Hi,
Wellcome to My Profile. I have been working for a US Medical Billing Industry as a Medical Biller and AR specialist (RCM Specialist ) for over 4 years. I am familiar with professional and hospital Billing, Account Receivable, and Denials Management, Reporting, OLD AR/ NEW AR.
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Work Experience:
In the course of my billing career, I have performed various duties such as HCPCS research, fee investigation for similar providers. I have great experience working on the below-mentioned functions of Medical billing.
1. Patient Registration
2. Insurance Verification
3. Charge Posting / Superbill review
4. Evaluation of valid HCPCS codes, ICD 9-10 and Modifier
5. Fixing Rejected Electronic claims
6. Checking clearinghouse reports
7. Provider PIN calling ( for verifying provider TAX id, NPI, and billing address, Pay to address)
8. EOB and check search via websites and batches
9. Payment Posting of Insurance
10. AR Follow up on denied claims via call or websites
11. Appeal project
12. Collection / Refund / Over-Payment
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In Credentialing I have expertise in the following Services:
• Primary Source Verification
• Updating CAQH Accounts
• PECOS Provider Enrollments
• Filing Applications
• Initiating Credentialing Process
• Credential new providers and re-credential current providers under different Tax ID's.
• Verify provider’s license through the state license authority website
• Licenses and Affiliation Check
• Payer Contract Evaluations and Negotiations
• Re-Enrolment and Re-Validation Solutions
• Maintain internal provider grid to ensure all information is accurate and logins are available
• Update each provider’s CAQH database file timely according to the schedule published by CMS
• Complete credentialing applications to add providers to commercial payers, Medicare, and Medicaid
• Complete re-credentialing applications for commercial payers
• Take follow up for the Credentialing applications and maintain the record.
• Maintain accurate provider profiles on CAQH, PECOS, NPPES, and CMS databases
• Form submission to different Insurance companies like Humana, United, Cigna, Aetna, Anthem, Medicare, Medicaid, BlueCross Blue Shield etc.
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AR Follow-up:
• Call Insurance companies on behalf of physicians and carryout further examination on outstanding Accounts Receivables
• Prioritize unpaid claims for calling according to the length of time it has been outstanding
• Call insurance companies directly and convince them to pay the outstanding claims
• Check the relevance of insurance info offered by the patient
• Evaluate unpaid insurance claims
• Call insurance companies and check on the status of claims
• Transfer the outstanding balance to the patient of he/she doesn’t have adequate insurance coverage
• If the claim has already been paid, ask the insurance company for Explanation of Benefits (EOB)
• Make corrections to the claim based on inputs from the insurance company.
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Project Specialists:
1. Publishing weekly/monthly report to clients.
2. Working on new ideas to improve process accuracy and productivity.
3. Doing calibration with QCA, Team, and Client to reduce process variances.
4. Tracking or identifying root causes of insurance denials and low revenue.
5. Suggesting corrective actions, implementing solutions, and reviewing implementation
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I am serving the US health care industry for the last four years in different states including, MO, CO, OK, CA, TX, MN, NJ, NY, OH, NV etc. I have worked for the below-mentioned specialties of the provider’s claims.
1. Gastroenterology
2. Renal
3. Physical Therapy
4. DME
5. Chiropractic.
6. Surgical
7. Internal Medicine
8. Behavioral and Mental Health
9. Podiatry
10. Lab Billing (Covid), etc
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EHR Software Work Experience:
I have also have a strong grip on different EMR/EHR and Billing Software's including.
• Advanced MD PM
• Office Ally Practice Mate
• eCW
• Kareo
• Care Cloud
• Simple Practice
• IPatientCare
• Care Tracker
• MD Vision
• CarRisk (For Worker Com)
• Athena
• Talk EHR
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I also have experience of using clearing house portal including
Change Healthcare, Office Ally, Availity, TriZetto, Zirmed, WayStari

Electronic Medical Record (EMR)
Accounts Receivable
Medical Procedure Coding
Electronic Medical Record
Medical Records Software
Data Entry
Account Reconciliation
Medical Terminology
Medical Billing & Coding
Healthcare Common Procedure Coding System
Insurance Verification
ICD Coding
Medical Mastermind Medical Billing Services