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Reimbursement Specialist Resume Samples
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0-5 years of experience
Coordinated billing, customer collections, cash application and pricing departments to secure payment on 1,000 patient accounts
- Analyzed and reviewed accounts receivable aging to report to senior management
- Tailored unique collections processes according to departmental guidelines
- Responsible for $3.5 million in accounts receivable on government payors
- Maintained bad debts at less than 2% sales
- Collected assets by ensuring timely and accurate follow-up for assigned therapies
0-5 years of experience
Initially responsible for providing accounting support to five branch offices, each containing approximately 60 accounts and totaling $1.2M in accounts receivable
- Progressed to being responsible for larger more complex offices totaling $2.2M in accounts receivable while maintaining 9% over 90 surpassing department standards
- Became responsible for supporting high profile National Accounts team and Maxim Health Information Systems, combined total accounts receivable of $7M
- Served as lead accounting contact by collecting, analyzing and prioritizing delinquent accounts’ information to provide direction and support to National Directors and Account Executives
- Recognized by manager and peers as subject matter expert and selected to train all new hires
- Selected by managers as corporate liaison for one of our most difficult National Accounts; analyze invoices for all teams and direct all collection efforts
- Analyzed financial credit reports and perform background investigations on potential clients
0-5 years of experience
Responsible for A/R for 20 physicians to insure timely and full allowable amount of payment according to BCBS, Aetna and Medicare contracts.
- Adjudication of appeals for various coverage issues and medical necessity denials for high dollar claims.
- Interpret medical records to insure coverage based on established medical policies for various chemotherapy and radiation treatments.
- Created, reviewed and analyzed reports which allowed identification of coding errors and payer trends.
- Daily transmission of electronic claims and follow-up of rejected claims including correction of ICD9, HCPCS, modifier, or other claim reject issues.
0-5 years of experience
Coordinated sales transactions and collected payables on orders initiated by outside sales representatives.
- Filed insurance claims to Medicare and other private insurance companies.
- Provided support to outside sales force by assisting with reimbursement training.
- Addressed and answered insurance-related questions from sales representatives and customers.
- Assessed and reconciled past due accounts in time-efficient manner.
- Answered customer inquiries and resolved issues regarding insurance coverage, billing, and claim status.
0-5 years of experience
Performed reimbursement functions with focus on collections. Responsible for resolving returned, disputed or rejected claims from payors.
- Worked on aged receivables and identified improper payments, inappropriate claim denials, billing errors and discrepancies on all returned claims through final resolution.
- Contacted insurance companies and third parties payors regarding errors and discrepancies.
- Resolved errors by resubmitting corrected or unacknowledged claims, medical records, appeals and other documentation required for timely payments.
- Issued refunds as needed.
- Educated in Medical Terminology, EOB’s, Remittances, CPT and ICD9.
- Worked independently and as a team member.
- Assisted with cash application and billing at months and year ends when needed.
- Discovered and led a project to recover funds paid to patients once it was determined insurance companies were issuing payment to the members in an early stage company. Received the Pacemaker Award in recognition for recovering $77k that was considered uncollectable.
0-5 years of experience
Created, analyzed and processed Accounts Receivable reports for Commercial, Traditional / Managed Care Medicare and Medicaid.
- Identified trends of payment / non-payment from insurance carriers. Developed relationships and worked in cooperation with carrier contacts to resolve issues and secure monetary settlements.
- Developed and maintained appeals process for denied claims.
- Trained and mentored new employees on all processes relating to their positions.
- Served as active member of NTD Labs Site Committee, which organized corporate social responsibility and employee oriented functions.
- Honored by management for Job Excellence.
0-5 years of experience
- Billed and collected for insurance/Medicaid claims submitted on behalf of two Maxim branch offices with sales totaling $750-$800K per month
- Managed an aging accounts portfolio to satisfy delinquent accounts
- Ensured strict compliance and adherence to State and Federal laws and regulations regarding medical reporting
- Collected over $1 million in aging accounts in less than one year
- Conferred with management to reduce operating costs and maximize profit
- Helped to develop a new Medicaid billing system to increase efficiency and accuracy
0-5 years of experience
Processed correspondence received EFT’s, lock boxes, credit cards, and check payments, daily deposits.
- Investigated and resolved issues with Medicare, Medicaid, Medcost, Veterans Administration, Tricare, PHCS and other commercial insurance carriers.
- Audited electronic claim filing process to ensure timely payment for Professional and Institutional claims.
- Assisted patients in understanding their charges and responsibilities, set payment plans, collections, and A/R productivity
- Assisted in web-based program Allscripts to monitor claims for rejections, insurance eligibility, and remittance notices for electronic payment.
0-5 years of experience
Performed all front office responsibilities including assisting with reception, performing full cycle billing and collections.
- Check patients in and out, collected co-payments, explained patient responsibility, processed referrals, scheduled patients, and completed patient registration.
- Touch an average of 75 claims a day for both billing and collections purposes.
- Responsible for accounts receivable duties, submitting electronic claims, verifying eligibility and benefits, and insurance follow-up.
- Performed the appeals and denial process; re-billed and researched discrepancies.
6-10 years of experience
Edited and billed home infusion pharmacy and DME claims for various State Medicaid’s and government payers
- Proficient in processing drug and pharmacy benefit claims though DayTech Claims Engine 2000
- Collaborated with collections division to research claims submission errors or payer requests to quickly and accurately collect payment for pharmacy shipments
- Researched and abided by all company and payer reimbursement policies, procedures, and guidelines to maintain compliance
- Collaborated with management to suggest submission corrections to reduce payment delays based on denial research efforts
- Consistently met and exceeded all productivity outlines
0-5 years of experience
Created and submitted Medicare claims for enteral and respiratory medication.
- Edited Medicare claims via Zirmed and Infusion Edits prior to release.
- Managed 0-30 days accounts receivable on Medicare claims.
- Performed collection calls and follow up on aging accounts.
- Submitted appropriate documentation for adjustments, write-offs, or bad debt.
- Surpassed monthly cash goal for fourth quarter by an average of 138%.
0-5 years of experience
Assisted medical device companies in obtaining Medicare reimbursement for new and emerging products as well as protecting reimbursement for established devices. Created economic programs which highlighted the benefits of clients’ products. Interacted with Senior Management of several Fortune 500 companies as well as top venture capital firms.
- Wrote numerous reimbursement strategies for new and established products.
- Designed easy to understand coding brochures for clients.
- Assisted clients with Investigational Device Exemption (IDE) clinical trial reimbursement.
0-5 years of experience
Reimbursement Specialist for Indiana and Michigan branch offices focusing on developing invoices and financial spreadsheets for data management and internal records.
- Collected over $92 Million in current cash.
- Researched and collected over $17 Million in A/R. (over 90 days past due)
- Monitor accounts to ensure regularity of payments and prevent/minimize delinquency.
- Make collection calls or send collection communications to obtain payment.
- Generate and distribute monthly A/R reports.
- Research unapplied funds on assigned accounts.
- Apply Open Credits to correct accounts and make adjustments to accounts as needed.
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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.
