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.
#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
- Superbill review
Gynecology and obstetrics
Physical Medicine and Rehabilitation
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.