Hi,
This is Shamila K and I am CPC, CCS & HIM-1 Certified Medical Coder, Medical Biller and Credentialing Specialist with direct experience in many specialties in inpatient and outpatient settings of 13 years. I specialize in working with small, medium and large sized medical practices and hospitals. Not only do I provide day-to-day help and support, I can also provide unique insights into various ways to improve the running of your business. I offer a high level of reliability, accountability, and knowledge backed by over 13 years of experience in Healthcare industry at different managerial positions.
I have excellent communication, computer, interpersonal skills, and knowledge of HIPPA laws and regulations. Track record of achieving exceptional results in quick paced work environment and contributing to a successful workplace.
I performing various duties as Medical Biller and Virtual assistant in the RCM cycle, from patient scheduling and reminders to Financial reports, including followings;
• Patients Appointments Handling (Phone, Online Zocdoc etc.)
• Patients Demographic Entry
• Eligibility and Benefits Verifications
• Preauthorization/Precertification with Tracking
• Charges/Claims Creation
• Electronic, Online & Paper Claims Submission
• Payment Posting (Insurances & Patients)
• AR Follow Up on Claims
• Denials Management
• Appealing on all Denied or Low Paid Claims
• Patients Billing/Statements
• Secondary Insurance Billing
• Providers & Patients Communication
• General & On demand Reports
• Providers, Staff and Patients Queries Handling
• Credentialing and Tracking
• EDI, ERA & EFT Enrollment
• HEDIS & QARR Incentives
• Providers & Staff Trainings
Medical Billing :
I have Medical Billing experience for almost eight years. During these 13 years, i have worked on many specialties. I do know the complete RCM flow, i have been doing charge entry, payments posting, and AR follow-up.
I have a working knowledge of Charge entry, claims submission, working on rejections, Benefits verification, ERAs/EOBs posting, Insurance Call for doing a follow-up on unpaid claims/denial management, and getting referral information using different resources. In addition to these, i can also handle patient calls; by this provider, the office can focus more on their patients' care.
Expertise:
#Account receiveables, #Collection management , #Outpatient and inpatient Billing, #ICD-10-PCS, #ICD-10-CM, #HCPCS, #CDT, #CPT, #ICD-10-AM
a) Medical Billing Services includes the following:-
- To check Eligibility and verification of patient’s health benefits from insurance carrier’s website and through Phone.
- Create appointments on scheduler while receiving patient calls
- Full patient demographics and charge entry
- Insurance claims submission (primary, secondary or tertiary)
- Accounts receivable analysis with corrective and preventive actions and decision making for Collections
- Strong claims follow up on denials from insurances like Workers Comp, Medicare, Medicaid, BCBS Semi-Government, Managed care and Commercial Insurances (Aetna, BCBS, Cigna, UHC, Oxford etc...)
- Patient billing inquiries as per received information from provider office
- To check claim status from insurance, websites, auto-response unit, and via live calls.
- To make on-call appeals for reprocessing of incorrectly processed claims based on billing knowledge
- ICD9, CPT and HCPCS Coding and/or review, Encoder pro Expert licensed version guided for correct coding
- Daily, Monthly, and annual AR Financial reports preparation
- Custom reports where required
- Patient billing as per instructions
- Credentialing guidelines
- Consulting/Training
- Superbill review
- Appeals
(c). Specialties
Anesthesiology
Cardiology
Chiropractic
Dermatology
Emergency Medicine
Endocrinology
Family Practice
Gastroenterology
General surgery
Geriatrics
Gynecology and obstetrics
Internal Medicine
Pneumology
Orthopedic
Otolaryngology
Pathology
Pediatrics
Physical Medicine and Rehabilitation
Physical Therapist
Psychiatry
Neurology
Radiology
Radiotherapy
Rheumatology
Urology
TECHNICAL SKILLS:
MS Office, MS Office Suite, Rational Rose, MS Visio, Agile/Scrum, UAT, Sales Management, MS Project, Rational Requisite Pro, Test Director, WinRunner, Excel, ERP, SOAP, Restful, LoadRunner, SDLC, Quick Test Pro, MS-Word, MS PowerPoint.
ShiftPlanning
