Medical Scribe | EMR Specialist | Insurance Verification | 5+ Years Remote Healt

- Managed medical billing processes, including charge entry, claim submission, payment posting, and accounts receivable follow-up. - Verified patient insurance eligibility, benefits, and prior authorization requirements for medical services. - Prepared and submitted accurate insurance claims to Medicare, Medicaid, and commercial payers while ensuring compliance with payer guidelines. - Reviewed and resolved claim denials, rejections, and underpayments by identifying issues and submitting corrections or appeals when necessary. - Processed patient billing inquiries and assisted with payment arrangements and account updates. - Maintained accurate patient records, billing documentation, and financial information in EMR and practice management systems. - Collaborated with providers and insurance representatives to obtain required documentation and facilitate timely reimbursement. - Utilized medical terminology, CPT, ICD-10, and HCPCS codes to support accurate claim processing and revenue cycle management.

- Managed medical billing processes, including charge entry, claim submission, payment posting, and accounts receivable follow-up. - Verified patient insurance eligibility, benefits, and prior authorization requirements for medical services. - Prepared and submitted accurate insurance claims to Medicare, Medicaid, and commercial payers while ensuring compliance with payer guidelines. - Reviewed and resolved claim denials, rejections, and underpayments by identifying issues and submitting corrections or appeals when necessary. - Processed patient billing inquiries and assisted with payment arrangements and account updates. - Maintained accurate patient records, billing documentation, and financial information in EMR and practice management systems. - Collaborated with providers and insurance representatives to obtain required documentation and facilitate timely reimbursement. - Utilized medical terminology, CPT, ICD-10, and HCPCS codes to support accurate claim processing and revenue cycle management.

- Managed provider credentialing and recredentialing processes for physicians and healthcare practitioners. - Prepared and submitted credentialing applications for Medicare, Medicaid, and commercial insurance payers. - Verified provider licenses, board certifications, DEA registrations, malpractice insurance, and work history to ensure compliance with payer requirements. - Monitored application statuses and followed up with insurance companies to expedite provider enrollment and resolve credentialing issues. - Maintained accurate provider records and updated credentialing databases and EMR systems. - Assisted with CAQH profile creation, maintenance, and attestation to ensure provider information remained current. - Coordinated with providers and insurance representatives to gather required documentation and facilitate timely enrollment. - Ensured compliance with credentialing standards, payer guidelines, and regulatory requirements while maintaining confidentiality and attention to detail.

- Managed prior authorization requests for medications, diagnostic tests, procedures, and specialty services for healthcare providers. - Verified patient insurance eligibility, benefits, and authorization requirements with Medicare, Medicaid, and commercial insurance payers. - Prepared and submitted complete prior authorization requests with supporting clinical documentation, progress notes, and medical necessity information. - Communicated with providers, pharmacies, and insurance representatives to obtain required information and expedite approvals. - Monitored authorization statuses, followed up on pending requests, and documented updates in EMR systems. - Reviewed denials and prepared appeals, reconsideration requests, and additional documentation to support approval. - Maintained accurate records and ensured compliance with payer guidelines, HIPAA regulations, and provider requirements. - Prioritized urgent requests and managed multiple cases efficiently to minimize delays in patient care and treatment.

- Assigned and reviewed appropriate ICD-10-CM, CPT, and HCPCS codes based on provider documentation and clinical encounters. - Ensured accurate coding of diagnoses, procedures, and services to support proper claim submission and reimbursement. - Reviewed patient charts, progress notes, and medical records to ensure coding accuracy and documentation completeness. - Identified coding discrepancies and communicated with providers to obtain clarification and supporting documentation when necessary. - Assisted with claim corrections, denial resolution, and coding-related inquiries to minimize reimbursement delays. - Maintained up-to-date knowledge of coding guidelines, payer requirements, and healthcare regulations. - Utilized EMR and practice management systems to document coding activities and support efficient revenue cycle management. - Maintained HIPAA compliance and ensured confidentiality of patient information throughout the coding process.

- Verified patient insurance eligibility, benefits, and coverage for medical services, procedures, and medications. - Confirmed patient demographics, policy information, copays, deductibles, coinsurance, out-of-pocket expenses, and referral requirements. - Determined prior authorization requirements and communicated necessary information to providers and patients. - Verified in-network and out-of-network benefits and identified coverage limitations and exclusions. - Contacted insurance companies via payer portals and phone calls to obtain accurate and up-to-date benefit information. - Documented insurance verification details and updated patient records in EMR and practice management systems. - Coordinated with providers, billing teams, and patients to ensure accurate insurance information and minimize claim denials. - Maintained HIPAA compliance and ensured timely completion of insurance verification processes to support efficient patient care and reimbursement.

- Provided comprehensive administrative and clinical support to healthcare providers, ensuring efficient practice operations and quality patient care. - Managed patient scheduling, appointment coordination, intake processes, and EMR documentation. - Performed insurance verification, benefits investigation, and eligibility checks for Medicare, Medicaid, and commercial insurance plans. - Processed prior authorizations for medications, diagnostic tests, procedures, and specialty services, including follow-up and appeals when necessary. - Assisted with medical billing functions, including claim submission, payment posting, denial management, and accounts receivable follow-up. - Supported provider credentialing and enrollment processes, including CAQH maintenance, payer applications, and recredentialing requirements. - Conducted chart reviews, maintained accurate medical records, and assisted with medical coding support using ICD-10, CPT, and HCPCS codes. - Prepared and managed clinical documentation, including SOAP notes and patient records, while ensuring HIPAA compliance and confidentiality. - Communicated effectively with patients, providers, pharmacies, and insurance representatives to coordinate care and resolve administrative concerns. - Demonstrated strong attention to detail, multitasking abilities, and proficiency in EMR/EHR systems and healthcare workflows.

Evaluated agent customer interactions and monitored live calls to ensure quality assurance standards. Handled high-priority escalation calls and resolved complex, supervisor-level customer issues. Assisted in setting performance metrics and workflow improvements covering payroll processing, tax calculation, and software troubleshooting. Guided corporate users through technical e-filing, e-payments, and tax form processing while utilizing remote systems access to resolve system bugs. Monitored multi-channel agent performance across phone, chat, and email to deliver technical feedback and coaching. Resolved supervisor-tier complaints concerning order statuses, delivery friction, tracking, cancellations, and refunds. Ensured team adherence to rigid corporate policy guidelines while meeting or exceeding key performance indicators (KPIs).

Managed high-volume email inboxes, ensuring timely responses and proper prioritization of communications. Monitored, organized, and categorized emails to maintain an efficient workflow and prevent missed correspondence. Responded professionally to patient, provider, and insurance inquiries via email while maintaining confidentiality and HIPAA compliance. Scheduled appointments, coordinated follow-ups, and communicated updates through email correspondence. Drafted, edited, and sent professional emails, letters, and documentation on behalf of healthcare providers and administrative teams. Handled billing, credentialing, prior authorization, and insurance-related email communications and follow-ups. Maintained accurate records of email communications and updated information in EMR and practice management systems. Demonstrated strong written communication, attention to detail, and the ability to manage multiple tasks in a fast-paced healthcare environment.

- Managed medical billing processes, including charge entry, claim submission, payment posting, and accounts receivable follow-up. - Verified patient insurance eligibility, benefits, and prior authorization requirements for medical services. - Prepared and submitted accurate insurance claims to Medicare, Medicaid, and commercial payers while ensuring compliance with payer guidelines. - Reviewed and resolved claim denials, rejections, and underpayments by identifying issues and submitting corrections or appeals when necessary. - Processed patient billing inquiries and assisted with payment arrangements and account updates. - Maintained accurate patient records, billing documentation, and financial information in EMR and practice management systems. - Collaborated with providers and insurance representatives to obtain required documentation and facilitate timely reimbursement. - Utilized medical terminology, CPT, ICD-10, and HCPCS codes to support accurate claim processing and revenue cycle management.

Detail-oriented, HIPAA Certified, and highly adaptable professional with over 9 years of experience across healthcare support, provider credentialing, medical billing, and high-volume customer service. Proven ability to manage clinical documentation standards, navigate complex revenue cycle workflows, and streamline processes for operational efficiency. Competent in remote collaboration, cross-functional problem-solving, and managing electronic health records (EHR). Seeking a remote role to leverage specialized expertise in medical administration, scribing, credentialing, billing, or patient communications