Hiring managers for Medical Biller roles aren't just seeking data entry specialists; they're searching for astute revenue cycle professionals who can immediately impact a practice's financial health. The critical challenge is identifying candidates who possess the precision to minimize claim denials, the diligence to accelerate reimbursements, and the expertise to navigate complex coding and compliance landscapes.Your resume must articulate not just what you've done, but the tangible financial results of your actions. It needs to position you as an indispensable asset who directly boosts profitability and ensures regulatory adherence, making you the undeniable choice in a competitive market.
Key Takeaways
- Quantify every achievement: Use numbers, percentages, and dollar amounts to demonstrate impact.
- Optimize for Applicant Tracking Systems (ATS): Strategically integrate industry-specific keywords throughout your resume.
- Highlight compliance expertise: Showcase your knowledge of HIPAA, ICD-10, CPT, and HCPCS.
- Showcase software proficiency: Explicitly list experience with relevant medical billing software (Epic, Cerner, Medisoft, etc.).
- Tailor your resume: Customize your summary, skills, and experience to match each job description.
Career Outlook
Average Salary: $40,000 - $65,000 annually (entry-level to experienced)
Job Outlook: Consistent growth is projected for Medical Billers and Coders in the healthcare sector, driven by an aging population and increasing demand for healthcare services.
Professional Summary
Highly analytical and detail-oriented Medical Biller with 7+ years of experience in optimizing revenue cycles, reducing claim denials, and ensuring compliance with healthcare regulations. Proven ability to manage high-volume claims processing, proficient in multiple EHR systems, and dedicated to maximizing reimbursement for healthcare providers.
Key Skills
- Revenue Cycle Management
- CPT & ICD-10 Coding
- Denial Management
- Accounts Receivable
- Insurance Verification
- EHR Systems (Epic, Cerner, Kareo)
- HIPAA Compliance
- Claim Submission & Follow-up
- Patient Collections
- Data Analysis
- Problem-Solving
- Attention to Detail
Professional Experience Highlights
- Successfully managed a portfolio of 500+ complex claims weekly across multiple specialties, consistently achieving an average clean claim submission rate of 98%.
- Reduced claim denial rates by 15% within the first year by identifying common billing errors, implementing corrective actions, and providing targeted feedback to clinical staff.
- Spearheaded the reconciliation of accounts receivable, recovering over $250,000 in outstanding payments through diligent follow-up with insurance companies and patients.
- Utilized Epic and Kareo to accurately code CPT, ICD-10, and HCPCS procedures, ensuring compliance with payer-specific guidelines and HIPAA regulations.
- Processed an average of 350 medical claims per week for orthopedic procedures, maintaining a 95% accuracy rate in coding and submission.
- Managed all aspects of insurance verification and prior authorizations, preventing delays in patient care and ensuring upfront payment eligibility.
- Resolved complex billing discrepancies and appeals, successfully overturning 90% of initial claim denials through detailed documentation and persistent follow-up.
- Educated patients on insurance benefits, co-pays, and deductible requirements, improving patient satisfaction scores related to billing by 20%.
- Assisted senior billers with data entry, charge capture, and claim submission processes for a multi-specialty hospital setting.
- Verified patient insurance eligibility and benefits for 100+ patients daily, ensuring accurate information was entered into the Cerner EMR system.
- Filed and organized Explanation of Benefits (EOBs) and Electronic Remittance Advices (ERAs), identifying discrepancies for further review.
- Handled patient inquiries regarding billing statements and payment plans, providing clear and empathetic explanations.
Jordan Smith
Medical Biller Resume Example
Summary: Highly analytical and detail-oriented Medical Biller with 7+ years of experience in optimizing revenue cycles, reducing claim denials, and ensuring compliance with healthcare regulations. Proven ability to manage high-volume claims processing, proficient in multiple EHR systems, and dedicated to maximizing reimbursement for healthcare providers.
Key Skills
Revenue Cycle Management • CPT & ICD-10 Coding • Denial Management • Accounts Receivable • Insurance Verification • EHR Systems (Epic, Cerner, Kareo) • HIPAA Compliance • Claim Submission & Follow-up • Patient Collections • Data Analysis
Experience
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Senior Medical Biller at Apex Healthcare Group, Phoenix, AZ ()
- Successfully managed a portfolio of 500+ complex claims weekly across multiple specialties, consistently achieving an average clean claim submission rate of 98%.
- Reduced claim denial rates by 15% within the first year by identifying common billing errors, implementing corrective actions, and providing targeted feedback to clinical staff.
- Spearheaded the reconciliation of accounts receivable, recovering over $250,000 in outstanding payments through diligent follow-up with insurance companies and patients.
- Utilized Epic and Kareo to accurately code CPT, ICD-10, and HCPCS procedures, ensuring compliance with payer-specific guidelines and HIPAA regulations.
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Medical Biller at Desert Valley Orthopedics, Phoenix, AZ ()
- Processed an average of 350 medical claims per week for orthopedic procedures, maintaining a 95% accuracy rate in coding and submission.
- Managed all aspects of insurance verification and prior authorizations, preventing delays in patient care and ensuring upfront payment eligibility.
- Resolved complex billing discrepancies and appeals, successfully overturning 90% of initial claim denials through detailed documentation and persistent follow-up.
- Educated patients on insurance benefits, co-pays, and deductible requirements, improving patient satisfaction scores related to billing by 20%.
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Billing Assistant at Horizon Medical Center, Phoenix, AZ ()
- Assisted senior billers with data entry, charge capture, and claim submission processes for a multi-specialty hospital setting.
- Verified patient insurance eligibility and benefits for 100+ patients daily, ensuring accurate information was entered into the Cerner EMR system.
- Filed and organized Explanation of Benefits (EOBs) and Electronic Remittance Advices (ERAs), identifying discrepancies for further review.
- Handled patient inquiries regarding billing statements and payment plans, providing clear and empathetic explanations.
Education
- Associate of Science in Medical Billing and Coding - Phoenix Community College, Phoenix, AZ (2016)
Why and how to use a similar resume
This resume effectively showcases Jordan Smith's comprehensive expertise as a Medical Biller by adopting a clean, results-oriented structure. It strategically uses an impactful summary to immediately highlight key qualifications and years of experience, followed by a robust "Experience" section. Each role demonstrates progressive responsibility, from a Billing Assistant to a Senior Medical Biller, detailing specific achievements with quantifiable metrics that directly address the financial and operational needs of healthcare organizations. The inclusion of specific software proficiencies and regulatory knowledge (HIPAA, CPT, ICD-10) throughout the experience section reinforces the candidate's technical competence, making it highly relevant and appealing to hiring managers in the medical billing field.
- Quantifiable achievements highlight direct impact on revenue and efficiency.
- Specific industry keywords (CPT, ICD-10, Epic, Kareo, A/R) demonstrate expertise.
- Clear career progression shows increasing responsibility and skill development.
- Focus on compliance (HIPAA) and denial management addresses critical industry concerns.
- Strong action verbs present accomplishments dynamically and professionally.
Sophia Rodriguez
Junior Medical Biller Resume Example
Summary: Detail-oriented and highly organized Junior Medical Biller with 5+ years of progressive experience in healthcare administration and billing. Proven ability to accurately process claims, manage denials, and optimize revenue cycle efficiency using industry-standard EMR/EHR systems. Committed to maintaining compliance with HIPAA regulations and ensuring timely reimbursement for medical services.
Key Skills
Medical Coding (CPT, ICD-10, HCPCS) • Claim Submission (CMS-1500, UB-04) • Denial Management & Appeals • EOB/ERA Analysis • Revenue Cycle Management (RCM) • Insurance Verification • EMR/EHR Systems (Epic, Kareo, Greenway Health) • Payer Portals • HIPAA Compliance • Patient Communication
Experience
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Junior Medical Biller at Midwest Medical Group ()
- Processed an average of 100+ medical claims daily for various specialties (e.g., Internal Medicine, Pediatrics) using Epic and Kareo systems, ensuring high accuracy rates.
- Managed and resolved claim denials and rejections, reducing the group's overall denial rate by 15% through meticulous follow-up and appeals.
- Reviewed and interpreted Explanation of Benefits (EOB) and Electronic Remittance Advice (ERA) to post payments and identify discrepancies.
- Verified patient insurance eligibility and benefits for complex procedures, minimizing front-end claim errors and improving clean claim submission rates.
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Billing Coordinator Assistant at Chicago Health Alliance ()
- Assisted Senior Medical Billers with claim preparation and submission, ensuring all necessary documentation was attached for timely processing.
- Conducted initial patient demographic and insurance information verification, updating records in Greenway Health EHR system.
- Maintained accurate patient accounts and financial records, reconciling daily charges and payments.
- Generated weekly reports on claim status and outstanding balances, contributing to improved revenue cycle management discussions.
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Administrative Assistant at Cityside Urgent Care ()
- Managed patient registration and scheduling for an urgent care facility, handling an average of 50+ patients daily.
- Collected co-pays and deductibles, processed payments, and provided receipts, ensuring accurate cash handling procedures.
- Maintained organized patient files and medical records, adhering strictly to HIPAA privacy regulations.
- Assisted with basic insurance verification and pre-authorization procedures, streamlining patient intake processes.
Education
- Associate of Applied Science in Medical Billing and Coding - City College of Chicago (2017)
- Certified Professional Biller (CPB) - AAPC (2018)
Why and how to use a similar resume
This resume is highly effective for a Junior Medical Biller because it strategically highlights both foundational knowledge and practical experience. It uses a clear, reverse-chronological format that allows hiring managers to quickly grasp Sophia's career progression and increasing responsibilities. The summary immediately positions her as a detail-oriented professional with a strong grasp of the revenue cycle, while the detailed bullet points under each experience entry demonstrate concrete achievements and proficiency with industry-standard tools and practices. The inclusion of specific software names and coding standards (CPT, ICD-10) directly addresses the technical requirements of the role.
- Quantifiable achievements demonstrate impact (e.g., 'reduced claim rejections by 15%', 'processed 100+ claims daily').
- Explicitly lists industry-specific software (Epic, Kareo, Greenway Health) and coding standards (CPT, ICD-10, HCPCS).
- Career progression from Administrative Assistant to Junior Medical Biller showcases growing responsibility and commitment to the field.
- Professional Summary provides a concise, impactful overview, aligning skills with the target role's demands.
- Skills section is targeted, balancing essential hard skills with crucial soft skills for the billing environment.
Jordan Smith
Senior Medical Biller Resume Example
Summary: Highly accomplished Senior Medical Biller with over 8 years of progressive experience in optimizing revenue cycles, managing complex claims, and drastically reducing Accounts Receivable. Proficient in CPT/ICD-10 coding, denials management, and advanced EMR/EHR systems, consistently achieving high collection rates and ensuring stringent compliance with healthcare regulations.
Key Skills
Medical Billing & Coding • Revenue Cycle Management • Accounts Receivable (AR) Management • Denials & Appeals • CPT/ICD-10 Coding • Payer Relations • EMR/EHR Systems (Epic, Waystar, Kareo, Cerner) • HIPAA Compliance • Insurance Verification • Payment Posting
Experience
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Senior Medical Biller at Apex Healthcare Solutions ()
- Led a team of 3 billers, overseeing the full revenue cycle for a multi-specialty clinic, increasing monthly collections by 18% within the first year.
- Reduced outstanding Accounts Receivable (AR) by 25% (over $350,000) by implementing targeted follow-up strategies and improving payer communication.
- Managed complex claim denials and appeals for high-value procedures, achieving a 92% success rate in claim reprocessing and recovery.
- Developed and delivered training modules on updated coding guidelines (CPT/ICD-10) and payer-specific requirements, enhancing team accuracy by 15%.
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Medical Biller III at Desert Bloom Medical Group ()
- Processed an average of 300+ medical claims weekly across various specialties including cardiology and orthopedics, maintaining a 98% first-pass clean claim rate.
- Successfully resolved insurance claim rejections and denials by performing in-depth analysis and submitting compelling appeals, recovering over $250,000 annually.
- Conducted comprehensive patient eligibility and benefits verification, preventing an estimated 15% in potential claim rejections due to coverage issues.
- Expertly handled payment posting and reconciliation for multiple insurance payers and patient accounts using Kareo, ensuring accurate financial records.
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Medical Biller at Grand Canyon Family Practice ()
- Managed all aspects of medical billing for a busy family practice, including charge entry, claim submission, and patient invoicing.
- Verified insurance coverage and patient demographics with 99% accuracy, minimizing front-end claim rejections.
- Processed patient payments and managed collections for outstanding balances, improving cash flow by 10%.
- Maintained strict adherence to HIPAA regulations and compliance standards in all billing practices and patient data handling.
Education
- Associate of Science in Medical Office Administration - Phoenix Community College (2015)
- Certified Professional Biller (CPB) - AAPC (2016)
Why and how to use a similar resume
This resume effectively showcases Jordan Smith's growth from a Medical Biller to a Senior Medical Biller by emphasizing progressive responsibilities and quantifiable achievements. The strategic use of action verbs and specific metrics provides concrete evidence of impact, while the dedicated skills section highlights critical industry competencies and software proficiencies. The summary acts as a powerful hook, immediately establishing expertise and value to potential employers.
- Quantifiable Achievements: Every experience entry features metrics (e.g., "reduced AR by 25%", "increased collections by 18%") demonstrating tangible impact and value.
- Progressive Experience: Clearly illustrates career advancement and increasing levels of responsibility across three distinct roles, showing a strong growth trajectory.
- Keyword Optimization: Incorporates essential medical billing terms like CPT/ICD-10, EMR/EHR, Denials Management, and Revenue Cycle Management, crucial for Applicant Tracking Systems (ATS).
- Software Proficiency: Explicitly lists relevant industry-standard billing and EMR software (Epic, Waystar, Kareo, Cerner), a key requirement for many roles.
- Leadership & Training: The Senior Biller role highlights leadership, team management, and training skills, essential for a senior-level position, demonstrating readiness for advanced responsibilities.
Sophia Rodriguez
Lead Medical Biller Resume Example
Summary: Highly accomplished and results-driven Lead Medical Biller with over 8 years of experience optimizing revenue cycles, managing complex claims, and leading billing teams in fast-paced healthcare environments. Proven expertise in denial management, compliance adherence, and leveraging advanced EHR/EMR systems to maximize collections and improve financial performance.
Key Skills
Revenue Cycle Management • Denial Management • ICD-10/CPT Coding • Epic EHR • Kareo • AdvancedMD • Accounts Receivable • Payer Relations • Claims Processing • HIPAA Compliance
Experience
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Lead Medical Biller at Desert Bloom Health Systems ()
- Led a team of 5 medical billers, providing ongoing training and mentorship, resulting in a 15% improvement in team claim accuracy and a 10% reduction in average denial rates.
- Managed the full revenue cycle for a multi-specialty clinic, overseeing claim submission, payment posting, and appeals for an average of 1,200 claims weekly.
- Implemented new denial management strategies, reducing outstanding Accounts Receivable (AR) by 20% and increasing monthly collections by an average of $30,000 within the first year.
- Spearheaded the integration of a new billing module within Epic EHR, streamlining workflow and cutting processing time by 12% for the entire department.
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Senior Medical Biller at Valley Med Group ()
- Processed and submitted complex medical claims for specialty services including cardiology and orthopedics, maintaining a 98.5% first-pass claim acceptance rate.
- Managed a portfolio of high-value accounts, proactively identifying and resolving billing discrepancies and insurance denials, recovering over 50,000 in previously denied claims.
- Provided expert guidance on CPT, ICD-10-CM, and HCPCS coding to junior billers and clinical staff, enhancing coding accuracy across the organization.
- Developed and maintained strong relationships with major insurance payers, expediting claim resolutions and appeals processes.
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Medical Biller at Grand Canyon Family Practice ()
- Accurately performed patient registration, insurance verification, and prior authorizations for an average of 70 patients daily.
- Submitted electronic and paper claims to various insurance carriers (Medicare, Medicaid, Blue Cross Blue Shield, Aetna) with an average of 97% clean claim submission rate.
- Posted patient and insurance payments, managed adjustments, and reconciled daily deposits, ensuring financial records were accurate and up-to-date.
- Addressed patient billing inquiries and resolved discrepancies with a strong focus on patient satisfaction and clear communication.
Education
- Associate of Science in Health Information Technology - Phoenix College (2016)
- Certified Professional Biller (CPB) - AAPC (2017)
Why and how to use a similar resume
This resume for a Lead Medical Biller is highly effective because it strategically highlights Sophia Rodriguez's progression from a foundational medical biller to a leadership role. It emphasizes quantifiable achievements in revenue cycle optimization, denial reduction, and team management, directly addressing the core responsibilities of a lead position. The inclusion of specific EHR/EMR systems and compliance knowledge demonstrates strong technical proficiency and industry relevance, making her an ideal candidate for a senior billing role.
- Quantifiable achievements (e.g., "15% improvement in team claim accuracy," "reduced outstanding AR by 20%") demonstrate tangible impact and value.
- Specific software proficiency (Epic EHR, Kareo, AdvancedMD) showcases technical readiness and reduces potential training burden for the employer.
- Leadership and mentorship responsibilities are clearly articulated, proving readiness for a supervisory and team development role.
- Strong emphasis on compliance (HIPAA, Medicare, Medicaid) and regulatory adherence, critical for risk management in healthcare.
- Clear progression of responsibilities across three distinct roles, illustrating consistent career growth and increasing expertise in medical billing.
Jordan Smith
Medical Billing Specialist Resume Example
Summary: Highly analytical and results-driven Medical Billing Specialist with 7+ years of experience optimizing revenue cycles, reducing claim denials, and improving accounts receivable for diverse healthcare practices. Proven expertise in CPT, ICD-10, and HCPCS coding, proficient in multiple EHR/PM systems, and dedicated to ensuring financial accuracy and compliance in a fast-paced environment.
Key Skills
CPT & ICD-10 Coding • Revenue Cycle Management • EHR/PM Systems (Epic, Waystar, Kareo, Athenahealth, Cerner) • Claim Submission (CMS-1500, UB-04) • Accounts Receivable Management • EOB & Denial Management • Payer Relations & Contracting • HIPAA Compliance • Medical Terminology • Data Analysis & Reporting
Experience
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Senior Medical Billing Specialist at Golden Gate Medical Group ()
- Managed full-cycle medical billing for a multi-specialty group, processing an average of 600+ claims weekly with a 98% first-pass resolution rate using Waystar and Epic.
- Reduced claim denial rates by 18% within the first year by meticulously reviewing EOBs, identifying common errors, and implementing proactive coding and documentation training for clinical staff.
- Spearheaded the recovery of over $250,000 in outstanding accounts receivable by developing and executing targeted follow-up strategies and negotiating with commercial and government payers.
- Analyzed complex payer contracts and fee schedules to ensure accurate reimbursement, identifying discrepancies that led to a 10% increase in collected revenue for specific high-volume procedures.
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Medical Biller at Bayview Health Services ()
- Processed medical claims (CMS-1500 and UB-04) for a busy community clinic, consistently exceeding monthly submission targets by 15% using Kareo and Athenahealth.
- Investigated and resolved claim rejections and denials efficiently, improving the average turnaround time for re-submissions by 20%.
- Collaborated with physicians and administrative staff to correct coding errors and improve documentation quality, directly impacting revenue capture.
- Managed patient billing inquiries and disputes with professionalism, maintaining a high level of patient satisfaction regarding billing transparency.
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Billing Assistant at Pacific Coast Physicians ()
- Supported the billing department by verifying patient insurance eligibility and benefits for 50+ patients daily, minimizing front-end denials.
- Assisted with charge entry and payment posting, ensuring data accuracy for over 200 transactions per week.
- Maintained updated patient demographic and insurance information in the EHR system (Cerner), reducing administrative errors.
- Handled initial patient billing inquiries and explained complex EOBs, improving patient understanding and reducing calls to senior staff.
Education
- Associate of Science in Health Information Technology - City College of San Francisco (2017)
Why and how to use a similar resume
This resume is highly effective for a Medical Billing Specialist because it immediately establishes the candidate's expertise and impact through a strong professional summary and action-oriented bullet points. It strategically uses industry-specific keywords and software names, which are critical for applicant tracking systems (ATS) and hiring managers in the medical field. The inclusion of quantifiable achievements throughout the experience section demonstrates tangible value and a direct correlation to improved revenue cycle management, making the candidate's contributions clear and impactful.
- Quantifiable achievements: Each experience entry includes metrics (e.g., 'reduced claim denials by 18%', 'recovered over $250,000') that demonstrate direct impact on revenue and efficiency.
- Industry-specific keywords: Incorporates essential terms like CPT, ICD-10, EOB, RCM, HIPAA, and specific EHR/PM systems (Epic, Waystar, Kareo), ensuring ATS compatibility and immediate relevance.
- Clear career progression: Shows a logical advancement from Billing Assistant to Senior Medical Billing Specialist, highlighting increasing responsibility and expertise.
- Action-oriented language: Starts bullet points with strong action verbs that showcase initiative and results, such as 'Managed', 'Reduced', 'Spearheaded', and 'Analyzed'.
- Tailored skills section: Lists 12 critical hard and soft skills directly relevant to the role, making it easy for recruiters to assess core competencies quickly.
Jordan Smith
Billing Coordinator Resume Example
Summary: Highly analytical and detail-oriented Billing Coordinator with 7+ years of progressive experience in medical billing, accounts receivable management, and revenue cycle optimization within diverse healthcare settings. Proven ability to reduce denial rates, accelerate payment posting, and ensure strict compliance with healthcare regulations, driving significant financial improvements and operational efficiency.
Key Skills
Medical Billing Software (Epic, Cerner, Kareo, Waystar) • CPT/ICD-10/HCPCS Coding • Accounts Receivable Management • Denial Management & Appeals • Revenue Cycle Management • Insurance Verification • Electronic Claims Submission • HIPAA Compliance • Patient Collections • EMR/EHR Systems
Experience
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Billing Coordinator at Summit Health Associates ()
- Managed the end-to-end medical billing process for a multi-specialty clinic, processing over 500 claims weekly with a 98% first-pass clean claim rate using Epic Systems.
- Reduced outstanding accounts receivable (AR) by 15% within 12 months by implementing a proactive denial management strategy and improving payer communication.
- Spearheaded the resolution of complex claim denials and appeals for commercial, Medicare, and Medi-Cal payers, recovering an average of $30,000 monthly in previously denied revenue.
- Conducted comprehensive insurance verification and patient eligibility checks, minimizing claim rejections due to inaccurate coverage information by 20%.
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Medical Billing Specialist at Coastal Medical Billing Solutions ()
- Processed and submitted electronic and paper claims for over 20 diverse medical practices, ensuring timely and accurate submission to various insurance carriers via Waystar clearinghouse.
- Managed patient accounts, including payment posting, statement generation, and resolving billing inquiries, resulting in a 95% patient satisfaction rate related to billing services.
- Reduced average days in AR by 10% through diligent follow-up on unpaid claims and effective negotiation with insurance companies for prompt payment.
- Identified and corrected coding errors (CPT, ICD-10) before claim submission, significantly improving reimbursement rates and reducing claim resubmissions.
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Billing Assistant at Bayview General Hospital ()
- Assisted with daily claim processing and data entry for inpatient and outpatient services, ensuring accuracy of patient demographics and service codes.
- Verified patient insurance eligibility and benefits for upcoming appointments and procedures, reducing registration errors by 15%.
- Posted patient payments and insurance remittances accurately into the Cerner EMR system, maintaining precise financial records.
- Responded to patient billing inquiries, explaining charges, insurance coverage, and payment options with clarity and empathy.
Education
- Associate of Science in Medical Office Administration - City College of San Francisco, San Francisco, CA (2016)
- Certified Professional Biller (CPB) - American Academy of Professional Coders (AAPC) (2016)
Why and how to use a similar resume
This resume for a Billing Coordinator is highly effective because it strategically combines a strong professional summary with quantifiable achievements, demonstrating a clear impact on revenue and operational efficiency. It uses industry-specific keywords and software proficiency to signal immediate value to potential employers, making it highly attractive to hiring managers and optimized for Applicant Tracking Systems (ATS).
- Quantifiable Achievements: Each experience entry features metrics (e.g., "98% first-pass clean claim rate," "Reduced outstanding AR by 15%") that showcase direct contributions to financial success.
- Industry-Specific Keywords: Incorporates essential terms like CPT, ICD-10, HCPCS, Epic Systems, Waystar, denial management, and revenue cycle management, optimizing it for Applicant Tracking Systems (ATS).
- Progressive Experience: Clearly illustrates a career trajectory from Billing Assistant to Billing Coordinator, highlighting increasing responsibilities and expertise.
- Software Proficiency: Explicitly lists key medical billing and EMR/EHR software, assuring employers of technical readiness and minimal training needs.
- Compliance Focus: Emphasizes adherence to HIPAA and other regulations, crucial for roles within the sensitive healthcare industry.
Alex Chen
Claims Processor Resume Example
Summary: Highly meticulous and results-driven Claims Processor with 8+ years of experience in medical billing, claims adjudication, and denial management within fast-paced healthcare environments. Proven ability to optimize revenue cycles, ensure HIPAA compliance, and accurately process a high volume of complex medical claims, consistently reducing errors and improving reimbursement rates.
Key Skills
Claims Adjudication • Medical Coding (CPT, ICD-10, HCPCS) • Denial Management • EOB Analysis • HIPAA Compliance • Revenue Cycle Management • Electronic Health Records (Epic, Cerner) • Insurance Verification • Appeals Processing • Data Entry
Experience
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Senior Claims Processor at Apex Health Solutions ()
- Adjudicated an average of 150+ medical claims daily, ensuring accurate processing according to payer guidelines, CPT, ICD-10, and HCPCS codes.
- Reduced claims denial rate by 15% through meticulous review, identification of common errors, and proactive communication with providers and payers.
- Managed the full lifecycle of appeals for complex denied claims, successfully recovering over $250,000 in previously uncompensated services annually.
- Collaborated with the billing department to streamline revenue cycle processes, improving claim submission efficiency by 20% using Waystar and Epic.
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Medical Billing Specialist at Desert Ridge Medical Group ()
- Processed and submitted medical claims to various insurance carriers, ensuring timely and accurate filing for a multi-specialty group.
- Analyzed Explanation of Benefits (EOBs) and Remittance Advices (RAs) to reconcile patient accounts and identify discrepancies.
- Researched and resolved billing discrepancies and patient inquiries, maintaining a high level of patient satisfaction and account accuracy.
- Managed accounts receivable, following up on unpaid claims and initiating appeals when necessary, contributing to a 10% increase in collections.
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Claims Assistant at Grand Canyon Insurance ()
- Assisted claims processors with data entry, documentation, and preliminary review of medical claims for completeness and accuracy.
- Verified patient eligibility and benefits with various insurance providers, reducing front-end claim rejections by 5%.
- Communicated with healthcare providers to obtain necessary medical records and supporting documentation for claims processing.
- Organized and maintained electronic and physical claims records, ensuring efficient retrieval and adherence to record-keeping policies.
Education
- Associate of Science in Health Information Technology - Phoenix College (2016)
Why and how to use a similar resume
This resume effectively highlights a candidate's expertise in claims processing by employing a clear, results-oriented structure. The professional summary immediately establishes the candidate's years of experience and core competencies, while the experience section utilizes strong action verbs and quantifiable achievements to demonstrate impact. Industry-specific keywords are strategically integrated throughout, ensuring the resume is optimized for Applicant Tracking Systems (ATS) and resonates with hiring managers in the medical billing and insurance sectors. The dedicated skills section provides a quick overview of both technical and soft skills, making it easy for recruiters to identify key qualifications.
- Quantifiable achievements demonstrate tangible impact and value.
- Strategic use of industry-specific keywords (e.g., CPT, ICD-10, EOB, HIPAA) enhances ATS compatibility.
- Professional summary provides an immediate overview of the candidate's qualifications and experience.
- Clear, reverse-chronological work history showcases career progression and consistent experience.
- Concise skills section offers a quick reference for essential technical and soft competencies.
Sophia Rodriguez
Reimbursement Specialist Resume Example
Summary: Highly analytical and results-driven Reimbursement Specialist with 8+ years of experience in optimizing revenue cycles, managing complex denial appeals, and ensuring compliance with payer regulations. Proven ability to reduce claim denials by 18% and recover significant underpayments, contributing directly to organizational financial health. Seeking to leverage expertise in CPT, ICD-10, and EMR systems to enhance reimbursement efficiency for a forward-thinking healthcare provider.
Key Skills
Revenue Cycle Management • Denial Management & Appeals • Claims Processing • ICD-10-CM / CPT / HCPCS • Payer Negotiations • Accounts Receivable • EMR Systems (Epic, Waystar) • Insurance Verification • HIPAA Compliance • Medical Terminology
Experience
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Reimbursement Specialist at MedStar Health Solutions ()
- Optimized appeals processes, resulting in an 18% reduction in denial rates and recovering over $500,000 in previously denied claims annually.
- Managed a portfolio of 300+ complex medical claims, meticulously reviewing EOBs, payer contracts, and clinical documentation to identify root causes of denials.
- Analyzed CPT, ICD-10, and HCPCS codes for accuracy and compliance, ensuring proper billing for services across multiple specialties.
- Collaborated cross-functionally with clinical staff and coding teams to resolve documentation deficiencies and prevent future billing errors.
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Medical Biller & Claims Specialist at Windy City Medical Group ()
- Processed an average of 150-180 medical claims daily, ensuring accurate data entry and timely submission to government and commercial payers.
- Conducted comprehensive insurance verification and patient eligibility checks, reducing front-end claim rejections by 15%.
- Managed accounts receivable for a multi-specialty clinic, actively following up on unpaid claims aged 30-90+ days.
- Researched and resolved claim rejections and denials by contacting insurance companies, identifying issues, and submitting corrected claims or appeals.
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Billing Assistant / AR Coordinator at Unity Healthcare Associates ()
- Performed charge entry and payment posting with 99% accuracy, reconciling daily deposits and maintaining precise financial records.
- Assisted with patient billing inquiries, explaining EOBs and resolving billing discrepancies to ensure high patient satisfaction.
- Managed initial claim scrubbing for common errors, preventing a significant number of rejections prior to submission.
- Generated and distributed patient statements, managing patient payment plans and follow-up on outstanding balances.
Education
- Associate of Applied Science in Medical Billing and Coding - City Colleges of Chicago (2016)
- Certified Professional Coder (CPC) - AAPC (2017)
Why and how to use a similar resume
This resume is highly effective for a Reimbursement Specialist because it strategically highlights quantifiable achievements and industry-specific expertise. It immediately establishes the candidate's proficiency in complex medical billing and revenue cycle management tasks, using strong action verbs and specific metrics to demonstrate direct impact on financial outcomes. The clear progression through roles showcases increasing responsibility and mastery, while the dedicated skills section provides a quick overview of essential technical competencies, making it easy for hiring managers to identify a strong fit.
- Quantifiable achievements: Metrics like 'reduced denial rates by 18%' and 'recovered over $500,000' directly demonstrate financial impact.
- Industry-specific keywords: Extensive use of terms like CPT, ICD-10, HCPCS, EOBs, revenue cycle, and EMR systems (Epic, Waystar) signals deep industry knowledge.
- Strong action verbs: Each bullet point begins with a powerful verb (e.g., 'Optimized', 'Managed', 'Analyzed', 'Streamlined') showcasing proactive contributions.
- Clear career progression: The experience section illustrates growth from Medical Biller to Reimbursement Specialist, reflecting increasing expertise and responsibility.
- Targeted skills section: Focuses on the top 10-12 critical hard and soft skills relevant to the role, ensuring quick readability and relevance.
Alex Chen
Revenue Cycle Specialist Resume Example
Summary: Highly analytical and results-driven Revenue Cycle Specialist with 8+ years of experience optimizing billing processes, enhancing collections, and minimizing denials in fast-paced healthcare environments. Proven ability to leverage advanced EHR systems and data analysis to improve financial performance and ensure compliance. Seeking to apply expertise in a challenging role focused on driving revenue integrity.
Key Skills
Revenue Cycle Management • Denials Management • Accounts Receivable • Medical Billing & Coding (ICD-10/CPT) • Claims Processing • Payer Relations • EHR Systems (Epic, Athenahealth) • HIPAA Compliance • Data Analysis • Problem-Solving
Experience
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Revenue Cycle Specialist at Golden Gate Medical Center ()
- Managed a diverse portfolio of accounts receivable exceeding $3.5 million, consistently achieving a 96% collection rate for patient and payer balances.
- Reduced average AR days by 18% (from 45 to 37 days) through meticulous follow-up, appeal strategies, and proactive communication with insurance carriers.
- Successfully appealed and recovered over $75,000 monthly in underpaid or denied claims by identifying coding discrepancies and providing robust clinical documentation.
- Utilized Epic EMR system for claim submission, denial management, and reporting, ensuring data accuracy and compliance with HIPAA regulations.
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Medical Biller & AR Specialist at Bayview Healthcare Services ()
- Processed an average of 400 medical claims daily across multiple specialties including Cardiology and Primary Care, ensuring 99% clean claim submission rate.
- Managed all aspects of accounts receivable, including patient statements, payment posting, and collections, resulting in a 15% increase in patient collections year-over-year.
- Resolved complex billing inquiries and disputes with patients and insurance companies, maintaining high levels of patient satisfaction.
- Identified and corrected coding errors (ICD-10, CPT, HCPCS) prior to claim submission, preventing potential denials and payment delays.
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Billing Assistant at Pacific Coast Urgent Care ()
- Supported the billing department by verifying patient insurance eligibility and benefits for over 100 patients daily.
- Assisted with claim submission, ensuring timely and accurate filing for various commercial and government payers.
- Responded to patient billing inquiries and explained EOBs, fostering positive patient relations.
- Maintained organized records of patient accounts, payments, and correspondence in a practice management system.
Education
- Associate of Science in Health Information Technology - City College of San Francisco (2016)
- Certified Professional Biller (CPB) - AAPC (2017)
Why and how to use a similar resume
This resume effectively highlights Alex Chen's expertise in Revenue Cycle Management by focusing on quantifiable achievements and industry-specific skills. The strategic placement of a concise professional summary immediately showcases key strengths and years of experience, setting the stage for detailed accomplishments. Each experience entry utilizes strong action verbs and concrete metrics, demonstrating direct impact on financial outcomes, which is crucial for a Revenue Cycle Specialist role. The skills section is well-curated, presenting a balanced mix of essential hard and soft skills that align perfectly with the demands of modern healthcare billing and financial operations.
- Quantifiable achievements throughout the experience section provide clear evidence of impact and value.
- Industry-specific keywords (e.g., ICD-10, CPT, Epic, Athenahealth, Denials Management) ensure ATS compatibility and relevance.
- The professional summary offers a strong, concise overview of the candidate's qualifications and experience.
- The 'Skills' section is targeted, listing only the most critical competencies, making it easy for recruiters to assess fit.
- The chronological layout with consistent formatting makes the resume highly readable and professional.
Alex Chen
Patient Account Representative Resume Example
Summary: Results-driven Patient Account Representative with 6+ years of experience in medical billing, accounts receivable management, and revenue cycle optimization. Proven ability to reduce AR days, resolve complex insurance denials, and enhance patient satisfaction through accurate billing and empathetic communication. Proficient in leading EMR systems and dedicated to maintaining HIPAA compliance.
Key Skills
Accounts Receivable (AR) Management • Denial Management & Appeals • Medical Billing Software (Epic, AdvancedMD, Kareo) • CPT/ICD-10/HCPCS Coding • Claims Processing & Submission • Payer Portals & Verification • Revenue Cycle Management • HIPAA Compliance • Patient Communication • Problem-Solving
Experience
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Patient Account Representative at Apex Healthcare Solutions ()
- Manages a portfolio of over 500 patient accounts, overseeing billing, collections, and payment posting for a multi-specialty clinic.
- Reduced average accounts receivable (AR) days by 15% within the first year by streamlining follow-up procedures and improving claim submission accuracy.
- Successfully resolved 90%+ of complex insurance denials by analyzing EOBs, appealing claims, and collaborating directly with payers (e.g., Blue Cross Blue Shield, Aetna, Medicare).
- Educates patients on billing statements, insurance benefits, and payment options, consistently achieving a 95% satisfaction rate for billing inquiries.
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Medical Biller at Unity Medical Group ()
- Processed an average of 100+ medical claims daily using AdvancedMD, ensuring accurate CPT, ICD-10, and HCPCS coding for diverse specialties.
- Performed thorough claim scrubbing and verification, reducing claim rejections by 20% and accelerating reimbursement cycles.
- Managed insurance verification and pre-authorization processes for all scheduled procedures, minimizing surprises for patients and staff.
- Collaborated with clinical staff to clarify documentation, ensuring coding compliance and supporting accurate billing practices.
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Billing Assistant at Community Health Clinic ()
- Assisted with daily payment posting, reconciling patient and insurance payments against posted charges.
- Managed patient registration and demographic data entry, ensuring accuracy for billing purposes.
- Handled incoming billing calls, addressing patient questions regarding statements and insurance coverage.
- Prepared and submitted secondary claims, coordinating benefits with multiple insurance carriers.
Education
- Associate of Science in Medical Billing and Coding - Houston Community College (2017)
Why and how to use a similar resume
This resume is highly effective for a Patient Account Representative because it strategically emphasizes key responsibilities, quantifiable achievements, and essential industry-specific skills. It showcases a clear career progression, demonstrating increasing levels of responsibility and expertise in medical billing and patient account management. The use of strong action verbs and metrics provides concrete evidence of impact, making the candidate stand out to potential employers in the healthcare revenue cycle.
- Quantifiable achievements highlight direct impact on revenue and efficiency.
- Industry-specific keywords (e.g., CPT, ICD-10, EMR, AR management, denial resolution) ensure ATS compatibility and relevance.
- Clear career progression across three roles demonstrates growth and increasing expertise.
- Balances hard skills (software proficiency, coding) with critical soft skills (patient communication, problem-solving).
- The professional summary provides a concise overview of qualifications, immediately grabbing the recruiter's attention.
Jordan Davis
Accounts Receivable Specialist (Medical) Resume Example
Summary: Highly analytical and results-oriented Accounts Receivable Specialist with over 7 years of experience in medical billing and collections. Proven ability to optimize revenue cycles, reduce denial rates, and recover outstanding claims for large healthcare organizations. Adept at navigating complex payer regulations and utilizing advanced EMR systems to ensure financial health and compliance.
Key Skills
Medical Billing & Coding (CPT, ICD-10, HCPCS) • Accounts Receivable Management • Denial & Appeal Management • Payer Portals (Availity, NaviNet) • EMR/EHR Systems (Epic, Cerner, Waystar) • Insurance Verification & Authorization • HIPAA Compliance • Revenue Cycle Optimization • Financial Reporting • Problem-Solving
Experience
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Accounts Receivable Specialist at Healthcare Solutions Group ()
- Managed a portfolio of over $2.5M in outstanding medical claims, consistently achieving a 95%+ collection rate across various specialties.
- Identified and resolved complex billing discrepancies, reducing denial rates by 18% through meticulous review of CPT, ICD-10, and HCPCS codes.
- Successfully appealed denied claims with major commercial and governmental payers (Medicare, Medicaid, Blue Cross Blue Shield), recovering an average of $50,000 monthly.
- Utilized Epic and Waystar for claim submission, tracking, and denial management, ensuring accurate and timely processing.
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Medical Biller at Lone Star Medical Center ()
- Processed an average of 300 claims daily for various specialties, including cardiology and orthopedics, using Cerner EMR.
- Verified patient eligibility and insurance benefits, minimizing claim rejections due to incorrect coverage information.
- Managed payer communications, resolving claim rejections and underpayments by engaging with insurance representatives.
- Maintained strict compliance with HIPAA regulations and evolving billing guidelines to ensure data security and accuracy.
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Billing Coordinator at Metroplex Family Practice ()
- Handled patient invoicing, payment posting, and managed patient account inquiries with a focus on customer service.
- Reconciled daily deposits and prepared weekly AR reports for management, providing insights into financial performance.
- Initiated collections calls for outstanding patient balances, recovering 85% of self-pay accounts through effective communication.
- Assisted with charge entry and coding audits to ensure accuracy before claim submission, reducing billing errors.
Education
- Associate of Applied Science in Medical Office Technology - Dallas College (2016)
Why and how to use a similar resume
This resume for an Accounts Receivable Specialist (Medical) is highly effective because it immediately establishes the candidate's expertise and value through a strong professional summary. It strategically uses action verbs, quantifiable achievements, and industry-specific keywords throughout the experience section, demonstrating a clear impact on revenue cycle management and financial health. The inclusion of specific EMR systems and compliance knowledge further validates the candidate's practical skills, making them a highly attractive prospect for medical billing roles.
- Quantifiable achievements (e.g., '95%+ collection rate', 'reduced denial rates by 18%') demonstrate direct impact on financial outcomes.
- Industry-specific keywords (CPT, ICD-10, HIPAA, Epic, Cerner, Waystar) ensure the resume passes ATS filters and resonates with hiring managers.
- Clear progression of roles and responsibilities showcases increasing expertise and leadership within medical AR.
- Detailed bullet points for each role provide concrete examples of problem-solving and process improvement skills.
- A concise and relevant skills section highlights critical hard and soft skills without overwhelming the reader.
Sarah Jenkins
Payment Poster Resume Example
Summary: Highly accurate and efficient Payment Poster with 7+ years of experience in high-volume medical billing environments. Proven expertise in processing EOBs, ERAs, and patient payments, coupled with meticulous account reconciliation to ensure precise revenue cycle management and minimize claim discrepancies.
Key Skills
Payment Posting • EOB/ERA Processing • A/R Reconciliation • Epic • Cerner • AdvancedMD • Kareo • CPT/ICD-10 Coding • Denial Management • HIPAA Compliance
Experience
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Payment Poster at Northwood Medical Group ()
- Accurately posted an average of 300+ payments daily, including EOBs, ERAs, and patient co-pays, into Epic and Cerner systems, maintaining 99.5% accuracy.
- Performed daily reconciliation of payment batches and deposits, identifying and resolving discrepancies to ensure financial integrity for over $500,000 in monthly collections.
- Identified and flagged underpayments, overpayments, and denials for further review by A/R follow-up team, reducing outstanding claims by 15%.
- Collaborated with billing specialists and collectors to resolve complex posting issues and ensure timely and accurate claim processing.
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Medical Billing Specialist at Plano Family Practice ()
- Managed end-to-end payment posting for a multi-specialty clinic, handling 150+ claims daily using AdvancedMD and Kareo.
- Processed electronic and manual remittances, ensuring correct application of payments, adjustments, and write-offs.
- Reconciled daily deposits with patient accounts, accurately posting payments and preparing daily financial reports.
- Assisted with charge entry and claim submission, ensuring clean claims and reducing initial denial rates by 10%.
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Billing Assistant at Apex Healthcare Solutions ()
- Provided administrative support to the billing department, including data entry for patient demographics and insurance information.
- Assisted with basic payment posting and reconciliation tasks, learning EOB interpretation and medical billing software.
- Processed patient statements and handled inquiries regarding billing and payment schedules.
- Organized and maintained physical and electronic billing records, ensuring easy retrieval and compliance.
Education
- Certificate in Medical Billing and Coding - Dallas Community College (2016)
Why and how to use a similar resume
This resume effectively showcases Sarah Jenkins' expertise as a Payment Poster by leading with a strong, keyword-rich professional summary that immediately highlights her experience and core competencies. The experience section uses powerful action verbs and quantifiable metrics (e.g., "300+ payments daily," "99.5% accuracy," "reduced outstanding claims by 15%") to demonstrate impact and efficiency. The inclusion of specific medical billing software (Epic, Cerner, AdvancedMD, Kareo) proves her technical versatility, while the progression through three relevant roles illustrates career growth and increasing responsibility. The concise skills section further reinforces her qualifications with a focused list of both hard and soft skills critical for the role.
- Quantifiable achievements using specific metrics to demonstrate impact.
- Strong action verbs demonstrating responsibility and positive outcomes.
- Inclusion of specific, industry-standard medical billing software.
- Clear career progression through relevant roles showcasing growth.
- Keyword optimization for Payment Poster and Medical Biller roles.
Alex Chen
Charge Entry Specialist Resume Example
Summary: Highly accurate and results-driven Charge Entry Specialist with over 7 years of experience in optimizing medical billing processes and revenue cycle management. Proficient in CPT, ICD-10, and HCPCS coding, with a proven track record of reducing claim denials, improving data integrity, and accelerating cash flow for diverse healthcare organizations. Adept at utilizing EMR/EHR systems and various billing software to ensure precise and timely charge capture.
Key Skills
CPT, ICD-10, HCPCS Coding • Charge Entry & Posting • Revenue Cycle Management • EMR/EHR Systems (Epic, AthenaHealth) • Medical Billing Software (Kareo, AdvancedMD) • Denial Management • Claim Submission (EDI) • HIPAA Compliance • Data Entry & Accuracy • Attention to Detail
Experience
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Charge Entry Specialist at Apex Medical Group ()
- Managed high-volume charge entry for over 300 claims daily across multiple specialties, consistently maintaining a 99.5% accuracy rate.
- Utilized Epic EMR system to accurately capture and post CPT, ICD-10, and HCPCS codes, ensuring compliance with payer-specific guidelines.
- Collaborated with clinical staff to clarify documentation discrepancies, preventing an estimated 15% of potential claim rejections and denials.
- Identified and resolved charge-related coding errors proactively, contributing to a 10% reduction in average accounts receivable days.
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Medical Biller & Charge Poster at Stellar Health Solutions ()
- Accurately posted charges and payments for a multi-specialty clinic, handling an average of 250 encounters per day using AthenaHealth.
- Reviewed patient demographics and insurance information prior to charge entry to minimize front-end errors, reducing claim rejections by 12%.
- Managed EOB and ERA reconciliation, identifying underpayments and escalating issues for further investigation.
- Assisted in training new billing staff on charge entry protocols and internal coding guidelines, improving team efficiency by 8%.
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Billing Assistant at Community Care Clinic ()
- Supported the billing department with data entry, charge review, and claim submission for primary care services.
- Entered patient and service charges into Kareo billing software with an average daily volume of 180 encounters.
- Verified insurance eligibility and benefits for 50+ patients daily, ensuring accurate information for billing.
- Assisted with basic coding review and identified common coding errors before claims submission, improving first-pass resolution rate.
Education
- Associate of Science in Medical Billing and Coding - Dallas Community College (2016)
Why and how to use a similar resume
This resume is highly effective for a Charge Entry Specialist because it immediately establishes the candidate's core competencies and experience in medical billing. It strategically uses industry-specific keywords, software, and quantifiable achievements to demonstrate a direct impact on revenue cycle management and operational efficiency. The clear, chronological format, coupled with a strong professional summary, allows hiring managers to quickly grasp the candidate's qualifications and value proposition.
- Quantifiable achievements highlight direct impact on revenue and efficiency.
- Strategic use of industry-specific keywords (CPT, ICD-10, EMR, Revenue Cycle) ensures ATS compatibility.
- Demonstrates expertise in multiple medical billing software and EMR systems.
- Clear, concise bullet points showcase a strong understanding of the entire charge entry process, from initial data entry to denial prevention.
- Professional summary immediately positions the candidate as an experienced and results-driven specialist.
Jordan Smith
Denial Management Specialist Resume Example
Summary: Highly analytical and results-driven Denial Management Specialist with 7+ years of progressive experience in medical billing, revenue cycle optimization, and claims resolution. Proven ability to recover significant revenue by meticulously appealing denied claims, identifying root causes, and implementing effective prevention strategies to enhance financial health.
Key Skills
Denial Management • Revenue Cycle Management • Medical Billing & Coding (CPT, ICD-10) • Claims Appeals • Payer Relations & Negotiations • EOB Analysis • A/R Management • EHR Systems (Epic, Athenahealth, Cerner) • Compliance & Regulations • Data Analysis
Experience
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Denial Management Specialist at Apex Healthcare Solutions, Dallas, TX ()
- Successfully appealed and resolved an average of 300+ denied claims monthly, contributing to a 15% increase in revenue recovery for complex surgical and specialty services.
- Identified root causes for recurring denials related to medical necessity and coding discrepancies, leading to a 10% reduction in denial rates within the first year.
- Collaborated cross-functionally with coding, credentialing, and clinical teams to implement proactive denial prevention strategies and improve documentation accuracy.
- Managed a portfolio of over $2.5 million in denied claims annually, consistently exceeding recovery targets by an average of 8%.
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Medical Billing Specialist at Pinnacle Medical Group, Dallas, TX ()
- Processed and submitted an average of 500+ claims weekly to various commercial and government payers (Medicare, Medicaid, Blue Cross Blue Shield).
- Analyzed Explanation of Benefits (EOBs) and Remittance Advices (RAs) to identify initial denial reasons and initiated timely follow-up actions.
- Maintained an average claims accuracy rate of 98% through meticulous review of patient demographics, insurance information, and CPT/ICD-10 codes.
- Resolved claim discrepancies and underpayments by communicating effectively with insurance companies and patients.
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Revenue Cycle Coordinator at Unity Health System, Fort Worth, TX ()
- Managed patient registration, insurance verification, and pre-authorization processes for a high-volume outpatient clinic.
- Reviewed patient accounts for accuracy of demographics, insurance coverage, and financial responsibility prior to service.
- Assisted patients with understanding their insurance benefits and estimated out-of-pocket costs, improving patient satisfaction scores by 12%.
- Coordinated with clinical staff to ensure proper documentation supported services rendered, minimizing front-end denial risks.
Education
- Associate of Science in Health Information Technology - Dallas County Community College (2016)
Why and how to use a similar resume
This resume is highly effective for a Denial Management Specialist because it immediately highlights quantifiable achievements and demonstrates a clear progression of responsibility within the revenue cycle. By starting with a strong professional summary that emphasizes years of experience and key outcomes, it quickly captures the recruiter's attention. The experience section uses powerful action verbs and specific metrics to showcase impact on revenue recovery, denial reduction, and process improvement, which are critical for this role. The inclusion of industry-specific software and keywords ensures it will pass through Applicant Tracking Systems (ATS) and resonate with hiring managers in the healthcare billing sector.
- Quantifiable achievements in revenue recovery and denial reduction are prominently featured.
- Demonstrates a clear career progression, showing increasing responsibility in revenue cycle management.
- Strong use of industry-specific keywords and software (Epic, Athenahealth, CPT, ICD-10) for ATS optimization.
- Highlights problem-solving abilities and proactive denial prevention strategies.
- Showcases effective cross-functional collaboration with clinical and coding teams.
Sophia Rodriguez
Insurance Verification Specialist Resume Example
Summary: Highly meticulous and results-driven Insurance Verification Specialist with 7+ years of experience optimizing healthcare revenue cycles and ensuring accurate patient eligibility. Proven ability to navigate complex payer portals, reduce claim rejections by up to 15%, and enhance patient financial understanding through proactive communication. Adept at leveraging EPIC and Cerner to streamline prior authorizations and benefit verification processes.
Key Skills
Insurance Verification • Prior Authorizations • EPIC • Cerner • Payer Portals (Availity, NaviNet) • Benefit Analysis • CPT & ICD-10 Coding • HIPAA Compliance • Revenue Cycle Management • Patient Communication
Experience
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Insurance Verification Specialist at Bayview Medical Center ()
- Managed daily verification of insurance eligibility and benefits for 75+ complex medical procedures, ensuring 98% accuracy for scheduled appointments.
- Utilized EPIC and various payer portals (e.g., Availity, NaviNet) to confirm patient coverage, co-pays, deductibles, and out-of-pocket maximums.
- Proactively obtained prior authorizations for high-cost services, reducing denial rates by 15% and accelerating revenue collection by an average of 7 days.
- Communicated complex insurance information to patients in a clear, empathetic manner, improving patient satisfaction scores related to financial counseling by 10%.
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Revenue Cycle Specialist at Premier Health Solutions ()
- Processed and submitted over 200 claims daily to various commercial and government payers, achieving a 95% clean claim submission rate.
- Analyzed Explanation of Benefits (EOBs) and Remittance Advices (RAs) to identify payment variances and initiate appeals for underpaid or denied claims.
- Managed accounts receivable for a portfolio exceeding .5 million, reducing outstanding A/R days by 12% through diligent follow-up.
- Identified root causes of claim rejections and implemented process improvements that led to a 10% reduction in resubmissions.
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Patient Access Representative at Metro General Hospital ()
- Registered an average of 60-70 patients per day, accurately collecting demographic, insurance, and medical history information.
- Verified patient insurance eligibility and benefits at the point of service, collecting co-pays and deductibles totaling over $20,000 monthly.
- Educated patients on their financial responsibilities and hospital policies, ensuring a smooth registration process.
- Maintained strict adherence to HIPAA guidelines to protect patient privacy and data security.
Education
- Associate of Science in Medical Office Administration - Dallas Community College (2016)
Why and how to use a similar resume
This resume effectively positions the candidate as a highly competent Insurance Verification Specialist by strategically highlighting core competencies, software proficiency, and quantifiable achievements. It immediately conveys a strong understanding of the revenue cycle and patient advocacy, crucial for success in medical billing. The structure is clean and easy to read, allowing hiring managers to quickly identify key qualifications.
- Quantifiable achievements demonstrate direct impact on revenue cycle efficiency and patient satisfaction.
- Specific mention of industry-standard software (EPIC, Cerner, payer portals) immediately signals technical readiness.
- Clear articulation of critical responsibilities like prior authorizations, benefit analysis, and compliance showcases comprehensive expertise.
- The 'Skills' section is concise and targeted, focusing on the most relevant hard and soft skills for the role.
- Progressive experience from Patient Access to Revenue Cycle to Insurance Verification illustrates a strong career path and foundational knowledge.
Jordan Smith
Medical Coder Resume Example
Summary: Highly skilled and AAPC-certified Medical Coder (CPC, CCS) with over 7 years of experience in multi-specialty coding, revenue cycle management, and compliance. Proven ability to maintain 98%+ coding accuracy, significantly reduce denial rates, and optimize reimbursement through meticulous application of ICD-10-CM, CPT, and HCPCS guidelines. Adept at leveraging EMR/EHR systems to ensure data integrity and streamline claim submission processes.
Key Skills
ICD-10-CM Coding • CPT & HCPCS Level II • Revenue Cycle Management • Epic EMR System • Athenahealth • HIPAA Compliance • Claims Processing • Denials Management • Medical Terminology • Attention to Detail
Experience
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Senior Medical Coder at Baylor Medical Center ()
- Lead coding efforts for complex inpatient and outpatient cases, including surgical procedures, E/M services, and ancillary diagnostics, maintaining an average 99% accuracy rate.
- Reduced claim denial rates by 15% through meticulous review of documentation, proactive identification of coding discrepancies, and collaboration with clinical staff.
- Processed an average of 150+ charts daily across multiple specialties (e.g., Cardiology, Orthopedics, Oncology) utilizing Epic EMR system.
- Provided ongoing training and mentorship to junior coders on ICD-10-CM, CPT, and HCPCS updates, ensuring team-wide compliance and efficiency.
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Medical Coder at Premier Billing Solutions ()
- Coded diverse medical records for a portfolio of 10+ physician practices spanning Family Medicine, Pediatrics, and Dermatology, achieving consistent 98% accuracy.
- Managed full-cycle claims processing from charge entry to payment posting, utilizing Medisoft and Athenahealth EMR systems.
- Collaborated with providers to clarify documentation queries, ensuring complete and accurate medical records to support coded services.
- Successfully resolved over 20 appeals per month, recovering an average of $20,000 in previously denied claims through thorough research and resubmission.
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Junior Medical Coder / Billing Assistant at Metro Health Clinic ()
- Assisted senior coders with data entry, charge capture, and basic ICD-10-CM and CPT coding for routine office visits and procedures.
- Verified patient insurance eligibility and benefits, reducing claim rejections due to incorrect or expired coverage by 20%.
- Managed patient billing inquiries and explained complex Explanation of Benefits (EOB) statements, enhancing patient satisfaction.
- Maintained strict confidentiality of patient health information (PHI) in accordance with HIPAA regulations.
Education
- Associate of Science in Health Information Technology - Dallas Community College (2016)
- Certified Professional Coder (CPC) - AAPC (2017)
- Certified Coding Specialist (CCS) - AHIMA (2020)
Why and how to use a similar resume
This resume is highly effective for a Medical Coder because it immediately establishes the candidate's core competencies and certifications in the summary, setting a strong professional tone. It strategically uses quantifiable achievements, demonstrating the direct impact on revenue cycle integrity, denial reduction, and compliance. The consistent use of industry-specific keywords and software names throughout the experience section ensures it passes Applicant Tracking Systems (ATS) and resonates with hiring managers who understand the nuances of medical coding operations. The progression through three distinct roles also showcases growth and increasing responsibility within the field.
- Strong professional summary highlights certifications (CPC, CCS) and key achievements upfront.
- Quantifiable metrics in bullet points demonstrate tangible impact on financial performance and operational efficiency (e.g., 'maintained 98% accuracy,' 'reduced denial rates by 15%,' 'processed over 150 charts daily').
- Extensive use of industry-specific keywords (ICD-10-CM, CPT, HCPCS, EMR/EHR, HIPAA, revenue cycle management) optimizes for ATS and demonstrates expertise.
- Clear career progression across three roles illustrates increasing responsibility and breadth of experience.
- Dedicated 'Skills' section provides a quick overview of both technical proficiencies and essential soft skills crucial for the role.
Olivia Hayes
Certified Professional Coder (CPC) Resume Example
Summary: Highly skilled and AAPC-certified Certified Professional Coder (CPC) with over 7 years of experience optimizing medical billing and coding processes across diverse healthcare settings. Proven track record in reducing denial rates by up to 20%, improving claims accuracy, and ensuring strict compliance with regulatory guidelines, resulting in enhanced revenue cycle management and operational efficiency.
Key Skills
ICD-10-CM • CPT • HCPCS Level II • E/M Coding • Revenue Cycle Management • Medical Billing & Claims Processing • EHR Systems (Epic, Cerner, Meditech) • Compliance & Auditing (CMS, HIPAA) • Medical Terminology & Anatomy • Denial Management & Appeals
Experience
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Certified Professional Coder (CPC) at Texas Health Resources ()
- Accurately coded an average of 150-200 complex medical charts daily using ICD-10-CM, CPT, and HCPCS Level II codes for multi-specialty clinics, maintaining a 98% accuracy rate.
- Reduced claims denial rates by 18% within the first year by proactively identifying coding discrepancies and providing targeted feedback to providers on documentation improvement.
- Managed full revenue cycle for high-volume surgical and internal medicine departments, contributing to a 15% increase in clean claim submission rates.
- Conducted regular internal audits of medical records and coding practices to ensure compliance with CMS regulations, OIG guidelines, and HIPAA, mitigating potential risks.
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Medical Coder & Biller at Baylor Scott & White Health ()
- Processed and submitted medical claims for primary care and specialty services, achieving an average collection rate of 95% for assigned accounts.
- Resolved complex billing inquiries and coding disputes, recovering over $50,000 in previously denied claims through meticulous appeals and resubmissions.
- Collaborated with physicians and clinical staff to improve documentation quality, directly impacting the accuracy and completeness of medical records.
- Trained new billing and coding specialists on company policies, software usage (Cerner), and best practices for CPT and ICD-10 coding.
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Billing Specialist at Prestige Medical Group ()
- Managed patient accounts, processed payments, and reconciled daily financial transactions, ensuring accurate ledger entries.
- Verified patient insurance eligibility and benefits for all scheduled appointments, reducing front-end denials by 10%.
- Submitted electronic and paper claims to various insurance carriers, maintaining detailed records of submissions and follow-ups.
- Assisted with accounts receivable follow-up, identifying and addressing outstanding balances and unpaid claims.
Education
- Associate of Applied Science in Health Information Technology - Dallas County Community College (2017)
- Certified Professional Coder (CPC) - AAPC (2017)
Why and how to use a similar resume
This resume effectively showcases Olivia Hayes as a highly competent Certified Professional Coder (CPC) by leading with a strong professional summary that immediately highlights her certification, years of experience, and measurable achievements like reducing denial rates. The experience section uses powerful action verbs and specific metrics to quantify her impact, such as coding 150-200 charts daily with 98% accuracy and reducing denials by 18%. It strategically incorporates industry-specific keywords like ICD-10-CM, CPT, HCPCS, Epic, Cerner, and compliance auditing, demonstrating deep expertise. The consistent structure and clear delineation of roles and responsibilities across multiple healthcare organizations paint a picture of a progressive and skilled professional.
- Quantifiable achievements in the summary and experience sections provide immediate evidence of impact and value.
- Strategic use of industry-specific keywords (ICD-10-CM, CPT, Epic, Cerner) ensures ATS compatibility and demonstrates deep expertise.
- Clear progression through three relevant roles highlights career growth and diverse experience across different healthcare settings.
- Strong action verbs and metrics in bullet points illustrate concrete contributions to revenue cycle management and compliance.
- Inclusion of certifications (CPC) and specific EHR systems reinforces specialized knowledge and practical skills crucial for the role.
Sarah Jenkins
Certified Billing and Coding Specialist (CBCS) Resume Example
Summary: Highly detail-oriented and results-driven Certified Billing and Coding Specialist (CBCS) with over 7 years of experience in optimizing revenue cycles, ensuring compliance, and accurately processing medical claims. Proven ability to reduce denial rates by up to 15% and accelerate reimbursement through expert application of ICD-10-CM, CPT, and HCPCS codes across diverse specialties.
Key Skills
ICD-10-CM Coding • CPT/HCPCS Coding • EHR Systems (Epic, Athenahealth, Cerner, Medisoft) • Revenue Cycle Management • Claim Submission & Processing (EDI) • Denial Management & Appeals • Accounts Receivable • HIPAA Compliance • Medical Terminology • Insurance Verification
Experience
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Certified Billing and Coding Specialist (CBCS) at Desert Bloom Medical Group ()
- Managed full-cycle medical billing and coding for a multi-specialty clinic, processing an average of 300+ claims weekly using Epic and Athenahealth EHR systems.
- Achieved a 98% clean claim submission rate by meticulously reviewing patient records and applying accurate ICD-10-CM, CPT, and HCPCS codes, significantly reducing rejections.
- Reduced accounts receivable days by 10% within the first year by proactively following up on denied claims and implementing effective appeals processes.
- Collaborated with providers to clarify documentation discrepancies, resulting in improved coding accuracy and a 15% increase in appropriate reimbursement for complex procedures.
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Medical Billing and Coding Specialist at Sunstone Healthcare Services ()
- Processed high volumes of medical claims for various payers, ensuring timely and accurate submission via electronic data interchange (EDI) systems.
- Successfully resolved an average of 50+ claim denials per week, recovering over $50,000 in previously uncollected revenue annually.
- Utilized Medisoft and Cerner for patient registration, charge entry, payment posting, and claims tracking, maintaining strict adherence to HIPAA regulations.
- Identified and corrected coding errors, reducing billing discrepancies by 12% and improving overall revenue cycle efficiency.
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Billing Assistant at Oasis Family Practice ()
- Assisted senior billing specialists with data entry, claim submission, and payment posting for a busy family practice.
- Verified patient insurance eligibility and benefits for all scheduled appointments, minimizing claim rejections due to coverage issues.
- Managed patient accounts, sending out statements and initiating collections processes for overdue balances.
- Maintained organized electronic and physical patient billing records, ensuring data integrity and confidentiality.
Education
- Certified Billing and Coding Specialist (CBCS) - National Healthcareer Association (NHA) (Certified: 2017)
- Associate of Applied Science (A.A.S.) in Medical Office Administration - Phoenix College (2017)
Why and how to use a similar resume
This resume for a Certified Billing and Coding Specialist (CBCS) is highly effective because it immediately establishes the candidate's core competencies and quantifiable achievements. The professional summary provides a concise overview of experience and impact, while the experience section uses strong action verbs and specific metrics to demonstrate tangible results in revenue cycle management, claim accuracy, and denial reduction. The clear organization, relevant keywords, and focus on compliance (HIPAA) and specific EHR systems make it highly scannable for recruiters, signaling a well-rounded and proficient professional.
- Quantifiable Achievements: Metrics like "98% clean claim submission rate" and "reduced accounts receivable days by 10%" demonstrate tangible impact.
- Industry-Specific Keywords: Inclusion of "ICD-10-CM, CPT, HCPCS," "EHR systems (Epic, Athenahealth)," "Revenue Cycle Management," and "HIPAA Compliance" ensures ATS compatibility.
- Strong Action Verbs: Each bullet point begins with a powerful action verb (e.g., Managed, Achieved, Reduced, Collaborated) to highlight proactive contributions.
- Clear Professional Summary: A concise, impactful summary immediately communicates the candidate's value proposition and key expertise.
- Relevant Software Proficiency: Explicitly lists widely used EHR and billing software, showcasing practical, hands-on experience.
Alex Chen
Healthcare Financial Counselor Resume Example
Summary: Highly analytical and empathetic Healthcare Financial Counselor with over 7 years of experience optimizing revenue cycles, ensuring patient understanding of financial obligations, and facilitating access to care. Proven ability to navigate complex insurance policies, negotiate payment plans, and secure financial assistance, consistently improving patient satisfaction and organizational financial health.
Key Skills
Revenue Cycle Management • Insurance Verification • Patient Advocacy • Financial Counseling • Payment Negotiations • Epic EMR • Cerner EMR • Medical Billing & Coding (ICD-10, CPT) • Accounts Receivable (AR) Management • HIPAA Compliance
Experience
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Healthcare Financial Counselor at Stellar Health System ()
- Provided comprehensive financial counseling to an average of 30+ patients daily, explaining complex medical bills, insurance benefits, and out-of-pocket costs with clarity and empathy.
- Developed and implemented customized payment plans, resulting in a 15% increase in patient collections for self-pay balances and a significant reduction in bad debt write-offs.
- Successfully identified and secured financial assistance programs (e.g., charity care, grants) for over 200 eligible patients annually, improving access to critical medical services.
- Collaborated closely with insurance verification teams to pre-authorize services and resolve coverage discrepancies, preventing claim denials and ensuring accurate patient estimates.
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Patient Account Representative at Prime Care Medical Center ()
- Managed a portfolio of over 500 patient accounts, overseeing accurate billing, payment posting, and resolution of patient inquiries regarding statements and balances.
- Processed and submitted an average of 250 medical claims daily to various commercial and government payers, achieving a first-pass clean claim rate of 95%.
- Investigated and resolved complex claim denials, recovering over $500,000 in previously denied revenue through effective appeals and re-submissions.
- Educated patients on their insurance coverage, deductibles, co-pays, and co-insurance, leading to improved patient understanding and reduced billing disputes.
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Medical Billing Specialist at Elite Physician Group ()
- Performed daily charge entry and coding (ICD-10, CPT) for a multi-specialty practice, ensuring accuracy and maximizing reimbursement for services rendered.
- Successfully managed Accounts Receivable (AR) for over $2 million in outstanding claims, reducing AR days by 10% within the first year.
- Conducted thorough follow-up on unpaid and underpaid claims, interacting with insurance companies to expedite payment processing and resolve discrepancies.
- Identified and reported billing trends and payer issues, contributing to process improvements that enhanced overall revenue cycle efficiency.
Education
- Bachelor of Science in Healthcare Administration - University of North Texas (2017)
Why and how to use a similar resume
This resume for a Healthcare Financial Counselor is highly effective due to its strategic focus on quantifiable achievements and direct alignment with the role's core competencies. It clearly demonstrates the candidate's impact on financial health and patient satisfaction, showcasing a progressive career path with increasing responsibility and specialized skills. The use of industry-specific terminology and technology further solidifies the candidate's expertise.
- Quantifiable achievements: Utilizes metrics like "15% increase in patient collections" and "recovered over $500,000" to demonstrate concrete impact and value.
- Industry-specific keywords: Incorporates essential terms such as "Revenue Cycle Management," "Epic EMR," "ICD-10, CPT," and "HIPAA Compliance," which are critical for ATS screening and recruiter understanding.
- Demonstrates patient advocacy: Highlights the candidate's empathetic approach to explaining complex bills, securing financial assistance, and improving patient understanding, crucial for this patient-facing role.
- Progressive experience: Shows a clear career trajectory from Medical Billing Specialist to Patient Account Representative to Healthcare Financial Counselor, illustrating a natural progression of skills and responsibilities.
- Balance of hard and soft skills: Effectively combines technical proficiency (EMR systems, billing codes) with essential soft skills like communication, negotiation, and problem-solving, vital for success in financial counseling.
Olivia Rodriguez
Medical Office Administrator (with billing duties) Resume Example
Summary: Highly organized and results-driven Medical Office Administrator with 7+ years of experience in front desk operations, patient scheduling, and comprehensive medical billing. Proven ability to optimize revenue cycles, reduce claim denials, and enhance patient satisfaction within fast-paced clinical environments, leveraging proficiency in Epic and other EMR systems.
Key Skills
Medical Billing • Revenue Cycle Management • Insurance Verification • CPT/ICD-10 Coding • EMR/EHR Systems (Epic, Kareo, Cerner) • HIPAA Compliance • Patient Scheduling • Accounts Receivable • Denial Management • Customer Service
Experience
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Medical Office Administrator (with billing duties) at Golden Gate Health Clinic ()
- Managed full revenue cycle operations, including patient registration, insurance verification, claim submission (CPT, ICD-10), payment posting, and denial management for a multi-specialty clinic, processing an an average of 150 claims daily.
- Reduced claim denial rates by 18% within the first year by implementing proactive pre-authorization checks and refining claim submission protocols using Epic Systems.
- Successfully recovered over $250,000 in outstanding accounts receivable through diligent follow-up and appeals, improving cash flow by 12%.
- Streamlined patient scheduling and check-in processes, decreasing average patient wait times by 10% and improving patient satisfaction scores by 7%.
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Billing Specialist & Front Desk Coordinator at Bay Area Pediatrics ()
- Handled all aspects of medical billing, including charge entry, claims processing, and payment posting for a busy pediatric practice, averaging 120 claims per day.
- Verified patient insurance eligibility and benefits, securing necessary pre-authorizations for procedures and reducing out-of-pocket costs for families.
- Managed front desk operations, including patient registration, appointment scheduling, co-pay collection, and answering multi-line phone systems.
- Resolved complex billing inquiries and patient account discrepancies, maintaining a high level of patient satisfaction and trust.
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Administrative Assistant (Medical) at Coastal Family Medicine ()
- Supported office operations for a family medicine practice, including managing patient flow, scheduling appointments, and preparing examination rooms.
- Assisted with basic medical billing tasks, such as data entry for charges and processing patient payments for co-pays and balances.
- Maintained electronic health records (EHR) accurately and confidentially using Cerner, ensuring strict HIPAA compliance.
- Managed inventory of office supplies and medical forms, optimizing stock levels and reducing waste by 5% through efficient ordering.
Education
- Associate of Science in Medical Office Administration - City College of San Francisco (2015)
Why and how to use a similar resume
This resume is highly effective for a Medical Office Administrator with billing duties because it strategically blends administrative expertise with critical revenue cycle management skills. It utilizes a clear, achievement-oriented format, highlighting quantifiable successes in areas crucial to a medical practice's financial health and operational efficiency. The inclusion of specific EMR/EHR systems and coding standards demonstrates immediate job readiness and technical proficiency, while the professional summary quickly establishes the candidate's value proposition.
- Quantifiable achievements in billing (e.g., 'Reduced claim denial rates by 18%') directly showcase financial impact.
- Specific mention of industry-standard EMR/EHR systems (Epic, Kareo, Cerner) validates technical proficiency.
- Clearly articulates a dual skill set in both administrative support and complex medical billing processes.
- Uses strong action verbs to describe responsibilities and outcomes, making accomplishments more impactful.
- The chronological format with detailed bullet points provides a comprehensive overview of progressive experience and responsibilities.
Olivia Hayes
Front Desk Coordinator (with billing duties) Resume Example
Summary: Highly organized and patient-focused Front Desk Coordinator with 6+ years of experience in medical office administration, specializing in integrated billing duties. Proven ability to streamline patient intake, accurately manage insurance claims, and optimize revenue cycles within fast-paced clinical environments. Adept at utilizing EMR systems and improving overall patient experience.
Key Skills
Medical Billing & Coding (CPT, ICD-10) • Insurance Verification • EMR Systems (Epic, Cerner) • Claims Submission & Denial Management • Patient Registration & Scheduling • Co-pay & Deductible Collection • HIPAA Compliance • Patient Relations & Customer Service • Microsoft Office Suite • Problem-Solving
Experience
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Front Desk Coordinator (with billing duties) at Desert Bloom Medical Group ()
- Managed comprehensive patient registration, scheduling, and check-in/out processes for an average of 40+ patients daily, ensuring a seamless experience.
- Verified patient insurance eligibility and benefits for all appointments, collecting co-pays and deductibles upfront, which improved collection rates by 15% annually.
- Processed and submitted medical claims (CPT, ICD-10) using Epic EMR, meticulously tracking claims status and resolving rejections to reduce denial rates by 10%.
- Handled patient billing inquiries, explained statements, and set up payment plans, enhancing patient understanding and satisfaction.
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Medical Receptionist at Valley Health Clinic ()
- Coordinated patient appointments and managed a multi-provider schedule, optimizing clinic flow and minimizing wait times.
- Acted as the primary point of contact for patient inquiries, triaging calls and providing accurate information on services and procedures.
- Assisted with basic insurance verification and prior authorizations, ensuring necessary documentation was complete before patient visits.
- Maintained patient records with high accuracy in Cerner EMR, including demographic updates and scanning medical documents.
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Administrative Assistant at Phoenix Family Practice ()
- Provided comprehensive administrative support to a team of 3 physicians and 5 clinical staff, ensuring smooth daily operations.
- Managed incoming and outgoing correspondence, including mail, faxes, and emails, maintaining organized filing systems.
- Maintained and updated patient demographic information and basic financial records with a focus on data integrity.
- Assisted with preparing patient charts and gathering necessary documentation for appointments, improving physician readiness.
Education
- Associate of Applied Science in Medical Office Administration - Phoenix College (2017)
Why and how to use a similar resume
This resume effectively showcases a candidate who is not only proficient in front desk operations but also possesses strong medical billing expertise. The strategic use of industry-specific keywords, software mentions, and quantifiable achievements in each role demonstrates a clear understanding of the medical administrative and financial landscape. The progression from administrative assistant to a front desk role with integrated billing responsibilities illustrates a growing skill set and career ambition, making the candidate highly attractive for a combined role.
- Clearly highlights the dual nature of the role (front desk and billing) through specific bullet points.
- Incorporates industry-standard EMR systems (Epic, Cerner) and billing codes (CPT, ICD-10) for immediate relevance.
- Quantifies achievements (e.g., 'improved collection rates by 15%', 'reduced claim rejections by 10%') to demonstrate tangible impact.
- Shows a logical career progression, indicating increasing responsibility and skill development over time.
- The 'Skills' section is concise and impactful, focusing on the most critical hard and soft skills for the target role.
Jordan Miller
Compliance Specialist (Medical Billing) Resume Example
Summary: Highly skilled and results-oriented Compliance Specialist with 8+ years of experience in medical billing, auditing, and regulatory adherence. Proven ability to develop robust compliance programs, conduct thorough audits, and optimize revenue cycles while ensuring strict adherence to HIPAA, CMS, and state guidelines. Seeking to leverage expertise to enhance compliance frameworks and mitigate risks for a forward-thinking healthcare organization.
Key Skills
Compliance Auditing • HIPAA & CMS Regulations • ICD-10 & CPT Coding • Revenue Cycle Management • Medical Billing Software (Epic, Cerner) • Denial Management • Risk Assessment • Data Analysis • Policy Development • Training & Development
Experience
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Compliance Specialist (Medical Billing) at United Health Solutions ()
- Developed and implemented comprehensive compliance training programs for 150+ billing staff, resulting in a 20% reduction in audit findings within the first year.
- Conducted internal audits of medical billing practices, identifying and correcting coding errors (ICD-10, CPT, HCPCS) that recovered over $75,000 in potential lost revenue annually.
- Monitored and interpreted changes in CMS, HIPAA, and state regulations, ensuring all billing processes and documentation remained 100% compliant.
- Managed the investigation and resolution of billing disputes and compliance-related inquiries, maintaining a 98% resolution rate within established timelines.
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Medical Billing Auditor at Premier Healthcare Services ()
- Performed comprehensive audits of patient accounts, claims, and medical documentation to ensure accuracy and compliance with federal and state guidelines.
- Identified over $50,000 in billing discrepancies and underpayments through meticulous review of EOBs and payment postings, leading to successful appeals.
- Provided detailed feedback and targeted training to a team of 10 billers, improving coding accuracy by 15% within six months.
- Utilized billing software (Cerner) to track, analyze, and report on billing performance metrics and identify potential compliance risks.
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Senior Medical Biller at Coastal Medical Group ()
- Processed high volumes of medical claims (100+ daily) across various specialties, consistently achieving a 97% clean claim submission rate.
- Resolved complex denials and rejections for commercial and government payers, recovering an average of $20,000 per month in outstanding receivables.
- Trained 5 new billing specialists on proper coding (ICD-10, CPT), claim submission protocols, and effective denial management strategies.
- Maintained up-to-date knowledge of payer-specific requirements and government regulations (Medicare, Medicaid) to ensure accurate claim processing.
Education
- Bachelor of Science in Healthcare Administration - University of Houston (2016)
Why and how to use a similar resume
This resume is highly effective for a Compliance Specialist (Medical Billing) because it strategically highlights a strong foundation in regulatory adherence, auditing, and revenue cycle optimization. It uses a clear, reverse-chronological format that emphasizes career progression and increasing responsibility in compliance-focused roles. The inclusion of specific software proficiencies, regulatory knowledge, and quantifiable achievements demonstrates a results-oriented professional capable of safeguarding an organization's financial and legal standing.
- Quantifiable achievements throughout the experience section demonstrate direct impact on revenue recovery and risk mitigation.
- Clear progression from Medical Biller to Auditor to Specialist showcases increasing expertise and leadership in compliance.
- Specific mention of industry-standard software (Epic, Cerner) and coding systems (ICD-10, CPT) immediately validates technical proficiency.
- Strong emphasis on regulatory knowledge (HIPAA, CMS) and policy development aligns perfectly with the compliance specialist role.
- The summary effectively condenses key qualifications and experience, providing an immediate overview of the candidate's value.
Jordan Smith
Medical Collections Specialist Resume Example
Summary: Highly motivated and results-driven Medical Collections Specialist with 7+ years of experience optimizing revenue cycles and significantly reducing outstanding accounts receivable. Proven ability to navigate complex insurance policies, negotiate payment plans, and maintain high patient satisfaction while ensuring HIPAA compliance and maximizing financial recovery.
Key Skills
Accounts Receivable Management • Epic Systems • AdvancedMD • Meditech • CPT/ICD-10 Coding • Denials Management • HIPAA Compliance • Revenue Cycle Management • Patient Payment Negotiation • Insurance Verification
Experience
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Medical Collections Specialist at Desert Bloom Health System ()
- Successfully managed a portfolio of over 500 patient accounts, consistently recovering an average of $80,000+ in outstanding balances monthly.
- Reduced Accounts Receivable (AR) days by 15% through proactive follow-up and effective negotiation strategies using Epic Systems.
- Identified and resolved complex billing discrepancies, leading to a 20% decrease in re-submission rates and improved first-pass resolution.
- Collaborated with insurance companies and patients to establish equitable payment plans, increasing patient payment compliance by 18%.
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Collections Specialist (Medical Accounts) at Apex Billing Solutions ()
- Managed a high-volume queue of medical claims, resolving over 100 accounts daily for various specialties, including cardiology and orthopedics.
- Negotiated settlements and payment arrangements with patients and third-party payers, achieving a 90% success rate in securing payment commitments.
- Processed appeals and denials efficiently, recovering approximately $50,000 annually in previously uncollected revenue using AdvancedMD.
- Educated patients on their financial responsibilities, insurance benefits, and billing statements to prevent future collection issues.
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Patient Account Representative at Valley Regional Clinic ()
- Supported the billing department by processing patient payments, posting adjustments, and reconciling daily deposits accurately.
- Verified patient insurance eligibility and benefits for over 75 patients daily, ensuring correct billing information was captured upfront.
- Assisted patients with billing inquiries, provided detailed explanations of charges, and resolved minor discrepancies with a 95% satisfaction rate.
- Maintained accurate and organized patient financial records in Meditech, ensuring data integrity for audit purposes.
Education
- Associate of Science in Medical Office Administration - Phoenix College (2016)
Why and how to use a similar resume
This resume for a Medical Collections Specialist is highly effective due to its strategic focus on quantifiable achievements and industry-specific expertise. It immediately establishes the candidate as a results-driven professional by leading with a strong summary that highlights years of experience and key outcomes. The use of action verbs coupled with specific metrics (e.g., "recovered an average of $80,000+", "Reduced Accounts Receivable (AR) days by 15%") across all experience entries provides concrete evidence of impact and value. Furthermore, the inclusion of relevant software (Epic Systems, AdvancedMD, Meditech) and compliance knowledge (HIPAA, FDCPA) directly addresses the technical requirements of the role, making it highly appealing to hiring managers in the medical billing and collections field.
- Quantifiable achievements clearly demonstrate impact and value to potential employers.
- Specific industry software and compliance knowledge (Epic, HIPAA) are highlighted, showcasing technical proficiency.
- Strong action verbs start each bullet point, emphasizing proactive contributions and leadership.
- Progressive career growth is evident through increasing responsibilities and complexity across roles.
- Tailored keywords directly align with Medical Collections Specialist job descriptions, optimizing for ATS.
Sarah Thompson
Practice Administrator (with billing oversight) Resume Example
Summary: Highly accomplished Practice Administrator with over 8 years of progressive experience in healthcare operations, financial management, and comprehensive revenue cycle oversight. Proven ability to optimize practice efficiency, enhance patient satisfaction, and significantly improve financial performance through strategic billing management and team leadership.
Key Skills
Revenue Cycle Management (RCM) • Medical Billing & Coding (CPT, ICD-10) • EMR/EHR Systems (Epic, Athenahealth) • Claims Management & Denial Resolution • Accounts Receivable (AR) Management • HIPAA Compliance & Regulations • Financial Reporting & Analysis • Operational Leadership & Efficiency • Strategic Planning • Staff Development & Training
Experience
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Practice Administrator (with billing oversight) at Premier Health & Wellness Clinic ()
- Direct and oversee all operational and financial aspects for a multi-specialty clinic, managing an annual budget of $2.5M and a team of 15+ staff.
- Spearheaded revenue cycle management (RCM) initiatives, resulting in a 15% increase in net collection rates and a 20% reduction in Accounts Receivable (AR) days within the first year.
- Implemented new EMR (Epic) billing modules and staff training programs, improving billing accuracy by 25% and accelerating claims submission processes.
- Developed and enforced HIPAA-compliant policies and procedures, ensuring 100% regulatory adherence and safeguarding patient data.
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Billing Manager at Unity Medical Group ()
- Managed a team of 8 medical billers and coders, overseeing full-cycle billing operations for a large multi-physician practice.
- Reduced claim denial rates by 18% through proactive identification of coding errors (CPT, ICD-10) and implementation of pre-submission verification protocols.
- Streamlined appeals processes, leading to a 30% increase in successful claim resolutions and recovery of over $250K in previously denied revenue.
- Conducted monthly audits of billing and coding practices, ensuring compliance with payer guidelines and federal regulations.
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Senior Medical Biller at North Star Family Medicine ()
- Executed full-cycle medical billing, including charge entry, claims submission, payment posting, and AR follow-up for a busy family medicine practice.
- Maintained a clean claim submission rate of 98% by meticulously verifying patient demographics, insurance eligibility, and coding accuracy prior to submission.
- Successfully resolved complex billing inquiries and patient account discrepancies, improving patient satisfaction scores related to billing by 20%.
- Managed patient collections, implemented payment plans, and reduced outstanding patient balances by an average of 10% monthly.
Education
- Bachelor of Science in Healthcare Administration - University of Texas at Dallas (2016)
- Certified Professional Coder (CPC) - AAPC (2017)
Why and how to use a similar resume
This resume effectively showcases a candidate for a Practice Administrator role with billing oversight by strategically combining leadership, operational management, and deep revenue cycle expertise. It emphasizes quantifiable achievements, specific industry software, and a clear progression in responsibilities, demonstrating both strategic thinking and hands-on capability in critical financial areas. The blend of administrative and billing competencies is crucial for this specialized role.
- Highlights a strong professional summary that immediately establishes the candidate's dual expertise in practice administration and billing oversight.
- Quantifiable achievements are consistently used in each experience entry, demonstrating tangible impact on financial performance and operational efficiency.
- Specific industry keywords (e.g., RCM, CPT, ICD-10, EMR systems) and software (Epic, Athenahealth) are integrated, signaling relevant technical proficiency.
- The career progression clearly illustrates increasing responsibility, from Senior Medical Biller to Billing Manager, culminating in a Practice Administrator role with billing oversight.
- The skills section is concise and targeted, listing essential hard skills (RCM, EMR, Billing & Coding) alongside critical soft skills (Operational Leadership, Strategic Planning).
Alex Chen
Health Information Technician (with billing focus) Resume Example
Summary: Highly skilled and Certified Health Information Technician (RHIT, CPC) with 5+ years of experience specializing in medical billing, coding, and revenue cycle management. Proven ability to optimize claims processing, reduce denial rates, and ensure strict HIPAA compliance, contributing to enhanced financial health and data integrity within diverse healthcare settings.
Key Skills
ICD-10-CM & CPT Coding • Revenue Cycle Management • Claims Processing & Denial Resolution • Epic & Cerner EMR Systems • HIPAA & Compliance • Medical Billing Software (Kareo, AdvancedMD) • Accounts Receivable Management • Data Integrity & Auditing • Medical Terminology • Attention to Detail
Experience
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Health Information Technician (Billing Focus) at St. David's Medical Center ()
- Manage full revenue cycle for high-volume specialty clinics, processing an average of 300+ claims weekly with 98% accuracy.
- Utilize Epic EMR for charge entry, coding (ICD-10-CM, CPT, HCPCS), and claims submission, reducing claim rejections by 15% through meticulous review.
- Conduct comprehensive denial management, identifying root causes and implementing corrective actions that recovered over $50,000 in previously denied claims annually.
- Ensure strict compliance with HIPAA, Medicare, Medicaid, and private payer regulations, maintaining 100% audit readiness for medical records and billing practices.
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Medical Biller & Coder at Austin Family Practice ()
- Managed all aspects of medical billing and coding for a busy multi-provider family practice, handling 150+ patient encounters daily.
- Applied ICD-10-CM and CPT codes to diagnoses and procedures, achieving a 97% clean claim submission rate using Kareo medical billing software.
- Investigated and resolved complex billing discrepancies and insurance denials, reducing outstanding accounts receivable by 20% within the first year.
- Provided patient education on billing statements, insurance benefits, and payment options, improving patient satisfaction scores related to financial services.
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Health Information Clerk at Lone Star Urgent Care ()
- Maintained and organized physical and electronic health records for a fast-paced urgent care center, ensuring accuracy and accessibility for 50+ patients daily.
- Assisted with basic charge entry and claims preparation, supporting the billing department in processing initial patient encounters.
- Managed the release of information (ROI) requests in compliance with HIPAA guidelines, processing an average of 25 requests per week.
- Conducted daily chart audits to ensure complete and accurate documentation prior to billing, preventing potential coding errors.
Education
- Associate of Science in Health Information Technology - Austin Community College (2018)
- Certified Professional Coder (CPC) - AAPC (2019)
- Registered Health Information Technician (RHIT) - AHIMA (2018)
Why and how to use a similar resume
This resume effectively showcases a Health Information Technician with a strong billing focus by employing a strategic blend of keywords, quantifiable achievements, and a clear career progression. It immediately highlights the candidate's dual expertise in health information management and revenue cycle operations, making them a highly attractive candidate for roles requiring both clinical data integrity and financial acumen. The structured bullet points under each experience entry provide concrete examples of impact, demonstrating not just responsibilities but measurable contributions to efficiency and revenue.
- Optimized with industry-specific keywords like 'ICD-10-CM', 'CPT', 'Epic EMR', 'Revenue Cycle Management', and 'HIPAA Compliance'.
- Quantifiable achievements are integrated throughout, demonstrating direct impact on claim accuracy, denial rates, and revenue recovery.
- A clear career progression is evident, starting from Health Information Clerk to a specialized Health Information Technician role with billing focus, showing growth and increasing responsibility.
- The 'Skills' section is concise and targeted, listing critical hard and soft skills that align directly with the job requirements of a billing-focused HIT.
- The professional summary provides an immediate snapshot of the candidate's core competencies and years of experience, grabbing the recruiter's attention quickly.
Good vs Bad Resume Examples
Professional Summary
❌ Avoid:
Experienced Medical Biller seeking a challenging role where I can utilize my skills in a dynamic healthcare environment.
✅ Do This:
Detail-oriented Medical Biller with 7 years of experience in high-volume clinics, recognized for consistently achieving a 98.5% clean claim submission rate and reducing outstanding AR by 20% within the first year.
Why: The 'good' example immediately showcases quantifiable achievements (98.5% clean claim rate, 20% AR reduction) and specific experience (7 years, high-volume clinics), proving immediate value. The 'bad' example is generic, focuses on the candidate's desires rather than the employer's needs, and lacks any concrete metrics or specific skills.
Work Experience
❌ Avoid:
Responsible for processing insurance claims and following up on unpaid balances.
✅ Do This:
Managed a portfolio of 500+ patient accounts, successfully recovering over 50,000 in outstanding claims and reducing average AR days from 60 to 45 within 18 months.
Why: The 'good' example uses a power verb ('Managed'), quantifies the scale of work (500+ accounts), and provides clear, measurable results (50,000 recovered, AR days reduced from 60 to 45). The 'bad' example is a task-based description of a duty, offering no insight into the candidate's efficiency, impact, or specific achievements.
Skills Section
❌ Avoid:
Computer Skills, Communication, Teamwork, Problem-Solving, Data Entry
✅ Do This:
Medical Billing Software: Epic, Cerner, Kareo, Medisoft | Coding: ICD-10-CM/PCS, CPT, HCPCS Level II | Compliance: HIPAA, OIG Guidelines | Processes: Denial Management, Accounts Receivable, Payment Posting, Insurance Verification, EOB Analysis
Why: The 'good' list is highly specific, listing industry-standard software, coding systems, compliance regulations, and critical billing processes. This immediately tells a hiring manager that the candidate possesses the exact technical skills required. The 'bad' list contains generic skills that, while important, don't convey specific medical billing expertise and are assumed for most professional roles.
Best Format for Medical Billers
The **Reverse-Chronological** format is overwhelmingly the best choice for Medical Billers. It highlights your most recent and relevant experience first, which is what hiring managers and ATS systems prioritize. This format allows you to clearly showcase your career progression, specific billing systems proficiency, and quantifiable achievements in a straightforward timeline.A **Functional** resume, which emphasizes skills over chronology, is generally not recommended unless you have significant gaps in employment or are making a dramatic career change with highly transferable skills, and even then, it's often viewed with suspicion by recruiters and can be less ATS-friendly. For Medical Billers, demonstrating a consistent track record of experience is paramount.
Essential Skills for a Medical Biller Resume
A robust skills section demonstrates your technical proficiency and interpersonal capabilities. For a Medical Biller, this section should be a strategic blend of hard skills (technical, measurable abilities) and soft skills (interpersonal, communication). Hiring managers seek candidates who can not only manage complex coding and claims but also communicate effectively with patients and insurance companies, and meticulously problem-solve.These skills matter because they directly impact a practice's financial health, patient satisfaction, and regulatory compliance. Proficiency in specific software, coding, and compliance is non-negotiable, while strong soft skills ensure smooth operations and effective issue resolution.
Technical Skills
- ICD-10-CM/PCS
- CPT & HCPCS Level II
- Epic/Cerner/Medisoft (EHR/EMR)
- Denial Management & Appeals
- Accounts Receivable & Collections
- HIPAA Compliance
Soft Skills
- Attention to Detail
- Analytical Thinking
- Problem-Solving
- Effective Communication
Power Action Verbs for a Medical Biller Resume
- Processed
- Managed
- Reconciled
- Audited
- Resolved
- Optimized
ATS Keywords to Include
Include these keywords in your resume to pass Applicant Tracking Systems:
- ICD-10
- CPT
- HCPCS
- Denial Management
- Accounts Receivable
- HIPAA Compliance
Frequently Asked Questions
What are the essential medical billing hard skills for a resume?
Essential hard skills include proficiency in ICD-10, CPT, and HCPCS coding; experience with medical billing software (e.g., Epic, Cerner, Kareo); expertise in denial management, accounts receivable, and claims submission; and knowledge of insurance verification and payment posting processes.
What is the best way to list ICD-10, CPT, and HCPCS codes on a medical biller resume?
List them explicitly in your 'Skills' section under a 'Coding' subsection. You can also mention them within your 'Work Experience' bullet points when describing claim processing or denial resolution, for example: 'Utilized ICD-10 and CPT codes to accurately process an average of 120 claims daily.'
How should I describe medical billing software proficiency (Epic, Cerner, Medisoft) on my resume?
Create a dedicated 'Technical Skills' or 'Software Proficiency' section and list each software by name. In your 'Work Experience' section, integrate how you used these systems: 'Managed patient accounts and claims processing within Epic, reducing billing errors by 10%.'
How do I describe denial management experience on a medical billing resume?
Focus on the actions taken and results achieved. For example: 'Investigated and appealed denied claims, successfully overturning 90% of rejections and recovering $X in lost revenue.' Mention specific strategies used to reduce future denials.
What action verbs are best for medical claims processing and accounts receivable on a resume?
Use verbs like Processed, Submitted, Reconciled, Managed, Audited, Collected, Resolved, Expedited, Analyzed, and Followed-up. Always follow with a quantifiable achievement.
What are the top soft skills for a medical billing specialist resume?
Key soft skills include attention to detail, analytical thinking, problem-solving, strong communication (written and verbal), organizational skills, and adaptability. These are crucial for navigating complex regulations and interacting with patients and insurers.
How can I create a medical biller resume with no experience?
Focus on relevant coursework, certifications (e.g., CBCS, CPC-A), internships, or volunteer work in healthcare settings. Highlight transferable skills from previous roles like data entry, administrative support, or customer service, emphasizing accuracy, organization, and compliance.
What tips are there for a career change resume from administrative assistant to medical biller?
Emphasize transferable skills such as data entry, scheduling, record keeping, communication, and organizational abilities. Highlight any exposure to medical terminology or healthcare environments. Consider taking a medical billing certification to strengthen your application.
What quantifiable achievements can I include for a medical biller resume (KPIs, metrics)?
Include metrics like 'reduced outstanding AR days by X%', 'increased clean claim rate to X%', 'recovered $X in denied claims', 'processed X claims daily with X% accuracy', or 'improved collection rates by X%'.
How can I show the impact of reducing outstanding AR days on a resume?
State the initial and final AR days, and the percentage reduction: 'Streamlined claims follow-up, reducing average outstanding AR days from 75 to 50 (a 33% reduction) within six months.'
What examples can I use for improving clean claim rates for a medical biller resume?
Quantify the improvement: 'Implemented new pre-submission review protocols, increasing clean claim submission rate from 92% to 98% and accelerating reimbursement cycles.'
How do I include medical billing compliance and HIPAA experience on a resume?
Mention it in your 'Skills' section. In 'Work Experience,' describe instances where you ensured compliance: 'Maintained strict adherence to HIPAA regulations and OIG guidelines in all billing practices, safeguarding patient data and minimizing compliance risks.'
What are good resume bullet points for insurance verification and patient eligibility?
'Verified patient insurance eligibility and benefits for an average of 30 patients daily, ensuring accurate billing and minimizing claim rejections.' or 'Communicated complex insurance benefits to patients, improving financial transparency and patient satisfaction.'
Where should certifications for a medical biller resume (CPC, CBCS) be placed?
Place them in a dedicated 'Certifications' section, typically below 'Education.' For highly relevant and current certifications, you can also briefly mention them in your 'Professional Summary' to immediately highlight your qualifications.
How do I tailor a medical biller resume for a hospital vs. private practice?
For hospitals, emphasize experience with high-volume claims, complex coding scenarios, specific hospital EHR systems (e.g., Epic, Cerner), and adherence to large-scale compliance protocols. For private practices, highlight adaptability, patient interaction, experience with smaller billing systems, and the ability to manage a broader range of billing tasks.
Should I use a medical biller resume objective vs. summary statement?
Always use a 'Professional Summary' statement. Objectives are outdated and focus on what you want, whereas a summary highlights what you bring to the employer, immediately showcasing your value with key skills and achievements.
What common mistakes should I avoid on a medical billing resume?
Avoid using generic language, failing to quantify achievements, including typos or grammatical errors, using an outdated resume objective, and neglecting to customize your resume for each job application. Also, don't include irrelevant personal information.
What are good cover letter tips for medical billing job applications?
Your cover letter should expand on 2-3 key achievements from your resume, demonstrating how your skills specifically align with the job description. Mention the organization by name, express genuine interest, and highlight how you can contribute to their financial success, perhaps by reducing denials or improving AR. Keep it concise and professional.