Medical Billing
Resume:
Pamela A. Colegrove
Nicholasville, KY 40356
859-***-**** (Home)
Certifications:
AAPC Certified Risk Coder-CRC
Education:
National College of Business, 2007
Medical Billing and Coding, Diploma,
Administrative Office Specialist, Medical Emphasis, Associates Degree
Business Management in Healthcare Administration, Bachelor Degree
Sullivan University, Lexington Campus, March 2011
Awards:
Honor Roll, National College of Business
Dean’s List, National College of Business
National Dean’s List Award, 2005
National Collegiate Dean’s List, 2006
Collegiate All-American Computer Science, 2006
National Collegiate Computer Science Award, 2006
Mary P McGurn Award for Administrative Office Professional
Member of the National Association of Professional Women, 2008
Deans’ List, Sullivan University
Member of Sigma Beta Delta 2012
Curriculum:
Medical Billing Practices
CPT, ICD-9, and HICFA coding
Medicare and Medicaid billing practices
Medical Terminology
Microsoft Word, Excel, Access, and Desktop Publishing
Medical Reimbursement and Billing
Medical Office Procedures
Oral and Written Communications
Work Experience:
Change Healthcare October 2017 -July 6, 2019
Coder Reader 2: Analyze medical records sent to us by the healthcare insurance company to find the medical diagnosis contained within the medical record for risk adjusting purposes before the insurance company chooses which charts to send in to Department of Medicare for the yearly audit of all insurance companies. I also worked on special projects such as testing new software for the use of coding for risk adjusting auditing medical records, and the Federal Program of HEDIS. I worked under the requirements of productivity and quality and was required to have a productivity of 95 percent and quality of 96 percent or more.
Xerox May 2015-October 2017
Worked inbound call center customer service for Express Scripts. Helped members order medications, pay their balance, give information about coverage and what was required before certain medications were dispensed per their policy’s requirements. Researched and rectified billing issues with the assistant of the billing department. Helped train new hires on how to access the parts of program needed during phone calls before finally being placed on the production floor.
Speedway, LLC March 2012-December 2014
Shift lead for store on Boston Rd, Lexington, KY. Was mostly shift lead on second shift but sometimes did open the store for the day by doing counts, reconciliation of the safe, setting up the change fund for the day, and other reports needed by home office for the prior day’s operation. I also ran a register and checked customers out when it became backed up in the morning rush. Supervised the employees after the manage had left for the day giving directions of what needed to be done and who was to do the task. Received the delivery truck and other vendors and make sure the order was correct and if short or over, filled out the report for home office and gave copy to delivery person.
National College Nov. 2011- Feb 2012
115 East Lexington Avenue
Danville, KY 40422
Instructed students in the subject of Medical Office Procedures, ICD-9 Coding, Beginning and Advanced. Also qualified to instruct students in the subjects of Introduction to CPT Coding, Advanced CPT and Into to Reimbursement & HIPPA, Intro Medical Insurance Billing Practices, Medicare & Medical Reimbursement, and Medical Office Finances.
Alliance Staffing June 2010-Mar 2011
3716 Willow Ridge Road
Lexington, KY 40514
This was a temporary work placement with Lexington Clinic Billing Office. Process secondary claims via electronic and paper submission, process insurance denials from mail, electronic A/R, and reports, verified insurance coverage and corrected incorrect information and re-file claims for payment. I worked with other team members and other teams to ensure smooth transfer of claims from commercial to government and HMO secondary insurance. Answered patient questions about insurance billing and explained their insurance to them if they had questions. Called insurance companies to inquire about the denials and corrected any problems with the claim to guarantee payment. Researched and processed refunds to both patients and insurance companies to correct overpayment on accounts. Kept track of patient calls on phone logs and worked the phone logs daily to answer any questions or correct any problems the patient was having with insurance company payments. Researched and corrected whole accounts that were filed to wrong insurance or with incorrect information for payment and to clear up collection balances that should never have been sent to collection department. Sent reports to cash posting department for corrections of payment postings as necessary to ensure correct balance on account due from patient. Posted cash payments when short staffed in posting department to ensure all payments were posted to accounts in a timely manner. Made sure that posted batches were balanced before returning to cash posting department
Spine & Brain Neurosurgical Center May 2005 to 2010
1713 Nicholasville Road
Lexington, KY 40205
Process secondary claims daily via electronic and paper submission, process insurance denials from mail and internet, file appeals for denied claims, run monthly A/R on seven commercials insurance companies, special projects as assigned by office manager, answer patients questions about insurance coverage and account balances, obtain retro pre-authorizations after claims have denied, enter patient charges, process billing exception reports, post payments manually and electronically, refunds for insurance and patient overpayments, Coordination of Benefits problem resolution, outside referrals, MRI scheduling, Worker Compensation claims resolution, patient, physician office, and disability medical records requests.
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