Medical Billing Project Manager
Last active: 1 day ago
To work as a Medical Billing Project Manager or in another Healthcare position which, fully utilizes my skills and experience while offering an opportunity for advancement.
I have worked 12 years in a US-based company. From a Medical billing specialist, AR, EDI Analyst to Management level had almost performed all the tasks related to Medical billing. As Manager Operations I lead the group of 120 employees and look after all of their administrative and operational tasks.
As a Manager Special Projects, Manager CPI and a Strategic Analyst I have worked on Company top priority projects. I have also made company's Business and strategic plans and also worked on highest priority projects and acquisitions assigned by company CEO and GM. I was the part of company's top managements so in that way mostly involved in making marketing strategies and guiding marketing executives in their projects. Financial analysis also been done for different projects. I have also experience to communicate with US doctors and other third party healthcare staff i.e. insurances, doctors, clearing houses and other third party payers. I have also visited US and visited doctors’ offices and hospitals to completely know about their processes.
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
- Super bill review
(b). Medical Coding
- To research the right DX and CPT code according to medical records
- Provide right DX pointers for the first time to avoid payment delays
- Suggest appropriate modifier for maximizing the revenue via Encoder pro Expert licensed version
Gynaecology and obstetrics
Physical Medicine and Rehabilitation