Medical Biller - AR| Credentialing Specialist

Followed up on unpaid and denied insurance claims to ensure timely reimbursement. Reviewed and analyzed Explanation of Benefits (EOBs) and Electronic Remittance Advices (ERAs) to identify denial reasons and payment discrepancies. Contacted insurance companies to verify claim status, obtain claim updates, and resolve billing issues. Submitted claim reconsiderations, appeals, and corrected claims as needed. Investigated underpayments and processed appropriate actions to maximize collections. Documented all account activities and insurance communications accurately in the billing system. Prioritized and managed aging accounts receivable to meet productivity and collection goals. Identified trends in denials and collaborated with internal teams to reduce recurring claim issues. Verified patient eligibility and insurance benefits when necessary to support claim resolution. Maintained compliance with payer guidelines, HIPAA regulations, and company policies.

As Medical Biller: - Preparing and submitting insurance claims accurately using billing software. - Recording payments from insurance companies and patients in the billing system. - Identifying denied claims, investigating the reasons, and correcting errors for resubmission. - Contacting insurance companies to check claim status and ensure timely reimbursement. - Writing and submitting appeal letters for denied or underpaid claims. - Maintaining detailed records of claim status, payment information, and follow-up actions. - Ensuring all billing activities follow HIPAA, insurance policies, and healthcare regulations.

As Credentialing Specialist: - Submitting applications to insurance companies and government programs to enroll providers. - Confirming provider credentials such as licenses, certifications, education, and work history. - Ensuring providers meet industry standards, state regulations, and accreditation requirements. - Monitoring expiration dates for licenses, certifications, and insurance enrollments to ensure timely renewals. - Coordinating with healthcare providers, insurance companies, and regulatory agencies. - Staying informed about industry regulations, payer requirements, and credentialing standards. - Resolving delays, discrepancies, or issues during the credentialing process.