Medical Insurance
Resume:
DERRICK KELLEY
Los Angeles, CA. 90015
*******@*****.***
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OBJECTIVE: To provide administrative healthcare services to the public and healthcare
providers with a high level of quality and professionalism.
EDUCATION: Baltimore Community College
September / 1983
Accomplished resourceful, driven Medical Collector/Biller with over 10 years experience in Hospitals,
Physicians Offices, and Collections and Billing Organizations.
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Analyze EOB's * Eligibility Verification * Insurance Follow-up
Secondary Billing * HIPPA Compliant * Medicare Online Systems (DDE)
Medical Records Clerk * Payment Posting * HCFA 1500 * UB-04 and UB-92
Inpatient and Outpatient Billing * A/R Clerk
EAST L.A. DOCTORS HOSPITAL, Los Angeles, CA Dec/2010 - March
2011
Medical Collector/ Biller (Contracted)
l Follow-up with HMO's, Commercial Insurances, and Medi-Cal MCO's
l Provide Medical records, letters of Medical Necessity, and other pertinent documents as needed
l Correct and/ or rebill claims for payment
l Appeal Claims for non payment and other discrepancies
BEVERLY HOSPITAL, Montibello,CA Feb/2010 - Sept/
2010
Medical Collector/ Biller/ A/R Clerk (Contracted)
l Responsible for insurance follow-up with HMO's, Medi-Cal MCO's and Commercial Insurances
for resolution of claims
l Responsible for 1st and 2nd Level Appeals
l Retrieve and forward Medical Records, letters of medical necessity and other documents as
needed to insurance companies
l Correct and/or rebill claims to insurance companies
CENTINELLA HOSPITAL, Inglewood,CA Sept/2009 - Dec/
2009
Medical Collector/ Biller (Contracted)
l Follow-up with HMO and Medi-Cal MCO Insurances for the resolution and timely filing of
claims
l Screen EOB's received online and via U.S.Mail for payments, denials, and contractual adjustments
l Correct and/ or rebill claims for payment
l Appeal claims as needed
CITRUS VALLEY HEALTH PARTNERS, Covina,CA May/2009 - Sept/
2009
Medical Collector/ Biller/ A/R Clerk (Contracted)
l Bill Medicare secondary insurances for payment of balance of claims
l Follow-up with HMO and Medi-Cal MCO Insurances for the resolution of claims
l Review EOB's received via U.S.Mail for payments, denials, and contractual adjustments
l Verify Medicare eligibility and secondary insurance information via DDE
PHNS, Cerritos,CA Feb/2009 -
May/2009
Medical Collector/ Biller (Contracted)
l Bill, add Late charges, make adjustments, and correct Medicare claims via DDE
l Paper bill secondary commercial insurances and Medi-Cal MCO's with Medicare EOB's
l Contact insurance companies in reference to status of claims
l Correct denied claims and provide insurances with any information that is needed to resolve issue
with claims
Derrick Kelley Page 2
ST JOHNS MEDICAL CENTER, Santa Monica, CA Sept/2008 -
Dec/2008
Medicare Collector/ Biller/ A/R Clerk (Contracted)
l Follow-up with Medicare and Commercial Insurances with denial issues
l Bill secondary insurances and Medi-Cal MCO's with Medicare EOB's
l Rebill Medicare and/or appeal claim when needed
l Check status of claims via DDE and EVS systems
l Provide Medicare and Commercial Insurances and Medi-Cal MCO's with any information needed
for resolution of claim
PHYSICIANS MANAGEMENT GROUP, Brentwood,CA May/2008 - Aug /
2008
Medical Collector (Contracted)
l Follow-up with Medicare, Medi-Cal MCO's and Commercial Insurances regarding accurate and
timely filing
l Correct and/or rebill claims for payment
l Appeal claims when necessary
ST. PAUL SPECIALTY/ MERCY MEDICAL CENTER, Baltimore,MD June 2007 -
April/2008
Medical Biller/ Collector/ A/R Clerk (Contracted)
l Responsible for charge entry, payment posting, electronic claims submission and A/R follow-up
l Secondary billing and adjustments and write offs
l Submitted appeals when necessary
JOHNS HOPKINS HOSPITAL, Baltimore,MD June 2006 -
Dec/2007
Payment Poster
l Post payments and offsets for Care First, Blue Cross and Blue Shield
l Follow-up with Medicare, Medicaid, and Commercial Insurances for resolution of claims
l Maintained Medical Records
PHYSCIANS TRANSPORT SERVICES, Herndon,VA June 2005 - May
2006
Medicare Billing Specialist
l Electronically bill Medicare for Ambulance services for Managed Care Facilities
l Follow up Medicare in reference to delinquent payments
l Posted Medicare payments and forward Medicare remits to secondary billers
CYSTIC FIBROSIS PHARMACY, Bethesda,MD April 2002 - May
2005
Medical Biller /Customer Support Representative / Pharmacy Technician
l Refill and ship prescription medications
l Implement and maintain Manufacturers Programs
l Receive, approve and post authorizations
l Verify insurance eligibility
l Register patients in appropriate programs
l Monitor and respond to CF Services "comment line" via e-mail
l Assist patients with problem accounts and mediations
l Responsible for automatic refill program (ARX)
l Outlined Standard Operational Procedures (SOP's) for Customer and office staff
l HIPPA Certified
Computer Skills
Microsoft Office Suite/ Windows2000+/ IDX/ Medisoft
Meditech/ Emdeon/ DDE/ Artiva/ HBOC/ Medical Manager/ AS400
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