Usama Sarwar

Manager Medical Billing & RCM

Alabama Clinics • Fulltime

Jun 2021 - Present • 4 yrs 11 mos

Performed end-to-end medical billing operations including insurance verification, charge entry, claim scrubbing, and submission using CMS-1500 and UB-04 forms Managed high-volume Accounts Receivable (AR) with consistent follow-ups to ensure timely reimbursement and reduced aging balances Conducted aggressive AR follow-ups with Medicare, Medicaid, commercial, and workers’ compensation insurance carriers Reviewed claim statuses, identified unpaid, underpaid, and denied claims, and took corrective actions to resolve issues. Analyzed claim denials and rejections to identify root causes, including coding errors, medical necessity, authorization, eligibility, and timely filing issues Prepared and submitted strong appeal letters with supporting clinical documentation to overturn denied claims Successfully handled medical necessity denials in accordance with LCD/NCD guidelines Reduced overall denial rates by implementing proactive claim review and coding audits Managed complex payer issues, including takebacks, recoupments, and underpayments. Applied accurate CPT, ICD-10-CM, and HCPCS codes with appropriate modifiers (25, 26, 59, 95, GT, TC) Ensured all claims met payer-specific billing rules and reimbursement policies Verified documentation supported medical necessity per LCD/NCD requirements Maintained strict compliance with HIPAA privacy and security regulations Performed internal billing audits to ensure accuracy and regulatory compliance Posted insurance and patient payments from EOBs / ERAs accurately Investigated and resolved underpayments, overpayments, adjustments, refunds, and reversals Ensured proper Coordination of Benefits (COB) and secondary claim submissions Reconciled accounts to ensure accurate financial reporting and balances Prepared and reviewed AR aging reports (0–30, 31–60, 61–90, 90+) Tracked key performance indicators (KPIs) related to collections, denial rates, and turnaround time

Medical Billing, AR & Denial Management Specialist

Claims Med • Fulltime

Jun 2020 - May 2021 • 11 mos

Perform end-to-end medical billing including insurance verification, charge entry, claim scrubbing, and submission using CMS-1500 / UB-04 Manage Accounts Receivable (AR) with aggressive follow-ups to recover unpaid and underpaid claims Analyze and resolve insurance denials and rejections, including medical necessity, coding, eligibility, authorization, and timely filing issues Prepare and submit strong appeal letters with supporting documentation to maximize reimbursements Apply accurate CPT, ICD-10-CM, and HCPCS codes with appropriate modifiers (25, 26, 59, 95, GT, TC) Ensure claims meet LCD / NCD medical necessity guidelines and payer-specific billing requirements Post payments from EOBs / ERAs, manage adjustments, refunds, and reversals Handle COB and secondary billing to ensure correct payer responsibility Maintain strict HIPAA compliance and perform internal billing audits Communicate with Medicare, Medicaid, commercial, and workers’ compensation payers Prepare AR aging, denial trend, and revenue performance reports

Senior Medical Billing & Revenue Cycle Specialist

CureMD • Fulltime

Mar 2018 - May 2020 • 2 yrs 2 mos

Perform end-to-end medical billing including insurance verification, charge entry, claim scrubbing, and submission using CMS-1500 / UB-04 Manage Accounts Receivable (AR) with aggressive follow-ups to recover unpaid and underpaid claims Analyze and resolve insurance denials and rejections, including medical necessity, coding, eligibility, authorization, and timely filing issues Prepare and submit strong appeal letters with supporting documentation to maximize reimbursements Apply accurate CPT, ICD-10-CM, and HCPCS codes with appropriate modifiers (25, 26, 59, 95, GT, TC) Ensure claims meet LCD / NCD medical necessity guidelines and payer-specific billing requirements Post payments from EOBs / ERAs, manage adjustments, refunds, and reversals Handle COB and secondary billing to ensure correct payer responsibility Maintain strict HIPAA compliance and perform internal billing audits Communicate with Medicare, Medicaid, commercial, and workers’ compensation payers Prepare AR aging, denial trend, and revenue performance reports