Sophia M.
Junior Medical Billing Specialist
Open to offersNew to PlatformAbout
Sophia M. is a seasoned Medical Billing Specialist and Medical Virtual Assistant based in Nairobi, Kenya, offering significant expertise in medical coding, insurance verification, claims submission, and revenue cycle management. With a proven track record in both long-term care and outpatient settings, she adeptly handles ICD-10-CM, CPT, and HCPCS codes, utilizing hands-on experience with industry-standard EHR systems like Epic and Cerner. Sophia is HIPAA-trained and excels in ensuring billing accuracy for faster reimbursements and enhancing administrative support. In her role at Community Wellness Medical Center, she managed medical billing and coding processes to reduce claim denials and supported revenue cycle management by partnering with clinical staff. Her tenure at Solemn Nursing Home further solidified her prowess in clean claim submission and timely cash flow improvement. Through her comprehensive experience, Sophia is committed to providing meticulous and efficient medical billing support.
Experience
Medical Billing Specialist
Community Wellness Medical Center · 2024 — 2026Assigned ICD-10, CPT, and HCPCS codes for both inpatient and outpatient procedures, ensuring compliance with healthcare billing regulations. Managed medical billing and charge entry processes, submitting clean insurance claims to minimize initial denial rates. Performed submission of insurance claims while tracking accounts receivable (AR) and following up on unpaid or denied claims. Supported revenue cycle management (RCM) operations in collaboration with clinical staff to obtain necessary documentation for accurate coding. Executed coding audits regularly to identify discrepancies and enhance billing precision. Verified insurance eligibility and benefits before patient services to reduce billing errors.Medical Billing Specialist
Solemn Nursing Home · 2022 — 2023Oversaw the complete medical billing and coding process for a long-term care facility, focusing on commercial and government payer accounts to ensure timely reimbursement. Followed up on denied claims to directly impact accounts receivable aging over 90 days, thus improving cash flow. Assigned ICD-10-CM and CPT codes across patient encounters, ensuring all billing documentation maintained accuracy and compliance. Submitted clean claims through electronic clearinghouse channels, achieving a high first-pass claim acceptance rate. Posted insurance and patient payments daily, reconciling against EOBs and ERA reports. Verified patient insurance eligibility pre-appointments to minimize claim denials related to eligibility.Customer Service Representative (Part-time)
Homecare Wellness Clinic · 2018 — 2020Handled customer inquiries through phone, email, and in-person interactions, consistently delivering high-quality service. Resolved customer concerns using effective communication and problem-solving skills. Maintained customer records accurately while ensuring confidentiality.Data Entry Specialist
Boresho Services · 2015 — 2017Maintained data accuracy in a high-volume environment, supporting administrative workflows. Verified and updated billing and administrative records to uphold compliance with data integrity standards. Generated administrative reports for billing and revenue teams, facilitating timely data retrieval and reconciliation. Took measures to improve data processing efficiency, contributing to reduced turnaround time for billing documentation while maintaining confidentiality of sensitive information.Call Center Representative
Boresha Services · 2012 — 2014Managed over 30 inbound calls daily to address patient billing inquiries, insurance questions, and payment arrangements. Communicated effectively with patients regarding their outstanding balances and billing statements. Trained new representatives on billing communication protocols and customer service best practices.
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