Insurance Billing Specialist Resume Sample

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Eulalia Kirlin
6888 Okuneva Plaza,  San Francisco,  CA
+1 (555) 824 7363

Work Experience

Insurance Billing Specialist
10/2017 - PRESENT
Los Angeles, CA
  • Plan and organize daily activities in a methodical and productive manor
  • Reviews ‘void’ reports to understand common errors and determine root causes
  • Prepares and submits clean claims to various insurance companies and other third party payers electronically or based on payer specific process
  • Prepares and submits clean claims to various secondary or tertiary insurance companies and other third party payers electronically or based on payer specific process
  • Maintain and utilize authorization and/or pre-determinations needed to secure reimbursement
  • Obtain missing insurance information, diagnosis code or any other requirements for billing by contacting the physician, patient or caregiver
  • Obtain pharmacy and/or medical benefits via phone, insurance website, or via fax for new and/or existing patients when required to address billing challenges
Insurance / Billing Specialist
06/2013 - 07/2017
Chicago, IL
  • Follows up with insurance companies or other third party payers on unpaid or rejected claims
  • Prepares appeal letters to insurance companies or other third party payers when not in agreement with claims denials
  • Collect all necessary information to accompany insurance or other third party payer appeals
  • Coordinates with accounts receivable department to provide patient statements for charges not covered by insurance
  • Maintain documentation of all communication to and from prescribers, payers and patients
  • Receives and tracks third party checks and explanation of benefits (EOB’s)
  • Manage and work insurance or other third party payer aging reports using company software
  • Maintains understanding of Diplomat contacted insurance company or other third party payer contracts
Premium Insurance Billing Specialist
08/2008 - 12/2012
San Francisco, CA
  • Maintains understanding of ICD10 and CPT coding in order to appropriately bill claims
  • Leverage provided software or other research methods to validate ICD10 and CPT coding
  • Medicare B: Obtain all audit documentation. Verifies shipping dates, proof of delivery, proper call logs, complaint scripts, and on hand documentation
  • Reports errors found during the billing process on the designated error log report or directly to operations as appropriate
  • Operating in Diplomat proprietary patient care system to perform job functions relative to patient history documentation needed for billing and reimbursement
  • Maintain confidentiality in accordance with regulations and/or policies and procedures
  • Investigating and analyzing payor remittance advices regarding denials and reimbursement discrepancies on assigned Medicaid and Tenncare accounts


Johnson & Wales University (JWU Charlotte)
2004 - 2008
School's Degree in Management

Professional Skills

  • Recent (within the past 3 years) experience providing insurance and billing customer service within a healthcare setting
  • Two years’ experience in call center, billing, collections or financial industry
  • CUBS computer system experience
  • Demonstrates a positive work attitude
  • Knowledge of insurance coding and billing procedure
  • Reviews and edits more complex and non-routine claims. Identifies and communicates problems regarding claims. Maintains pending claims at minimal levels
  • Assists Lead and Supervisor with training/orienting and provides guidance to lower level staff members

How to write Insurance Billing Specialist Resume

Insurance Billing Specialist role is responsible for insurance, research, basic, printing, finance, credit, training, compensation, shipping, reporting.
To write great resume for insurance billing specialist job, your resume must include:

  • Your contact information
  • Work experience
  • Education
  • Skill listing

Contact Information For Insurance Billing Specialist Resume

The section contact information is important in your insurance billing specialist resume. The recruiter has to be able to contact you ASAP if they like to offer you the job. This is why you need to provide your:

  • First and last name
  • Email
  • Telephone number

Work Experience in Your Insurance Billing Specialist Resume

The section work experience is an essential part of your insurance billing specialist resume. It’s the one thing the recruiter really cares about and pays the most attention to.
This section, however, is not just a list of your previous insurance billing specialist responsibilities. It's meant to present you as a wholesome candidate by showcasing your relevant accomplishments and should be tailored specifically to the particular insurance billing specialist position you're applying to. The work experience section should be the detailed summary of your latest 3 or 4 positions.

Representative Insurance Billing Specialist resume experience can include:

  • Experience in physical therapy, laboratory, pharmacy, dental, and radiology coding and billing
  • Experience with CCare billing and policies
  • Experience with provider credentialing and DMAP enrollment
  • : Two years of insurance, pharmacy, medical or billing experience required
  • Coordinates claims editing software and application processes for identifying and correcting claims submission/payment errors
  • Resolves complex payer inquiries and other billing procedural discrepancies including payor no-response reports

Education on an Insurance Billing Specialist Resume

Make sure to make education a priority on your insurance billing specialist resume. If you’ve been working for a few years and have a few solid positions to show, put your education after your insurance billing specialist experience. For example, if you have a Ph.D in Neuroscience and a Master's in the same sphere, just list your Ph.D. Besides the doctorate, Master’s degrees go next, followed by Bachelor’s and finally, Associate’s degree.

Additional details to include:

  • School you graduated from
  • Major/ minor
  • Year of graduation
  • Location of school

These are the four additional pieces of information you should mention when listing your education on your resume.

Professional Skills in Insurance Billing Specialist Resume

When listing skills on your insurance billing specialist resume, remember always to be honest about your level of ability. Include the Skills section after experience.

Present the most important skills in your resume, there's a list of typical insurance billing specialist skills:

  • Recent (within the past 3 years) experience working with electronic health records and billing software
  • One year of experience working with electronic insurance registration and verification
  • Communicate in a compassionate and patient manner with other employees and patients
  • Knowledge of email, fax transmission and copy equipment
  • Participate in continuous quality improvement activities
  • Knowledge of email, fax transmission, and copy equipment are essential

List of Typical Skills For an Insurance Billing Specialist Resume


Skills For Insurance / Billing Specialist Resume

  • Obtain pharmacy and/or medical benefits via phone, insurance website, or via fax for new and/or existing patients prior to any services rendered
  • Facilitate prior authorization, pre-determination and/or appeal as required by the insurance company
  • Performs charge entry, claims processing, and line-item payment posting
  • Obtain and review clinical documentation (chat notes, labs, testing, etc.) necessary to complete insurance authorizations and appeals
  • Advanced knowledge of drug and payor criteria

Skills For Medical Insurance Billing Specialist Resume

  • Advanced knowledge of high touch specialty medication
  • Intermediate motor abilities for the operation of calculator, typewriter, and computer terminal. Accuracy is essential
  • Moderate mathematical proficiency required to include addition, subtraction, multiplication, and calculation of percentages. Accuracy is essential
  • Certified Patient Account Technician
  • Two years of recent experience (within the past 3 years) in health insurance billing and accounts receivable management and reconciliation, including Personal Insurance Protection (PIP) and Worker’s Compensation billing, ICD-10, HCPC, and CPT coding with use of modifiers
  • Experience in Electronic Data Interchange (EDI) billing including, but not limited to, EDI edits, enrollment, submissions, claim tracking and Electronic Remittance Advice (ERA)
  • Two (2) years professional fee billing experience directed toward accounts receivable management, automated patient accounts systems, and insurance recovery processes required

Skills For Premium Insurance Billing Specialist Resume

  • Contacts insurance companies and other ancillary hospital departments for information needed to correct claims in order to receive optimal reimbursement
  • Act as a liaison between company, patients, insurance, Pharma, and provider’s office via phone, fax and/or email communication
  • Obtain missing insurance information, diagnosis code and other applicable information by contacting the physician or patient in order to complete the benefits investigation, authorization and/or appeal
  • Navigate through payer websites and portals including, but not limited to: MedAccess, webDENIS, Medi-Cal’s Online Portal, Partnership Health Online, Express Path (Express Scripts Online Portal)
  • Understands how and when to utilize external authorization systems including insurance and third party portals

Skills For Insurance Billing Specialist Resume

  • Research published insurance coverage criteria and locates authorization forms via payer websites/portals and other applicable avenues
  • Initiate authorization and/or appeal, including all available information, based on insurance requirements and completes appropriate follow up to complete pending cases
  • Process prescriptions through the pharmacy dispensing software as required
  • Maintain knowledge of clinical background and insurance requirements for new and emerging therapies
  • Coordinate with prescribers, nurses, office staff to facilitate insurance authorization and/or appeal requirements
  • Communicate the insurance investigation, authorization and/or appeal outcome with physician’s office and/or sales team via fax or email
  • Work in conjunction with Diplomat’s clinical team to research and maintain studies applicable to specific insurance appeals cases

Skills For Insurance / Billing Specialist Resume

  • Facilitate special requirements for insurance companies, prescriber offices or designated therapies
  • Review and understand insurance denials to determine, in conjunction with patients and prescribers, the next appropriate action
  • Maintains documentation of calls to and from patients, caregivers, insurance and providers
  • Answer calls and provide assistance as needed to patients, prescribers and internal departments
  • Review inbound faxes and assign to appropriate queues for further action and/or handle as appropriate
  • Operating Diplomat’s proprietary patient care management tool to perform job functions relative to documentation of the benefit investigation and authorization
  • Analyzes more complex accounts for collectibility purposes

Skills For Medical Insurance Billing Specialist Resume

  • Reviews, follows up, and collects payment of claims on more complex accounts
  • Reviews and issues insurance bills. Reviews account related correspondence
  • Determines resolution of credit balances
  • California Payor knowledge

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