HIPAA Certified Medical Biller/AR Claims Specialist

3 years of experience processing 50–150 claims daily, including charge entry, claim submission, denial handling, and follow-up.

Accurate input of patient demographics, CPT, and diagnosis codes into billing systems.

Ensured accuracy in codes, amounts, and insurance information to avoid denials.

During my tenure as a Content Moderator for TikTok, a vibrant and fast-paced platform under the ByteDance umbrella, I undertook a pivotal role in maintaining the integrity, security, and positive user experience within this thriving online community.

Over the course of one year, I had the privilege of immersing myself in a dynamic and essential position, where I was entrusted with the critical task of processing claims and administering benefits to ensure the well-being of countless policyholders. Processing Claims, Registering Clients, Invistigating a claim, Calling Providers and Members, Calling Hospitals in the US and Canada.

Verified insurance details and prior authorization requirements from facesheets.

Maintained patient confidentiality and followed U.S. healthcare data privacy standards.

Used for tracking claims, logging follow-ups, and generating simple reports.

Communicated clearly with clients and insurance representatives over the phone.

Communicated with patients and insurance companies to resolve claim issues.

3 years of experience processing 50–150 claims daily, including charge entry, claim submission, denial handling, and follow-up.

I have experience handling end-to-end Revenue Cycle Management (RCM) in the healthcare industry. My role involved patient data entry, charge posting, claim submission, denial management, payment posting, and follow-up with insurance companies. I ensured accurate billing and timely reimbursement by closely monitoring each step of the billing process and resolving issues efficiently. I’m familiar with U.S. healthcare systems and worked to maintain clean claims and improve collection rates.

I have experience assisting in the credentialing process for healthcare providers by preparing, submitting, and tracking credentialing applications with insurance companies and healthcare networks. My tasks included collecting and verifying provider documents (licenses, certifications, NPI, DEA), maintaining credentialing records, and following up on application status to ensure timely approval and compliance with payer requirements. I am familiar with CAQH and understand the importance of accuracy and deadlines in credentialing.

I have extensive experience in denial management, including identifying the root causes of denied claims, correcting errors, and resubmitting claims for reimbursement. I review EOBs and denial codes, analyze claim issues such as coding errors, missing documentation, eligibility, or authorization problems, and take appropriate actions to resolve them. I also communicate with insurance companies and, when necessary, patients to gather missing information or clarify concerns. My goal is always to minimize revenue loss and ensure timely payment.

I have solid experience working with ICD-10 codes as part of my role in medical billing and charge entry. I accurately assign appropriate diagnosis codes based on the patient’s medical records or facesheets provided by healthcare providers. I ensure proper code selection to support claim validity, reduce denials, and comply with insurance and billing guidelines. I am familiar with commonly used ICD-10 codes across multiple specialties, including mental health, physical therapy, and home health care.