EXPERIENCED Medical Virtual Assistant | US Healthcare Ins Expert

Proficient in managing the full claims lifecycle, including accurate claim submission, tracking, denial management, and resubmissions. Strong knowledge of CPT, ICD-10, and HCPCS coding, with a focus on maximizing claim acceptance and minimizing denials.

Skilled in end-to-end medical billing processes, including charge entry, claim submission, payment posting, and patient invoicing. Proficient in reviewing and correcting billing errors to reduce claim denials and delays. Knowledgeable in CPT, ICD-10, and HCPCS coding, with experience working across multiple specialties and payer types. Adept at using EHR systems and billing software to ensure accurate and timely reimbursement.

Knowledgeable in using various EHR systems such as ModMed EMA, EClinicalWorks, and Athena.

Experienced in managing prior authorization processes for medical services, procedures, and medications. Skilled in verifying insurance requirements, gathering necessary clinical documentation, and submitting timely authorization requests. Strong ability to follow up with payers, resolve issues, and ensure approvals to avoid delays in patient care.

Experienced in managing provider credentialing and re-credentialing processes with insurance payers and healthcare networks. Skilled in preparing and submitting applications, maintaining up-to-date provider files, and ensuring compliance with regulatory and payer requirements.

Thorough understanding of HIPAA regulations and privacy standards related to handling protected health information (PHI). Skilled in maintaining confidentiality across all communication, documentation, and electronic systems. Experienced in using HIPAA-compliant platforms for data storage, billing, and virtual communication. Committed to upholding security protocols and ensuring regulatory compliance in all administrative and patient-related tasks.

Skilled in identifying, analyzing, and resolving claim denials to optimize reimbursement. Experienced in reviewing explanation of benefits (EOBs), correcting billing or coding errors, and submitting timely appeals. Proficient in communicating with payers to clarify denial reasons and implement preventive solutions. Strong attention to detail and follow-up to reduce recurring denials and improve claim success rates.

Skilled in verifying patient insurance coverage, benefits, and eligibility across commercial, Medicare, and Medicaid plans. Proficient in interpreting insurance policies, understanding payer requirements, and obtaining necessary authorizations. Experienced in resolving coverage issues, coordinating with insurance representatives, and ensuring accurate billing and reimbursement. Strong knowledge of EOBs, insurance terminology, and claims processes.