I have over five years of experience in medical billing and collections, primarily in a hospital setting. I am proficient in using billing software like Epic and Cerner to manage claims and follow up on unpaid accounts. My role involved ensuring accurate coding and billing, negotiating with insurance companies, and maintaining patient accounts to maximize revenue recovery.

When facing difficult insurance claims or denials, I first review the claim thoroughly to understand the reason for denial. I then gather all necessary documentation and follow the insurer's appeal process meticulously. Communication is key; I maintain regular contact with the insurance adjusters to advocate for the claim and ensure all necessary information is provided to support the claim's approval.

To improve collections efficiency, I focus on timely follow-up with insurance companies and patients. I also analyze payment trends to identify areas for improvement, such as common reasons for denials or delays. Implementing automated reminders for outstanding balances and enhancing patient education about payment policies can significantly boost collections rates.

Ensuring compliance with HIPAA is paramount. I regularly review and update my knowledge of HIPAA regulations through training sessions and updates from regulatory bodies. I strictly adhere to privacy and security protocols, such as using secure channels for communication and properly disposing of sensitive documents. I also educate colleagues on HIPAA best practices to maintain a culture of compliance.

One challenging account involved a patient with a complex insurance situation that resulted in multiple claim denials. I worked closely with the patient to understand their coverage details and coordinated with the insurance provider to resolve discrepancies. By meticulously following up and providing all required documentation, I was able to successfully appeal the denials and secure payment for the services rendered.