Senior Medical Biller Resume Example

Senior Medical Biller (Oncology Specialist) · Rocky Mountain Cancer Centers

Denver, CO · 2020 - Present

• Managed a monthly claim volume exceeding $3.5M for complex oncology treatments including chemotherapy, radiation, and surgical oncology, maintaining a clean claim submission rate above 98%.
• Reduced denial rates by 18% within the first year by implementing proactive pre-authorization checks and refining appeals processes for high-cost medications and therapies, improving cash flow by $250K quarterly.
• Identified and recovered over $500K in underpaid claims by conducting thorough analysis of insurance payment policies and negotiating effectively with payers, directly impacting the practice's bottom line.
• Trained 5 junior billers on specialized oncology coding (J-codes, CPT, ICD-10-CM) and complex authorization workflows, leading to a 20% increase in team efficiency and a 10% reduction in billing errors.
• Developed and implemented a new denial tracking system using Epic, providing granular insights that informed process improvements and decreased A/R days by an average of 7 days.

Medical Biller II · Centura Health Physician Group

Denver, CO · 2016 - 2020

• Processed an average of 150-180 claims daily for multiple specialties including internal medicine and gastroenterology, achieving a 95% first-pass resolution rate.
• Increased collections by 12% for assigned accounts through persistent follow-up on outstanding balances and effective communication with patients and insurance carriers.
• Contributed to a 15% reduction in accounts receivable aging by meticulously reviewing denied claims, correcting errors, and submitting timely appeals within payer guidelines.
• Collaborated with clinical staff to improve documentation accuracy, resulting in a 5% decrease in coding-related denials and enhanced compliance.

Bachelor of Science in Healthcare Administration · University of Colorado Denver

Denver, CO · 2012 - 2016

• Graduated Magna Cum Laude, GPA: 3.85/4.0
• Relevant Coursework: Healthcare Finance, Medical Ethics, Health Information Systems, Revenue Cycle Management, Managed Care Operations
• Completed capstone project on reducing administrative waste in outpatient clinics, presenting a model projected to save 15% annually

Senior Medical Biller · Piedmont Healthcare

Atlanta, GA · 2022 - Present

• Led a team of 5 billing specialists, increasing overall team productivity by 20% through targeted training and implementation of best practices in claims management and follow-up.
• Reduced accounts receivable days by 18% (from 45 to 37 days) through proactive payer engagement, appeals processes, and streamlined reconciliation.
• Developed and implemented a new denial management protocol, decreasing denial rates by 12% across multiple service lines and accelerating reimbursement cycles.
• Conducted comprehensive audits of billing processes and patient accounts, identifying and rectifying compliance gaps to ensure 100% adherence to CMS and HIPAA regulations.

Medical Billing Specialist · Northside Hospital

Atlanta, GA · 2019 - 2022

• Processed an average of 300 complex medical claims weekly for various specialties including cardiology and orthopedics, maintaining a consistent 98% clean claims submission rate.
• Successfully appealed and resolved over 150 denied claims monthly, recovering an average of $25,000 in previously lost revenue through meticulous documentation and payer communication.
• Collaborated with clinical staff and coders to ensure accurate documentation for services rendered, resulting in a 5% improvement in CPT code specificity and reduced coding errors.

Healthcare Operations Coordinator · WellStar Health System

Atlanta, GA · 2016 - 2019

• Managed patient scheduling, registration, and administrative workflows for a high-volume outpatient clinic, improving patient throughput by 15% through process optimization.
• Coordinated insurance verification and eligibility checks for over 50 patients daily, ensuring accuracy and reducing pre-service denials by 10% through proactive communication with payers.
• Implemented a new electronic health record (EHR) system module for appointment management and patient intake, decreasing data entry errors by 20% and enhancing patient experience.

BS, Health Sciences (Health Administration) · Georgia State University

Atlanta, GA · 2012 - 2016

• Graduated Magna Cum Laude, GPA: 3.8/4.0
• Relevant Coursework: Healthcare Finance, Medical Ethics, Health Information Systems, Healthcare Policy and Management
• Capstone Project: Analyzed revenue cycle efficiency in local hospital systems, proposing strategies for improved claims processing and accounts receivable management.