Medical Billing Case Manager
Resume:
Thomas Bruhn
Minneapolis, MN *****
ad80i5@r.postjobfree.com
Willing to relocate: Anywhere
Work Experience
Medical Billing Specialist
PGLS Piedmont Global Language Solutions-Minneapolis-Saint Paul, MN November 2023 to March 2024
Work on the accounting team to help with the transition from having the claims billing outsourced to bringing it in house and training accounting team and medical billing specialists on Office Ally's clearing house
Neuromodulation Facilitator
Twin Cities Pain Clinic-Edina, MN
March 2021 to June 2023
Received all spinal cord stimulator and intrathecal Pump orders. Create and maintain work logs. Schedule and monitor all insurance prerequisites for successful completion. Identify any issues with ex codes or no covered services. Gather all pertinent documentation including specific forms for prior authorization completion using online portals and websites. Sending all approved services to scheduling. Work with patients on appeals when services have been denied by their medical insurance. Billing Manager
Minnesota Head and Neck Pain Clinic-Saint Paul, MN July 2017 to July 2020
JOB SUMMARY: The Medical Billing Manager is a full-time position responsible for overseeing the billing coding staff and making day-to-day decisions; responsible for understanding and coding all procedures within regulatory mandates; assists with following up on insurance claims and submit appeals as needed. This position is responsible for directing and coordinating the overall functions of the billing and coding office to ensure maximization of cash flow while improving patient, physician, and other customer relations. The Medical Billing Manager position requires the ability to produce and present detailed billing activity reports
• ESSENTIAL DUTIES AND RESPONSIBILITIES include the following as well as other duties and responsibilities that may be assigned:
• Oversees the operations of the billing department, encompassing medical coding, charge entry, claims submissions, payment posting, accounts receivable follow-up, and reimbursement management
• Serves as the practice expert and go to person for all coding and billing processes
• Plans and directs patient insurance documentation, workload coding, billing and collections, and data processing to ensure accurate billing and efficient account collection
• Analyze billing and claims for accuracy and completeness; submit claims to proper insurance entities and follow up on any issues
• Follow up on claims using various systems, i.e. practice management and clearinghouse
• Maintains contacts with other departments to obtain and analyze additional patient information to document and process billings
• Prepares and analyzes accounts receivable reports, and weekly and monthly financial reports in concert with the Practice Administrator and Business Manager. Collects and compiles accurate statistical reports
• Audits current procedures to monitor and improve efficiency of billing and collections operations
• Ensures that the activities of the billing operations are conducted in a manner that is consistent with overall department protocol, and are in compliance with Federal, State, and payer regulations, guidelines, and requirements
• Participates in the development and implementation of operating policies and procedures
• Reviews and interprets operational data to assess need for procedural revisions and enhancements; participates in the design and implementation of specific systems to enhance revenue and operating efficiency
• Analyzes trends impacting charges, coding, collection, and accounts receivable and take appropriate action to realign staff and revise policies and procedures
• Keep up to date with carrier rule changes and distribute the information within the practice
• Performs physician credentialing actions
• Understands and remains updated with current coding and billing regulations and compliance requirements
• Maintains library of information/tools related to documentation guidelines and coding
• Supervises billing office personnel, which includes work allocation, training, and being available for staff needs; motivates employees to achieve peak productivity and performance
• Provides, oversees, and/or coordinates the provision of training for new and existing billing staff on applicable operating policies, protocols, systems and procedures, standards, and techniques
• Coordinates team member time off in a manner that does not negatively impact necessary daily functions.
• Other duties as assigned by the Practice Administrator GENERAL RESPONSIBILITIES:
• Performs all duties and responsibilities in an efficient, team-oriented manner.
• Accountable for being knowledgeable and understanding of all aspects of the billing and coding staff duties to include:
• Entering patient demographics and insurance information
• Verifying patient eligibility and benefits for upfront collection on unmet deductibles and co-insurance
• Enter charges accurately according to insurance payors/contracts
• Submitting clean claims by attaching necessary documentation for payment
• Follow-up on electronic claims and paper claims
• Posting insurance payments to patient accounts
• Submit all secondary claims when necessary
• Accountable for reviewing daily schedules for estimates, authorizations and 3rd party billing
• Conducts self in a manner that reflects a positive representation of the company, and encourages others to do the same
• Observes strict patient confidentiality in dealing with patients
• Performs all duties and responsibilities in an efficient, team-oriented manner.
• Accountable for being knowledgeable and understanding of all aspects of the billing and coding staff duties to include:
• Entering patient demographics and insurance information
• Verifying patient eligibility and benefits for upfront collection on unmet deductibles and co-insurance
• Enter charges accurately according to insurance payors/contracts
• Submitting clean claims by attaching necessary documentation for payment
• Follow-up on electronic claims and paper claims
• Posting insurance payments to patient accounts
• Submit all secondary claims when necessary
• Accountable for reviewing daily schedules for estimates, authorizations and 3rd party billing
• Conducts self in a manner that reflects a positive representation of the company, and encourages others to do the same
• Observes strict patient confidentiality in dealing with patients. Office Manager
Sheaman Inc./Newsense LTD/Legacy Mental Health Center-Edina, MN January 2012 to December 2017
• JOB SUMMARY: The Medical Office/Billing Manager is a full-time position responsible for overseeing the contract providers and billing coding staff and making day-to-day decisions; responsible for understanding and coding all procedures within regulatory mandates; assists with following up on insurance claims and submit appeals as needed. This position is responsible for directing and coordinating the overall functions of the office, billing and coding office to ensure maximization of cash flow while improving patient, physician, and other customer relations.
• ESSENTIAL DUTIES AND RESPONSIBILITIES include the following as well as other duties and responsibilities that may be assigned:
• The Office/Medical Billing Manager position requires the ability to produce and present detailed billing activity reports.
• Oversee payroll for contracted providers. Establish office policies and procedures.
• Manage insurance contracts and ensure compliance with contracts.
• Responsible for facility cleaning, hygiene, safety and maintenance.
• ensure compliance with current healthcare regulations, medical laws and ethics
• liaise with vendors regarding equipment and supplies
• ensure patient records are current and accurate
• supervise patient scheduling
• oversee registration of patients
• supervise medical coding, medical billing and banking
• provide education material to patients
• communicate with patients regarding inquiries and complaints
• Other duties as assigned by provider/owner
General Responsibilities:
• Performs all duties and responsibilities in an efficient, team-oriented manner.
• Accountable for being knowledgeable and understanding of all aspects of the billing and coding staff duties to include:
• Entering patient demographics and insurance information
• Verifying patient eligibility and benefits for upfront collection on unmet deductibles and co-insurance
• Enter charges accurately according to insurance payors/contracts
• Submitting clean claims by attaching necessary documentation for payment
• Follow-up on electronic claims and paper claims
• Posting insurance payments to patient accounts
• Submit all secondary claims when necessary
• Accountable for reviewing daily schedules for estimates, authorizations and 3rd party billing
• Conducts self in a manner that reflects a positive representation of the company, and encourages others to do the same
• Observes strict patient confidentiality in dealing with patients Pharmacy Technician
Target-Richfield, MN
January 2008 to December 2012
• Filled prescriptions, while monitoring for drug interactions.
• Worked with insurance companies to process accurate claims.
• Released medications to patients, while creating a rapport with reoccurring and new patients.
• Worked with McKesson to maintain accurate levels of in house medications, thus minimizing out of stock medications.
Senior Program Manager
Mains'l Services, Inc-Maple Grove, MN
January 1999 to December 2008
• Anoka County hiring representative.
• Worked directly with Anoka, Hennepin, Washington and Ramsey Counties providing and implementing individual service plans.
• Staffing Coordinator for PCA, HHA and Homemaking In-Home
• program
Budgeted individual finances for 13+ individuals with developmental disabilities.
• Provided financial summaries to county social workers.
• Maintained health management for 13+ individuals with developmental disabilities. Direct Supervisor
Merrick Companies-Vadnais Heights, MN
January 1993 to December 1999
Behavior Trainer
• Provided vocational training to individuals with developmental disabilities.
• Implemented individual goals and outcomes.
• Taught daily living skills to individuals with developmental disabilities.
• Implemented behavior management programs.
• Assisted with rec. /leisure activities. Certificates /Awards
• Health Counseling Medication course, Completed 1992
• Picture Exchange Communication System, Completed March 2001
• Employers Association Supervisory 1, 10-week course, Completed Nov. 2005 Education
High school diploma
Thomas Jefferson High School Bloomington
1989
Skills
• Accounts receivable
• Documentation review
• Conflict management
• ICD-9
• Medical Billing
• ICD-10
• Case management
• Medical Scheduling
• Medical Terminology
• Quantitative analysis
• Medical Office Experience
• Documentation review
• ICD-10
• Customer service
• Office management
• Accounting
• Medical Records
• CPT Coding
• EMR Systems
• Analysis skills
• Microsoft Word
• Operating systems
• Healthcare Management
• McKesson
• Microsoft Office
• Supervising experience
• Time management
• Negotiation
• Financial acumen
• Revenue cycle management
• Customer service
• Budgeting
• EMR systems
• Accounts Receivable
• Medical Coding
• Accounting
• Medical records
• Microsoft Outlook
• Financial report writing
• Microsoft Excel
• Medical terminology
• Medical coding
• Conflict management
• Intake
• EMR Systems
• Insurance Verification
• Practice Management
• ICD-9
• Medical Office Experience
• Employee Orientation
• Behavior Management
• Management
• Triage
• Anatomy Knowledge
• NextGen (7 years)
• Athenahealth (7 years)
• Office ally (10+ years)
• Experience Administering Injections
Certifications and Licenses
Driver's License
Assessments
Customer focus & orientation — Proficient
May 2024
Responding to customer situations with sensitivity Full results: Proficient
Attention to detail — Proficient
May 2024
Identifying differences in materials, following instructions, and detecting details among distracting information
Full results: Proficient
Food service: Customer situations — Proficient
June 2024
Identifying and addressing customer needs in a food service setting Full results: Proficient
Sales skills — Proficient
June 2024
Influencing and negotiating with customers
Full results: Proficient
Inside sales — Proficient
June 2024
Understanding and responding appropriately in sales scenarios, and performing common sales calculations
Full results: Proficient
Medical billing — Proficient
May 2024
Understanding the procedures and forms used for medical billing Full results: Proficient
Protecting patient privacy — Proficient
May 2024
Understanding privacy rules and regulations associated with patient records Full results: Proficient
Working with MS Word documents — Proficient
June 2024
Knowledge of various Microsoft Word features, functions, and techniques Full results: Proficient
Work style: Reliability — Proficient
June 2024
Tendency to be reliable, dependable, and accountable at work Full results: Proficient
Medical terminology — Completed
September 2024
Understanding and using medical terminology
Full results: Completed
Office manager — Proficient
June 2024
Scheduling and budgeting
Full results: Proficient
Spreadsheets with Microsoft Excel — Proficient
June 2024
Knowledge of various Microsoft Excel features, functions, and formulas Full results: Proficient
Clinical judgment — Proficient
September 2024
Assessing a patient's condition and implementing the appropriate medical intervention Full results: Proficient
Time management skills — Proficient
May 2024
Managing one's own time to complete tasks quickly and efficiently Full results: Proficient
Principles of accounting — Proficient
May 2024
Preparing financial records according to federal policies Full results: Proficient
Administrative assistant/receptionist — Proficient July 2024
Using basic scheduling and organizational skills in an office setting Full results: Proficient
Technical support: Customer situations — Completed May 2024
Responding to technical support situations with sensitivity Full results: Completed
Managing accounts in QuickBooks — Completed
September 2024
Using QuickBooks software to manage business financials Full results: Completed
Technical support — Proficient
May 2024
Performing software, hardware, and network operations Full results: Proficient
Case management & social work — Proficient
May 2024
Determining client needs, providing support resources, and collaborating with clients and multidisciplinary teams
Full results: Proficient
Medical receptionist skills — Proficient
June 2024
Managing physician schedules and maintaining accurate patient records Full results: Proficient
Indeed Assessments provides skills tests that are not indicative of a license or certification, or continued development in any professional field.
Additional Information
Board member Shout Out Loud For Suicide Prevention
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