Medical Billing & AR Specialist | Revenue Cycle Management | Denial Management |

Generated and issued accurate customer invoices in accordance with contract terms and company policies. Recorded incoming payments and applied them to appropriate customer accounts using accounting software. Managed timely collection of outstanding receivables through email, phone, and written communications. Monitored aging reports and followed up on delinquent accounts to minimize bad debt. Reconciled customer accounts by resolving discrepancies, chargebacks, and payment disputes. Assessed customer creditworthiness and maintained records of credit approvals and limits. Prepared and delivered regular reports on accounts receivable aging, collections status, and cash flow projections.

Reviewed and verified insurance claims for accuracy, completeness, and eligibility according to policy terms. Processed incoming claims data using specialized claims management systems Determined claim validity and coordinated with policyholders, providers, or internal departments for clarification. Identified and flagged discrepancies, errors, or fraudulent activities for investigation and resolution. Calculated and issued reimbursements or denials based on contract terms and coverage limitations. Maintained detailed documentation of claim decisions, communications, and status updates. Responded to customer and provider inquiries in a timely, professional manner. Participated in audits and quality assurance reviews to ensure processing accuracy and compliance. Collaborated with billing, collections, and appeals teams to resolve complex or escalated claim issues.

Highly organized and detail-oriented Medical Biller Specialist with 10 years of experience in medical billing and coding. Proficient in processing insurance claims, understanding medical terminology, and navigating complex billing systems. Demonstrated ability to ensure accurate and timely claim submissions, reduce claim denials, and maintain compliance with healthcare regulations.

Review and analyze denied and rejected insurance claims. Determine the root cause of denials like coding, documentation, eligibility, authorization, etc. Initiate appeals and re-submissions with supporting documentation and justification. Track and monitor denial trends to identify recurring issues. Collaborate with coding, billing, and clinical teams to correct and prevent denials. Communicate with insurance companies to clarify denial reasons and resolve discrepancies. Maintain detailed records of denial and appeal activities. Ensure all appeals are filed within payer-specified timeframes. Assist in training staff on best practices for denial prevention. Generate and distribute regular denial management reports to leadership.

Answer incoming calls and respond to patient inquiries regarding appointments, services, and scheduling needs. Schedule, reschedule, and cancel patient appointments in accordance with provider availability and clinic protocols. Confirm patient appointments and provide pre-visit instructions. Verify and update patient demographic and insurance information at the time of scheduling. Coordinate referrals, authorizations, and follow-up appointments as needed. Work closely with clinical teams to prioritize urgent or time-sensitive appointments. Notify appropriate staff of no-shows, cancellations, and schedule changes. Maintain accurate scheduling records and ensure compliance with HIPAA and confidentiality policies. Handle high call volumes and multitask in a fast-paced environment. Escalate scheduling issues or conflicts to supervisors or appropriate personnel.

Review scheduled services, referrals, and provider orders to determine if prior authorization is required. Submit prior authorization requests to insurance payers, including all supporting clinical documentation. Follow up with insurance companies to track status and resolve delays or denials. Communicate authorization approvals or denials to patients, providers, and billing staff. Work with clinical teams to collect additional documentation when needed. Ensure all approvals are obtained before the scheduled service date to prevent rescheduling or claim denials. Accurately document all authorization activities in the electronic health record (EHR) or practice management system.