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Anthem - Medical Billing Specialist Resume Example

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XXXX XXXXXXXX XXXXX
PELHAM, NY 10803
Ph: XXXXX XXXXXXXX
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Isabella Reed
Summary

32 years of experience in the medical profession as LPN, 10 years of experience as medical billing specialist and office management, 
17 years in customer service.

Highly trained medical professional with strong clinical abilities and a successful career in both clinical setting and utilization management review or administration environment. Proactive and organized with passionate commitment to first-rate patient care. Licensed in New York with expertise in patient advocacy.

Skills
  • Customer and Personal Service
  • Active Listening
  • Speaking
  • Service Orientation
  • Critical Thinking
  • Coordination
  • Time Management
  • Complex Problem Solving
  • Judgment and Decision Making
Experience
Oct 2012Present Anthem, Inc Albany, NY
  • Utilization Review Management LPN National accounts.
  • Coordinated benefits and services based on medical necessity per Anthem medical policies and clinical guidelines as well as per contract.
  • Managed high call volume.
  • Electronic documentation of cases.
Nov 2011Feb 2012 Walrath Recruiting Albany, NY
  • Managed high call volume.
  • Electronic documentation of cases.
  • CDPHP; LPN Referral Case Manager for Home Care Coordinated benefits and services based on medical necessity per CDPHP guidelines.
Jan 2011Nov 2011 Maxim Healthcare Albany, NY
  • Flu Clinic LPN Administered flu vaccine in corporate settings, stores and clinics.
Apr 2011Jul 2011 Kelly Services Albany, NY
  • Wellpoint insurance; Utilization Review LPN.
  • Made pre-determinations for medications and procedures based on clinical guidelines.
  • Managed high call volume.
  • Electronic documentation of cases.
Aug 2003May 2011 New York State Medicaid Cohoes, NY
  • Private duty LPN; independent contractor Supervisory work as charge nurse, or in case management Proficient in administering patient care in a medical facility, at home, in a medical office per physician's orders, in a nursing care plan, and as standard nursing guidelines Based on state and federal guidelines Billed state Medicaid fees for services using ePACES program to receive reimbursement Registered as an independent home care provider for six years on the county level, And more recently on the federal level.
Medical Billing Specialist Nov 2010Feb 2011 Nyack Manor Nursing Home Niskayuna, NY
  • Maintained admission and discharge demographics.
  • Undertook facility-based billing.
  • Performed Medicare, Medicaid, commercial and private-pay billings.
  • Full accounts receivable follow-up.
Clinic Specialist Feb 2010Jun 2010 Center for Disability Services Albany, NY
  • Checked clients in and out for appointments.
  • Verified insurance eligibility and collected applicable co-payments.
  • Scheduled multiple-provider appointments.
Finance Assistant Aug 2009Feb 2010 Sargent and Blais Guilderland, NY
  • Obtained maximum reimbursement per contractual agreements and billing guidelines.
  • Informed medical billing staff of necessary procedural changes to obtain reimbursement.
  • Proficient in filing claims appeals.
Jun 2010Jan 2010 Accu Care Healthcare Rensselaer, NY
  • High-tech pediatric home care.
  • Part of professional team with nurses, therapists, physicians and community agencies.
  • Provided medical care in a safe environment, and assisted in daily living activities.
Medical Billing Specialist Aug 2006Jan 2007 AOR Management Clifton Park, NY
  • Managed 740 patient accounts; prepared monthly statements; resolved patient concerns Detail-oriented; maintained accurate patient demographics; verified and updated all insurance information; obtained required prior authorizations Able to interpret and explain benefits to assure proper utilization and coordination of benefits per plan guidelines, and to relay information to patients Managed aging reports; compiled and generated weekly and monthly reports for supervisors and satellite branches.
Education
NHA-certified phlebotomy technician; certified medical reimbursement specialist Albany, NY Bryant & Stratton Professional Skills Center Jan 2009
Medical Billing Specialist Certificate Latham, NY Andrews & Holbrook Training Corporation Jan 2004
diploma Adams, NY South Jefferson Central School Jan 1983
Personal Information
Active involvement in church ministries and community outreach projects Proficient cook, baker, seamstress, craftsperson, reader Personal medical advocate and assistant Versatile and varied skills; congenial; able to work independently or as part of a professional team Reliable transportation; able to travel on notice No child care responsibilities
Community Service
Active in various church ministries and community related activities such back pack giveaways, community meals preparation and serving.
Affiliations
Additional Information
  • PERSONAL Active involvement in church ministries and community outreach projects Proficient cook, baker, seamstress, craftsperson, reader Personal medical advocate and assistant Versatile and varied skills; congenial; able to work independently or as part of a professional team Reliable transportation; able to travel on notice No child care responsibilities
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Resume Details

This is a real resume for a Medical Billing Specialist in PELHAM, New York with experience working for such companies as Anthem, Inc, Walrath Recruiting. This is one of the hundreds of Medical Billing Specialist resumes available on our site for free. Use these resumes as templates to get help creating the best Medical Billing Specialist resume.

Previous Companies:

  • Anthem
  • Inc
  • Walrath Recruiting

Previous Job Positions:

  • Medical Billing Specialist
  • Clinic Specialist
  • Finance Assistant

Schools:

  • Bryant & Stratton Professional Skills Center
  • Andrews & Holbrook Training Corporation
  • South Jefferson Central School

Level of Education:

  • NHA-certified phlebotomy technician; certified medical reimbursement specialist
  • Medical Billing Specialist Certificate
  • diploma

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