Usama Waheed

Medical Billing and Credentialing Specialist

Upwork • Full time

Feb 2021 - Present • 5 yrs 3 mos

I am a Medical Billing and Credentialing Specialist with 6 years of hands-on experience in U.S. Healthcare Revenue Cycle Management (RCM). I have worked with private practices, clinics, and healthcare providers to manage full-cycle medical billing operations from patient eligibility to final payment posting and AR resolution. My experience includes end-to-end claim management such as insurance verification (VOB), charge entry, claim creation and submission (CMS-1500 & UB-04), denial management, appeals, and payment posting (ERA/EOB/EFT). I specialize in Accounts Receivable (AR) follow-up, reducing aging claims, and improving reimbursement timelines for healthcare providers. I have successfully supported providers in resolving denied and rejected claims, identifying billing errors, correcting coding issues (ICD-10, CPT, HCPCS), and ensuring compliance with payer guidelines and HIPAA regulations. My focus is always on maximizing clean claim rates and reducing revenue leakage. In credentialing, I have experience with provider enrollment, CAQH setup and maintenance, Medicare, Medicaid, and commercial insurance credentialing, as well as NPI registration, license verification, and payer contracting support. I also handle ERA/EFT setup and clearinghouse configurations for seamless billing workflows. I am proficient in working with multiple EHR/PM systems including AdvancedMD, Athenahealth, Kareo (Tebra), Office Ally, eClinicalWorks (eCW), Practice Fusion, SimplePractice, TherapyNotes, and more. I also use clearinghouses such as Availity, Waystar, Change Healthcare, and Trizetto for claim submissions and tracking. I have worked with major U.S. insurance payers including Medicare, Medicaid, Blue Cross Blue Shield (BCBS), Aetna, Cigna, UnitedHealthcare (UHC), Humana, Tricare, and other commercial insurers. My key achievements include improving revenue cycle efficiency, reducing 90+ day AR, increasing first-pass claim acceptance rates.