Ismail K.

HIPAA Certified Medical Biller | AR & Billing Specialist/Credentialing

You will get many services at one time investment. I have more than 6 years of experience from Dec 2019 to present in medical billing. Please feel free to contact me if you need my help. Work Experience: In the course of my billing career, I have performed various duties such as HCPCS research, fee investigation for similar providers, as well as development of procedure manuals and business form creation. I have great experience working on the below-mentioned functions of Medical billing. 1. Patient Registration 2. Insurance Verification 3. Pre Authorization Request and verification 4. Charge Posting / Superbill review 5. Evaluation of valid HCPCS codes, ICD 9-10 and Modifier 6. Fixing Rejected Electronic claims 7. Checking clearinghouse reports 8. Provider PIN calling ( for verifying provider TAX id, NPI, and billing address) 9. EOB and check search via websites and batches 10. Payment Posting of Insurance and Patient 11. AR Follow up on denied claims via call or websites 12. Appeal project 13. Collection / Refund / Over-Payment 14. Scheduling new patients AR Follow-up: • Call Insurance companies on behalf of physicians and carryout further examination on outstanding Accounts Receivables • Prioritize unpaid claims for calling according to the length of time it has been outstanding • Call insurance companies directly and convince them to pay the outstanding claims • Check the relevance of insurance info offered by the patient • Evaluate unpaid insurance claims • Call insurance companies and check on the status of claims • Transfer the outstanding balance to the patient of he/she doesn’t have adequate insurance coverage • If the claim has already been paid, ask the insurance company for Explanation of Benefits (EOB) • Make corrections to the claim based on inputs from the insurance company. In Credentialing I have expertise in the following Services: • Primary Source Verification • Updating CAQH Accounts • PECOS Provider Enrollments • Filing Applications • Initiating Credentialing Process • Credential new providers and re-credential current providers under different Tax ID's. • Verify provider’s license through the state license authority website • Licenses and Affiliation Check • Payer Contract Evaluations and Negotiations • Re-Enrolment and Re-Validation Solutions • Maintain internal provider grid to ensure all information is accurate and logins are available • Update each provider’s CAQH database file timely according to the schedule published by CMS • Complete credentialing applications to add providers to commercial payers, Medicare, and Medicaid • Complete re-credentialing applications for commercial payers • Take follow up for the Credentialing applications and maintain the record. • Maintain accurate provider profiles on CAQH, PECOS, NPPES, and CMS databases • Form submission to different Insurance companies like Humana, United, Cigna, Aetna, Anthem, Medicare, Medicaid, BlueCross Blue Shield etc. I am serving the US health care industry for the last five years in different states including, IL, MO, NY, TX, NJ, CA, MO, AZ, FL, TN etc. I have worked for the below-mentioned specialties of the provider’s claims. 1. Behavioral and Mental Health 2. Chiropractic. 3. Genetic Testing 4. DME 5. Physical Therapy 6. Pain management 7. Doctor's clinic or office setting 8. Surgical. 9. Internal Medicine, etc. 10.Urology EHR Software Work Experience: I have also have a strong grip on different EMR/EHR and Billing Software's including. • Advanced MD PM • Office Ally Practice Mate • ECw • Luminello • Practice Fusion • Kareo • Care Cloud • Simple Practice • ClaimMD • IntakeQ • Dr Chorno • Athena health • waystar I hope that after reviewing professional experience can help your business get to the next level and accomplish what you as the client needs. I look forward to every project and give my full effort at all times. All projects are completed thoroughly and within the time lines given. Best Regard Ismail