Billing Specialist – DR Medical LLC
Authorized to work in the US for any employer
January 2017 to Present
• Preparation of claims for transmitting to Payer websites for payment on Durable Medical Equipment (DME) services.
• Communicating with Payer’s to correct and re-submit denied claims.
• Posting payments to claims received electronically and manually.
• Processing changes in the Empower software system to support accurate/efficient billing.
April 2016 to October 2016
• Preparation of claims to upload to Payer websites for payment on Behavioral/Substance Abuse services.
• Verification on patient eligibility.
• Communication with Payer’s to correct and re-submit denied claims.
• Process changes on information in the SMART software system to support accurate and efficient billing.
July 2007 to April 2016
Brockton, MA 7/07 – 4/16
Third Party Claims Reconciliation
• Works with federal and state reimbursement sources to ensure compliance with third-party reimbursement policies, contractual terms and regulatory requirements for all payers are filed.
• Works with Claims Reconciliation Supervisor to provide communication regarding the status of A/R and specific account activity to the Director and pharmacy general manager.
• Achieves productivity goals with regard to claims resolution as determined by the Collection Manager and Claims reconciliation supervisor.
• Working with external customers like Medicaid, Hospice and Private Insurances and internal departments of Pharmacy Corporation of America to resolve issues that may be preventing the payment of pharmacy invoices that are older than the standard terms of payment.
• Admission/Billing Coordinator, setting up patient profiles in the AS400 system, benefit verification for drug coverage for residents entering into a skilled nursing facility or assisted living facility.
• Maintain pharmacy bills for 18 skilled nursing facilities for Beverly/Golden Healthcare Company in Massachusetts.
• Making sure that pharmacy bills are being billed correctly to Medicare, Medicaid and Private Insurance sources.
February 2005 to June 2006
As an Executive Assistant, I provided support to the WW Director of Clinical Research and Regulatory Affairs, Director of Regulatory Affairs and Regulatory Compliance and Manager of Clinical Research.
• Maintain and track Educational Grants, Clinical Contracts and Agreements.
• Calendar management, scheduling meetings (internal and external), and travel coordination (domestic and international).
• Provide administrative and logistical support to the entire department in the coordination and execution of various projects for the clinical research and regulatory affairs within the Mitek industry.
August 2004 to January 2005
As a Senior Administrative Assistant, I supported the in-house attorney and the V.P. of Sales and Marketing.
• Maintained monthly organizational charts, various Excel program logs, client and contingency list(s).
• Created a highly effective organizational and filing systems, including quick and thorough indexing, filing and offsite storage, resulting easy access to critical information and stream lined to office functioning.
December 2003 to May 2004
As Senior Administrative Assistant, I supported two V.P. of Client Services and 30 Client Service Representatives.
• Created and edited proposals and presentations
• Coordinated preparation and timely dissemination of company reports and slide presentations for clients.
June 2000 to September 2002
As an Executive Assistant, I provided support to the President/CEO and Chief Operations Officer, Chief Financial Officer, V.P. of Marketing and Chief Clinical Officer in the management of Skilled Nursing Facilities.
• Acted as liaison and maintained open lines of communication among senior executives, board members, middle management and administrative staff.
• Collaborated with managers on weekly postings for master reports to facilitate the accurate and timely writing, editing, and preparation of final copy from draft to distribution.
September 1997 to June 2000
As the Administrative Assistant II, I supported the Medical Director and Sr. Manager of the First Seniority Department plus a staff of four (4).
• Distribution of forms and materials to HPHC PCP providers regarding the program of First Seniority.
• Receiving of the Intake forms from HPHC providers and patients and imputing information into an AS400 system.
• Development of reports and distribution to various skilled nursing facilities.
• Provided administrative support to the entire department on various projects.
• Scheduling of internal meetings.
February 1992 to September 1997
Supporting the President/Owner of a small computer/software company.
As the office manager, I maintained the office and supported the principle owner.
• Maintained and tracked all sales, prepared and sent out invoices.
• A/R and A/P
• Calendar management for external and internal meetings.
• Ordered and maintained office supplies.
State of Massachusetts Cosmetology
• Ten plus years of experience managing business relations and special projects at the senior management level.
• Serve as primary point of contact for a liaison between management, sales teams, personnel, clients, and vendors.
• Maintain excellent written and oral communication skills, problem resolution abilities, and a high level of confidentiality.
• Software Skills: Microsoft Word, Excel, Power Point, Access, Project, Publisher, WordPerfect, Lotus 1-2-3, PageMaker, Visio, Corel Draw, MS Outlook, Lotus Notes and Microsoft Explorer.
• Certification in Health Care compliance, Records Management, Privacy: Safe Harbor Clinical Data.
• Training on FDA / ISO requirements.