Claims Resolution Specialist I, Hospital Billing Office Resume

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Claims Resolution Specialist I, Hospital Billing Office Resume Heaven Heath Claims Resolution Specialist I, Hospital Billing Office (407) 555-6148 heaven.heath@example.com linkedin.com/example/heavenheath Orlando, FL 32801 STRENGTHS Claim Investigation Followed difficult accounts through payer research, billing review, and documented next steps. Teams relied on clear findings. Denial Pattern Review Tracked recurring denial causes and shared useful trends with leadership. That practice helped teams focus correction work. Payer Communication Asked focused questions during insurer calls and captured commitments clearly. Colleagues could continue follow up without guesswork. Account Prioritization Sorted worklists by balance, age, and actionable status. High value accounts received attention at the right time. Cross Team Coordination Connected coding, registration, billing, and payment posting partners around account issues. Shared ownership kept resolution moving. SKILLS Revenue Cycle Operations Accounts Receivable Medical Billing Medical Insurance Reimbursement Claims Resolution EOB Analysis Denial Follow Up Corrected Claims Adjustments Overpayments Commercial Insurance Government Payers Hospital Billing Physician Billing LANGUAGES English Native 40 Spanish Intermediate 20 MY CAREER 5.8 Years Claims Resolution Specialist at Suncrest Regional Medical Center (2.8 Years) Revenue Cycle Accounts Receivable Specialist at Lakeside Physician Partners (1.6 Years) Patient Financial Services Representative at Gulfview Community Hospital (1.5 Years) SUMMARY Revenue cycle specialist with five years of experience resolving hospital and physician billing accounts across commercial insurance , government payers , and third party reimbursement workflows. Skilled in accounts receivable , medical billing , EOB analysis, denial follow up, corrected claims, adjustments, overpayments, and payer communication. Applies working knowledge of CPT, ICD 10, HCPCS, and modifiers while investigating claim outcomes and supporting accurate reimbursement. Prioritizes account worklists by balance, age, and actionable payer status, then documents activity clearly for continued resolution. Identifies recurring denial patterns and coordinates with coding, registration, clinical, billing, and payment posting teams. Experience across Hospital Billing and Physician Billing supports dependable account follow up, compliant documentation, and timely financial outcomes. EXPERIENCE Claims Resolution Specialist Suncrest Regional Medical Center January 2024 - Present Orlando, Florida Supports hospital billing revenue cycle operations across commercial and government payer accounts. Owns daily follow up, payment review, denial resolution, overpayment investigation, and account documentation. Partners with coding, registration, clinical, billing, and payment posting teams to advance reimbursement and address recurring claim issues. Prioritized hospital billing accounts by balance, age, exposure, and payer status for focused reimbursement follow up. Compared EOBs with billed services, payments, adjustments, and patient responsibility to identify processing discrepancies. Resolved rejected and denied claims through payer research, billing validation, corrections, resubmissions, and documented appeals. Investigated overpayments with billing and payment posting teams before correcting balances or coordinating refunds. Reported recurring coding, eligibility, authorization, and claim data denials to leadership and operational partners. Applied CPT, ICD 10 , HCPCS, and modifier knowledge while routing coding questions to specialists. Revenue Cycle Accounts Receivable Specialist Lakeside Physician Partners May 2022 - December 2023 Kissimmee, Florida Managed Physician Billing accounts from payer follow up through resolution, using aging worklists and claim status information to focus effort on recoverable balances. Coordinated with insurers, third party administrators, and internal billing staff while building broader competency across hospital and physician billing workflows. Managed Physician Billing accounts through aging worklists, payer status review, and recoverable balance follow up. Contacted commercial insurers and third party administrators for processing requirements, commitments, and documented next actions. Analyzed denials and EOB details to separate registration, coverage, coding, modifier, filing, and payer issues. Prepared corrected claim information and supporting documentation for accurate resubmission within payer requirements. Reconciled payments and adjustments to identify unresolved balances, duplicate processing, and potential overpayments for review. Compared HB and PB payer rules, claim formats, reimbursement behavior, and follow up practices across service lines. Patient Financial Services Representative Gulfview Community Hospital October 2020 - April 2022 Tampa, Florida Supported hospital accounts receivable follow up while developing practical knowledge of billing, reimbursement, payer correspondence, and account documentation. Worked with senior specialists and internal departments to identify data issues, maintain complete processing histories, and move unresolved accounts toward appropriate action. Reviewed claim status, payer correspondence, and account notes for unresolved balances requiring additional hospital follow up. Verified insurance and billing information before escalating rejected claims with complete supporting account documentation . Recorded payer contacts and follow up dates so staff could continue resolution from a clear processing history. Reviewed common EOB messages with senior specialists to recognize payment, denial, adjustment, and patient responsibility outcomes. Coordinated claim questions with registration, billing, and insurance verification teams for timely ownership and correction. Developed supervised familiarity with CPT , ICD 10, HCPCS, modifiers , hospital billing, and reimbursement workflows. PROJECTS Denial Trend Review 2024 Created a recurring review of coding, eligibility, authorization, and claim data denials. Organized findings for leadership and operational partners, supporting clearer escalation and focused account follow up. Payer Reconciliation Workflow 2023 Structured a payer account review process covering EOB details, payment activity, adjustments, corrected claims, and overpayments. Improved documentation continuity across Physician Billing follow up. LEADERSHIP & AWARDS Recognized by revenue cycle leadership for dependable follow up on complex hospital billing accounts. Selected by peers as a trusted resource for EOB review, denial research, and account documentation. Received positive team feedback for clear coordination across coding, registration, billing, and payment posting. EDUCATION High School Diploma Lake Nona High School GPA: 4.0 2020 Orlando, Florida Coursework: Medical billing, health information systems, business communication, accounting CERTIFICATIONS Florida Driver's License 2026 Revenue Cycle Billing Knowledge 2026 TECHNICAL SKILLS Revenue Cycle Systems: Hospital Billing, Physician Billing, Revenue Cycle Operations Claims Processing: Rejected Billings, Corrected Claims, Claim Adjustments Payer Analysis: EOB Analysis, Payer Responses, Remittance Review Medical Coding: CPT, ICD 10, HCPCS Coding Modifiers: Modifier Review, Coding Questions, Billing Codes Account Resolution: Denial Follow Up, Account Aging, Balance Review Payment Management: Overpayments, Payment Posting, Patient Responsibility Insurance Operations: Commercial Insurance, Government Payers, Third Party Organizations Documentation Systems: Account Notes, Payer Contacts, Follow Up Dates Denial Management: Denial Trend Analysis, Eligibility Review, Authorization Review SKILLS Revenue Cycle Operations Accounts Receivable Medical Billing Medical Insurance Reimbursement Claims Resolution EOB Analysis Denial Follow Up Corrected Claims Adjustments Overpayments Commercial Insurance Government Payers Hospital Billing Physician Billing PROFESSIONAL AFFILIATIONS Revenue cycle operations team contributor supporting shared account resolution and practical knowledge exchange. Hospital and Physician Billing workgroup participant focused on consistent payer follow up and documentation. LANGUAGES English (Native) Spanish (Intermediate) ADDITIONAL INFORMATION Work Status : Authorized to work in United States. No sponsorship required. ADDITIONAL INFORMATION Work Status : Authorized to work in United States. No sponsorship required. REFERENCES AVAILABLE ON REQUEST

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