Mahers
Mahershalal P
S/o Late. Rev. J. Philip
19 Anusha Enclave 1st Cross St Jashwant Nagar Mogappair West Chennai - 600037
Email:-Indian Phone # -; -
USA Phone # -; -
Detail oriented and quality focused professional trained in medical administrative support. Successful track
record of handling complicated assignment and administrative/clerical requests. Highly experienced in posting,
deposits/payments and reconciling accounts
accounts with a high degree of accuracy. Offer solid foundation in software
applications, database management, and data entry; proven ability to readily master new technology. Dedicated
to maintaining strict Patient & Provider confidentiality.
Key sKills:
Confidentiality.
ICDICD-9+10 & CPT -10.
HCPCS.
HCPCS.
MS Office.
Medical Terminology.
Medical Transcription.
Medical Billing.
Medical Insurance.
Online Claim Submission.
Medical Software (Advanced
(AdvancedMD,
AdvancedMD, Medgen, Eclinical
Eclinical Works, Healthfusion, WRS, Etc.).
Etc.).
Scheduling Patients.
Verifying Benefits and Eligibility.
Banking.
Placing
Placing an Order for Office Supplies.
Excellent typing speed.
Professional exPerience:
1. Worked as a Medical Billing and Coding Team Leader in Ajuba Pvt. Ltd. from June 2006 to April 2014.
2. Freelancer Medical Biller from 2014 o till date
resPonsibilities (What I Can Offer):
Offer):
Insurance Verification Process:
Process:
Check Eligibility
Verify coverage on all Primary and Secondary Insurance
Check Benefits for both in Network & out of Network services
Obtain Authorizations if needed
Contact patient if information such as Referrals or additional Medical Records needed
Obtain referral from PCP
Explain the benefits to the patient
Appointment Scheduling:
Obtain all required information on the Call sheet/Face
sheet/Face sheet
Enter Patient Demographics in the Billing software
Schedule the patient in the available slot on the scheduler
Confirm appointment 24 hours prior to the patient visit
Clean Claims Creation:
Creation:
Getting the claims accepted, on the first submission! It is the most crucial juncture
juncture in the billing cycle.
cycle. The key
details, that are needed to get your insurance claims processed are entered here, and includes, the face sheet of
the patient, physician details, information about the insurance coverage of the patient
patient and billing information.
It plays a vital role in medical billing management. Well versed with internationally recognized and followed,
medical coding systems such as, HCPCS, CPT, ICDICD-9. Helps the providers get medical reimbursement a whole
faster!
deal fa
ster!
Entering
ntering the billing details of the patient in the Billing software
Entering Referring/ Rendering provider’s information
Entering the primary payer & Secondary payer’s information
Entering The correct diagnosis codes & procedure codes for the service dates
Adding modifiers if required
Entering the required billed amount for each procedure
Creating Clean Claims in a timely manner
Working on Rejections:
Claims that do not meet the specific data requirements or the basic format necessary will be rejected,
rejected, according
to the Centers for Medicare & Medicaid Services (CMS). Rejected claims will not be processed because they are
not considered to have been “received” by the payor, thus do not make it into the adjudication system. This
may sound complicated, but it really isn’t.
Correcting Errors and resubmitting on a daily basis
Print and mail claims if not set up for Electronic Data Interchange
Accounts Receivables Process:
Any claims which remain unpaid for various reasons. These claims are routinely followed
followed up on a monthly basis.
The reasons for rejections include:
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Authorization Issues
Referral Issues
Medical Necessity and Medical Records requests
NonNon-Participation with Insurance Network
Terminated Insurance
Coordination of benefits
Wrong Diagnosis
Inclusive Procedures
Partial Payments
OutOut-ofof-network claim status and deductibles
EDI Rejections
Letter of Protection from Attorney cases
No status and No claim on File
Workers' Compensation
PIP case
Maximum Reimbursement
Reimbursement:
eimbursement:
Claims are followed up systematically
systematically and quickly. Claim followfollow-up is handled utilizing our electronic
clearinghouse, insurance websites and direct contact via telephone. We diligently pursue the claims for
maximum reimbursement and appeal the denials.
Aggressive FollowFollow-up:
up:
All unpaid claims are aggressively pursued daily. Expert at getting through to the insurance companies to
dispute improper denials and slow payments.
Claim Appeals:
ppeals:
Denials and rejections are always handled by an appeal. Once the denial is evaluated, I utilize the appeal process
to handle incorrect claim denials. Claims are never written off without being appealed first.
The FollowFollow-Up Process:
rocess:
Use various Insurance company websites and internet payer portals to check on the status of
outstanding claims
Automated
Automated Claims FollowFollow-Up (IVR)
Insurance Company Representative – If necessary calling a "live" Insurance company representative will
give us a more detailed reason for claim denials when such information is not available from either
websites or Automated
Automated phone systems.
Claim Correction and Resubmission done when required
Attached Additional Documentation if required
Appeal if Needed with Medical records or Proof of timely Filing
Bill patients for Deductibles, CoCo-pays, CoCo-insurance
Bill Secondary with Primary
Primary payer’s Payment information
In cases where partial payments are made, necessary investigation and analysis is initiated, after which
corrective steps are taken.
Payment Posting:
Involves posting and deposit functions and reconciling posting activities
activities with deposits. The payment posting
process effects many other functions of the medical office and can have a major impact on patient satisfaction,
efficiency, and overall financial performance.
Read EOBs/ ERAs accurately
Enter the payment details for a each line item from EOBs accurately in the Billing Software
Transfer Patient balances
Create Deposit Batch on a daily basis
Review Auto posting
Upload EOBs in the Billing Software
Patient Collection:
Collection:
Providing
roviding patients with the best possible customer service to answer their questions, interpret their EOBs, and
work with their insurance companies to get their claims resolved.
Co--pays, CoPrinting statements for patients for Deductibles, Co
Co-insurance, NonNon- Covered Services & COB
updates
Setting up Payment plans
plans for huge payments
Discuss Courtesy on patient’s that cannot afford
Sending friendly reminders of the payment owed
Issue No balance statement when payment collection is completed
Medical Billing Reports:
Reports:
The Accounts Receivable Aging Report
The Key Performance Indicators Report
The Top Carrier/Insurance Analysis Report
Provide posting by Procedure codes/ Providers
Create Report on weekly & monthly basis
educational Qualification:
-B.Sc. Chemistry.
Chemistry.
-CCAT in Medical
Medical billing and Coding (Conducted by AAHAM).
AAHAM).