payers. Performed file audits & quality control of provider profiles to ensure complete and accurate credentialing.

Ensured accurate entry of consultation item codes for proper billing compliance. Handled billing verification tasks, including contacting ACFs and Medicare to resolve billing rejections and Provider number approvals status. Issued invoices via Xero, processed payments through BPOINT, and followed up on rejected claims via SMS/email. Verified & audited Medicare, PHI, and DVA eligibility to ensure proper bulk billing processes and maintained accurate patient records in electronic systems.

Handling Insurance verification for the purchase of CPAP supplies or durable medical equipment for patients that have sleeping disorder particulary those who have APNEA, we are using tools for verifying insurance eligibility or by calling insurance to ensure claims will be processed smoothly, (ex including Medicare, Medicaid and Tricare, BCBS bluecross blueshield, Allianz) to gather/obtain patients coverage, securing and reviewing patient documents, updating records to and from databases like SNAP, Emdeon, OneSource, Availity, Brightree to contact different insurance provider as well.