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Medical Billing Specialist Resume Samples
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0-5 years of experience
All aspects of medical billing including coding, charge entry, transmission, correction and resubmission as required, posting of payments including patient/mail and ERA.
- Established guidelines for proper coding/billing for providers.
- Worked hand in hand with front office staff to ensure that the proper information was received for claims processing.
- Oversaw and ran necessary reports to ensure that all statuses were worked in a timely manner and helped in any capacity necessary.
- Maintained and updated all files including insurance companies, diagnosis, procedure, fees/profiles.
- Ran, processed and ensured accuracy of patient statements on a bi-monthly basis.
- Worked collections which included mailing of correspondence, working with patients to establish promissory notes for payment and if necessary forwarded accounts to collection agency.
6-10 years of experience
Responsible for following up on claims, calling and collecting money from insurance companies.
- Resolved billing issues identified by insurance carriers and patients.
- Reviewed claim denials and payer requirements for corrective action and prevention in the future.
- Researched and replied in a timely manner to insurance, patient, and internal customer inquiries.
- Kept accurate records of all activity and conversations for each file.
10+ years of experience
Submitted detailed claims to insurance companies for several practicing health care providers
- Maintained the highest levels of accuracy and patient confidentiality
- Quickly identified and resolved medical billing, coding and insurance discrepancies
- Responsible for cash management, supply ordering, and customer service relations
- Reviewed patient bills for accuracy and completeness, and obtained any missing information
- Followed the guidelines and be in compliance with local, state or federal laws and regulations
- Reviewed accounts for possible assignment and made recommendations to the Billing Supervisor, also prepared information for the collection agency
0-5 years of experience
Submitted claims to Medicaid/Medicare with attention to detail and accuracy.
- Posted payments to patient’s accounts and verified medical insurance.
- Researched and resolved denials and EOB rejections within standard billing cycle timeframe.
- Arranged Medical files in numerical order and schedule appointments.
- Reviewed billing edits and provided insurance company with correct information.
0-5 years of experience
Identified and/or located patient, insurance carrier or third party responsible for payment
- Identified account discrepancies and issues that hindered claim payments
- Identified document and report payer trends
- Managed high call from both inbound and outbound call from 300-1000 per day
- Posed and updated account data to [company name] and client hospital systems to ensure accuracy
0-5 years of experience
Specialized in radiation oncology billing.
- Promoted to a “Super biller” based on demonstrated ability to determine priorities, establish timelines, and effective manage workflow.
- Responsible for all providers and/or practices that required special accounts receivable clean-up.
- Selected to participate in a high-visibility project, which resulted in refunds in the hundreds of thousands of dollars.
0-5 years of experience
Utilized internet based medical billing software to work closely with healthcare providers to help manage their practices
- Received physicians charges via a super bill and submitted electronically to insurance carriers
- Responsible for all follow up on insurance claims to Medicare, Medicaid and commercial insurance.
- Answered all patient telephone inquiries regarding their bills and insurance questions
- Provided physicians with monthly reports of their receivables
0-5 years of experience
Prepared and submitted medical claims from consultation and operative reports.
- Corrected and resubmitted claims denied by insurance company.
- Coding of inpatient and outpatient procedures from operative reports by using ICD 9 and CPT codes and applying modifiers when needed.
- Charge entry of daily office visits received from physicians.
- Electronic billing of commercial, HMO and managed care carriers.
6-10 years of experience
- Processed and audited workers compensation claims according to the various medical fee guidelines.
- Managed hospital bills by utilizing the Acute Care Inpatient and Ambulatory Surgical Center Guidelines.
- Handled provider and client appeal/reconsideration request.
- Applied PPO contract according to client terms.
- Maintained accurate records and resolve billing issues.
Credentialing Specialist Duties and Responsibilities
Credentialing Specialists must complete a variety of tasks in verifying and maintaining licensure and other information for a healthcare facility. We have reviewed several job listings and found the following among the core Credentialing Specialist duties and responsibilities.
Verify Healthcare Credentials It is up to the Credentialing Specialist to ensure that all necessary licenses and credentials are verified and updated for the healthcare facility in which they work. This might include conducting background checks, contacting licensing boards, reviewing license applications, obtaining education information and interviewing references.
Review Applications and Resumes A Credentialing Specialist can assist with the new-hire process by going over information contained in job applications and resumes. They can help to ensure that applicants meet all licensing and credential requirements for the healthcare industry and for the specific position that is being applied for.
Assess Facility Practices To ensure that a healthcare facility is operating within state and federal regulations, a Credential Specialist will review the ways in which services are being handled. They will also review facility-specific rules and regulations for compliance with internal processes.
Maintain Databases Once they have compiled necessary documentation, most Credentialing Specialists will input information into a database. They might have several databases that track licensing, compliance with federal standards, completion of necessary training and education and continuing education completion.
Credentialing Specialist Skills
To be a Credentialing Specialist, one should be a detail-oriented, organized decision-maker with the ability to work both independently and in teams. Strong oral and written communication skills are also essential, as these specialists spend a lot of time communicating with doctors, healthcare administrators, higher education institutions and government officials. In addition to these general skills, a Credentialing Specialist could be expected by potential employers to possess the following skills. Core skills: Based on job listings we looked at, employers want Credentialing Specialists with these core skills. If you want to work as a Credentialing Specialist, focus on the following.
- Using strong research skills to gather pertinent information regarding healthcare facilities and staff
- Keeping updated on medical licensing and certification requirements
- Auditing paperwork such as applications and licensing documentation for accuracy
- Processing privilege requests for healthcare employees at hospitals and other healthcare facilities
- Understanding current healthcare laws and regulations
Advanced skills: While most employers did not require the following skills, multiple job listings included them as preferred. Add these to your Credentialing Specialist toolbox and broaden your career options.
- Possess knowledge of basic computer programs, such as Microsoft Word and Excel, as well as database programs
- Recognize credentialing guidelines of various organizations
- Understand auditing processes
Credentialing Specialist Resources
It is beneficial to conduct research additional information if you are considering a career as a Credentialing Specialist. We have provided links to online and print resources about this career, which appear below. On the Web NAMSS Blog – Updated once or twice per month, this blog, hosted by the National Association Medical Staff Services, provides information about new regulations, healthcare practices and more.
ICE Blog – Hosted by the Institute for Credentialing Excellence, this blog offers links to ICE features and relevant industry news. Industry Groups
Institute for Credentialing Excellence (ICE) – An association, founded in 1977, offering networking opportunities and information about educational requirements and trends in the credentialing industry.
National Association Medical Staff Services (NAMSS) – Formed in 1971, this organization offers support to Credentialing Specialists with continuing education opportunities, training webinars and advocacy. Books
The Medical Staff Services Handbook: Fundamentals and Beyond, Second Edition – A practical overview of and advice for those in all types of medical staff services positions, including Credentialing Specialist.
Verify and Comply: Credentialing and Medical Staff Standards Crosswalk, Sixth Edition – A comprehensive look at the credentialing process, medical standards and regulations, and the responsibilities of a medical staff.
Credentialing and Privileging Your Hospital Medical Staff, Second Edition – This short but informative book provides details about the processes by which credentials and privileges are granted to medical personnel.
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Last edited by: Gabriela Barcenas, CPRW, Content Writer II -
Gabriela Barcenas
CPRW, Content Writer IIGabriela is a Certified Professional Resume Writer (CPRW) and career adviser. With 10 years of digital media experience and five years of resume writing expertise, her publication history includes fashion, education, travel, social justice, equitable design and career advice.
