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Medical Billing Specialist

Kauai Therapy & Wellness • Freelance

May 2022 - Present • 4 yrs

Manage end-to-end medical billing for a therapy clinic (PT/OT/ST), from charge entry to payment posting. Verify patient insurance eligibility, benefits, deductibles, copays, and coinsurance. Review clinical documentation and assign accurate CPT, ICD-10, and modifier codes (e.g., 59, GP/GO/GN as applicable). Prepare, review, and submit clean claims to Medicare, Medicaid, commercial, and government payers. Monitor claim status and follow up on unpaid, underpaid, and denied claims. Analyze Explanation of Benefits (EOBs) and remittance advice to identify discrepancies and payment issues. Correct claim errors, reprocess denied claims, and submit appeals with supporting documentation. Post insurance payments and patient payments accurately in the billing system. Generate and send patient statements; follow up on outstanding patient balances. Coordinate with front desk and clinical staff to resolve eligibility, authorization, and documentation issues. Ensure proper use of modifiers and compliance with payer-specific billing rules. Track timely filing limits and ensure claims are submitted within payer deadlines. Maintain billing reports (AR aging, denial trends, collections) and share updates with management. Communicate with insurance companies to resolve claim issues and payment delays. Ensure compliance with HIPAA, Medicare, and payer billing guidelines. Support audits and provide documentation when requested by payers. Identify process improvements to reduce denials and improve reimbursement turnaround time. Maintain accurate patient accounts and billing records.