Hetal Patel317 Daphne CT ▪ Reisterstown, MD 21136

Cell: 410-236-4157 Home: 410-286-1526 Email: hetalpatel7@gmail.com

Relevant Experience:• Nine years experience working with physician offices, Surgery Centers, & Pharmacies• Knowledge of ICD-9, diagnosis codes, CPT procedure codes, HCPCS• In-depth understanding of medical terminology • Knowledge and adherence to HIPAA and company policies • Successful track record handling complicated assignments• Highly experienced in reconciling insurance and patient payments and resolving account disputes• Experience with both Government and commercial insurance companies including Medicare, Blue shield, Blue

Cross, United Healthcare, workers’ comp., etc.

Medical Biller, Insurance verifier and Accounts Receivable Experience:Windsor Mill Surgery Center Jan 2013 to current Accounts Receivable / Insurance Verifier

• Researched and responded to patient concerns and other inquiries regarding individual account balance and other information

• Maintained patient accounts receivable files in an accurate, orderly and confidential manner• Served as liaison with customer service regarding member-billing issues and adjusted accounts accordingly • Initiated and conducted collections and accounts receivable activities with plan participants to recover

payment owed, including follow-up on collections, allocation of payments to appropriate accounts, and researching and resolving payment discrepancies

• Carried out billing collection and reporting activities according to specific deadlines• Reviewed mainframe screen aging to ensure compliance and as process adjustments, credit card payments

and investigate and resolve customer queries• Initiate and conduct accounts receivable calls with plan participants in order to process prescription request• Explained policies regarding services• Provide expertise in insurance pre-certification and authorization of services by communicating with

insurance companies and patients to verify insurance information• Develop and maintain positive relationships with referring physicians, patients, and staff • Creates a positive experience for every customer, Prioritize workload to ensure all patients are contacted

prior to their exam and determines if patient’s insurance is a part of the provider network• Makes outgoing calls to insurance companies for pre-certification or any authorization• Receive and document pre-authorization from patients and/or insurance companies • Contact patient and referring offices using HIPAA guidelines prior to scheduled exam when additional

insurance information is needed• Back up front desk reception and scheduling area as needed• Accurately enter a variety of information including date schedule requests received, patient name, referring

physician, and procedures into computer system• Completes payer-related information, payer class, date of appointment• Obtains all workers compensation approvals from insurance companies prior to scheduled exam• Obtains signs and symptoms in order to support medical necessity and Completes other duties as assigned Dec 2011 - Dec 2012 Maternity Live

Target Pharmacy, Owings Mills, MD (Full Time-Returned to MD) May 2009 –Dec 2011 Rite Aid pharmacy (Part Time Evenings) May 2009 – Dec 2011

Responsibilities including answer multiple phone lines, prepping patients, take messages,

• interacting with patients on billing questions and objections• Ensure legitimacy of each prescription and verify patient data • Dispensed prescriptions and reviewed patient charts• Responsible for maintaining inventory and expired medications• Enter data and filled new prescription, refills • Contact doctor for new prescriptions or for clarifications• Correspond with insurance companies regarding rejected claims and denials • Responsible for placing pharmacy OTC and prescriptions medication orders• Responsible for calling doctors for approval for refills • Perform clerical pharmacy duties including inputting insurance codes to get claims through with medical

terminology, releasing prior authorization forms to physician’s office, and organizing documents in timely manners

• Responsible for the timely and accurate processing of all paper claims submitted• Support the timely resolution of internal and external customer inquiries received through electronic mail.• Supports the Customer Service Call Center with incoming calls from clients and members to achieve all service

level standards• Electronic Billing

Dr. Shoe Clinic OB Gyn Maryland (Part time) May 2009 – May 2010 Accounts Receivable Specialist (Cash Management)

• Account Receivable, Cash Management Specialist providing financial and administrative services to ensure efficient, timely and accurate payment of accounts.

• Transfers patient payments from “account” to “encounter” in Nextgen and ACS software• Maintains working knowledge of new insurance changes and billing codes• Creates encounter forms, paper and electronic, as needed to post charges• Work closely with sites and other billing staff to resolve coding/keying issues• Knowledge of billing/coding and clinical operation policies and procedures• Input data/information into the system, meet deadlines, and resolve billing issues• Provided research, correspondence, and coverage review of the plans coverage• Post payment on mainframe screen• Assist with departmental communication including phone calls inbound and outbound, e-mails, mailings and

faxes• Performed all research regarding patient concerns and provided the patient with resolutions and options.

North Carolina Orthopedic clinic, NC (part time as needed) July 2007 –Apr 2009Medical Biller

• Post and reconcile insurance and patient payments• Research and resolve incorrect payments, EOB rejections, and other issues with outstanding accounts• Accurately apply payments to patient accounts• Ensure claims are entered and submitted within 48 hours of receipt• Set up new patient accounts• Work with clearinghouse to resolve file compatibility issues• Retrieve Electronic Remittance Advice (ERA's)• Send secondary claims upon processing of primary insurance• Answer and resolve patient billing inquires• Follow up on Insurance and patient aging• Re-submit insurance claims as necessary• Maintain patient data • Inpatient/outpatient coding, self-pay collections, TAR

• Knowledgeable in timely filing restrictions• Insure office practices complies with HIPPA regulations• Front Desk responsibilities including answering multiple phone lines, prepping patients, take messages, etc.

Data Entry Specialist/Pharmacy Technician Target, Apex, NC (Full Time) July 2007- Apr 2009Rite Aid Pharmacy, North Carolina, NC (Part Time Evenings)

• Responsibilities including answer multiple phone lines, prepping patients, take messages, • interacting with patients on billing questions and objections• Ensure legitimacy of each prescription and verify patient data • Dispensed prescriptions and reviewed patient charts• Responsible for maintaining inventory and expired medications• Enter data and filled new prescription, refills • Contact doctor for new prescriptions or for clarifications• Correspond with insurance companies regarding rejected claims and denials • Responsible for placing pharmacy OTC and prescriptions medication orders• Responsible for calling doctors for approval for refills

Data Entry Specialist/Pharmacy Technician Experience:Target Pharmacy, Owings Mills, MD (Full Time) September 2005 – July 2007

• Responsibility as above

EDUCATIONDiploma of Pharmacy, Sardar Patel University, V.V. Nagar, Gujarat, India – June 1998Associates of Science Degree, A.R. College of Pharmacy, Gujarat, India - June 2002 - June 2005

CERTIFICATIONSCertified Pharmacy Technician by MD State Board of PharmacyCertified Pharmacy Technician (Nationally)Successfully finished class of Medical Terminology from CCBC (Baltimore, MD) Jan 2013–Apr 2013 Medical Biller CCBC (Baltimore, MD) with HIPPA Exam

COMPUTER SKILLSMS Office, Word, PowerPoint, Excel MEDICAL SOFTWARE EXPERIENCEASC Software, VISION & ADVANTx, Nextgen, Cerner, MOSS, PDX

References:1) Jill Drew ( Former Administrator at Windsor Mill Surgery Center) Phone No: 503-705-8750 2) Paulomi Patel (Manager Timonium surgery)

Phone no: 510-386-4545 3) Sheena William (Target pharmacist) Phone Number: 803-983-8912 4) Paul (Wal-Mart pharmacy manager) Aberdeen, MD Phone: 617-571-1982