A highly skilled professional with 15 years of experience in healthcare account management under Business Process Outsourcing (BPO), specializing in team supervision, benefits and eligibility, billing, authorizations, and provider communications. Adept at leading and mentoring teams to deliver excellent service in a fast-paced environment, ensuring accurate and timely processing of claims, authorizations, and explanations of benefits (EOBs). In addition, experienced as a medical virtual assistant, providing efficient administrative and operational support, managing healthcare-related tasks remotely, and utilizing cutting-edge technology to improve workflows and communication.
Experience: 10+ years
• Benefits & Eligibility verification for healthcare providers and members • Medical billing and payments, including coding and claims management • Handling authorizations for treatment and managing authorization workflows • Explanation of Benefits (EOB) analysis and communication with providers and members • Addressing provider inquiries and resolving operational issues • Compliance with HIPAA and other healthcare regulations
Experience: 10+ years
• Benefits & Eligibility verification for healthcare providers and members • Medical billing and payments, including coding and claims management • Handling authorizations for treatment and managing authorization workflows • Explanation of Benefits (EOB) analysis and communication with providers and members • Addressing provider inquiries and resolving operational issues • Compliance with HIPAA and other healthcare regulations • Virtual management of provider communications and client interactions • Data entry and CRM management • Medical transcription, documentation, and record keeping • Telemedicine support, remote administrative duties • Familiarity with electronic health records (EHR) systems and other healthcare software
Experience: 10+ years
• Supervising and training teams handling benefits, billing, authorizations, and EOBs • Mentoring team members for performance improvement and operational excellence • Ensuring compliance with healthcare policies, regulations, and industry standards
Experience: 10+ years
Intake Notification SME June 2013- June 2014 Co-managed a team of 15 associates in overseeing authorizations, and provider support services for a BPO-based healthcare client. Oversee the intake and notification process for new patient admissions and outpatient services, ensuring that all required documentation and information are gathered and submitted accurately. Provided support to associates in addressing provider inquiries regarding the intake notification process, responding promptly and professionally to ensure satisfaction and clarity. Identify opportunities for streamlining the intake notification process, proposing and implementing improvements to increase efficiency and reduce turnaround times. Intake Notification Coordinator April 2012- June 2014 Assisted providers on the intake and notification process for new patient admissions and outpatient services, ensuring that all required documentation and information are gathered and submitted accurately. Track the status of submitted notifications and follow up with case reviewers upon provider’s request. Ensure all intake notifications meet the organization’s compliance standards, including HIPAA regulations, insurance requirements, and organizational policies.
Experience: 6 months - 1 year
1. Patient Registration Collecting patient information (personal, insurance details, etc.) Verifying insurance eligibility and benefits Ensuring accurate data entry to avoid billing issues 2. Charge Capture Documenting and coding the medical services provided (e.g., CPT, ICD-10 codes) Ensuring that all services provided are accurately recorded for billing purposes Reviewing clinical documentation to ensure proper coding Handling any issues related to incorrect or missing codes 3. Billing Generating and submitting claims to insurance companies and payers Ensuring accurate and timely submission of claims for reimbursement Handling different payer requirements (commercial insurance, Medicare, Medicaid) 5. Claims Management Tracking the status of claims submitted to insurance companies Addressing claim denials, rejections, or underpayments Resubmitting claims or appeals when necessary Ensuring timely follow-up to maximize reimbursements 6. Payment Posting Recording payments received from patients and insurance companies Applying payments to the correct accounts Ensuring accuracy in payment amounts and applying appropriate adjustments (e.g., co-pays, deductibles)
“My life has gotten so much better. It changed my life, and I know it can change yours”
- Lukas Rohler
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