Medical Biller

I have over 2 years of hands-on experience in medical billing, working with US-based providers and DME suppliers. I’m skilled in preparing and submitting claims using systems like AMD and verifying that all information aligns with payer requirements, including accurate CPT and ICD-10 coding. I regularly reviewed EOBs, posted payments, and followed up on unpaid or denied claims to ensure timely reimbursement. I’ve also worked closely with providers and insurance companies to resolve billing discrepancies, support appeals, and ensure compliance with federal billing guidelines. Additionally, I have experience indexing faxed documents, attaching supporting documentation for claims, and entering billing data in EMR/EHR systems such as Epic and Athena.

I have extensive experience handling prior authorizations for various medical services, including DME equipment, outpatient procedures, and specialist visits. I coordinated directly with insurance companies to determine if prior authorization was required, gathered all necessary clinical documentation, and submitted requests via payer portals or by phone/fax. I’ve worked with both government and commercial plans (Medicare, Medicaid, PPOs, HMOs) and followed up on pending requests to ensure timely approvals. I also updated the status in EMR systems like Epic and communicated with providers, patients, and billing teams to avoid delays in care or claim denials.

I have over 7 years of experience in insurance verification for US-based healthcare providers, hospitals, and DME suppliers. My responsibilities included verifying patient insurance coverage, checking eligibility and benefits, and confirming requirements for pre-authorizations. I worked with various payers including Medicare, Medicaid, HMO, and PPO plans through portals like Availity and directly with insurance companies by phone. I verified both medical and DME services, including high-cost items like respiratory equipment and outpatient procedures. I’m also experienced in entering verified data into EMR systems like Epic and Athena, ensuring accuracy and compliance. I’ve supported specialty clinics (e.g., skin grafting, radiology) and helped providers understand payer rules, coverage limitations, and documentation requirements — all while maintaining patient confidentiality and turnaround time standards.

I have experience handling high-volume fax data entry in a healthcare setting, particularly supporting radiology and DME clinics. I managed incoming faxes through a fax server, reviewed documents such as physician orders, authorizations, and patient forms, and accurately indexed and attached them to the correct patient records using systems like IndxLogic and Athena. I ensured that all documentation was properly organized and accessible for billing, insurance verification, and clinical review. My work helped streamline the workflow for pre-authorizations and claim processing while maintaining HIPAA compliance and data accuracy.

I have experience supporting provider credentialing, including maintaining and updating profiles in the CAQH ProView system. My tasks included ensuring that all provider information—such as licenses, certifications, insurance, and practice details—was accurate and up to date in CAQH to comply with payer requirements. I also assisted with reattestation, uploading required documents, and responding to payer requests for additional information. This work helped ensure that providers remained eligible for claims submission and network participation with commercial and government payers.