Gladys M.
Junior Medical Billing Specialist
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Gladys M. C. is a Medical Billing Specialist with extensive experience in the U.S. healthcare industry, excelling in areas such as insurance verification, claim submission, denials management, and accounts receivable recovery. With a focus on Medicare and commercial payers, she boasts a proven track record of reducing aging accounts receivable and accelerating cash flow. Gladys adeptly navigates ICD-10, CPT, and HCPCS coding guidelines and maintains a strict adherence to HIPAA compliance. Her expertise includes using electronic health record systems and billing clearinghouses to optimize revenue cycle operations. At Premier Medical Billing, she successfully managed primary and secondary insurance claims, posting payments, and submitting appeals to resolve claim denials. Previously, at Equinox Billing LLC, Gladys ensured clean claim submissions by auditing clinical documentation and applying accurate charge entries. Her proficiency with EHR/EMR systems and payer portals underscores her ability to streamline billing processes and improve practice profitability.
Experience
Medical Billing Specialist
Premier Medical Billing · 2024 — 2026Executed precise charge entry utilizing CPT, ICD-10, and HCPCS codes, along with patient encounter data to guarantee clean claim submissions, thus minimizing billing inaccuracies. Processed electronic submissions of primary and secondary insurance claims to Medicare and commercial payers, adhering to filing deadlines and payer guidelines. Investigated claim rejections and denials, diagnosing root causes and resubmitting corrected claims for revenue recovery. Handled payment postings and adjustments from EOBS/ERAS to ensure proper account reconciliation. Oversaw accounts receivable by tracking aging claims and engaging with payers through portals and calls to decrease pending balances. Compiled and sent appeals with supporting documentation to contest denied claims, collaborating with intake and provider contacts to rectify any discrepancies prior to submission. Upheld compliance with HIPAA regulations and specific payer billing requirements.Change Entry Specialist
Equinox Billing LLC · 2022 — 2023Converted clinical documentation into accurate billable charges through the use of ICD-10-CM, CPT, and HCPCS coding systems, ensuring proper application of modifiers for clean claims. Conducted audits on patient demographics, active insurance coverage, and pre-authorizations prior to charge entry, successfully reducing the likelihood of claim rejections. Evaluated provider notes and Superbills for coding compliance, working to avoid errors such as unbundling or upcoding. Engaged in routine cross-referencing of daily patient appointment logs against charges entered, ensuring all procedures and service dates were billed accurately. Reconciled provider logs with charges entered to detect any unbilled services and prevent financial losses. Contributed to the revenue cycle process while consistently maintaining strict HIPAA compliance.
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