Customer Service Medical

Marcus Moore

Government Patient Account Representative - Daughters of Charity

*************@*****.*** - 510-***-****

WORK EXPERIENCE

Government Patient Account Representative

Daughters of Charity - Redwood City, CA - January 2011 to Present

Bills or re-bills necessary

• Work all denials within 48 hours of receipt whatever action may be required to obtain

account resolution

• Make necessary correction to electronic billing.

• Reconciles cash posting with batch posting control totals.

• Call insurance companies to obtain correct information when unable to identify if account payment is to be

posted.

• Contact third party payers and guarantors electronically and via phone to resolve account balances on all

assigned accounts.

• Work all correspondence within 24 hours or receipt. Detailed notes regarding correspondence must be

entered into the system.

• Appeals all accounts denied for medical necessity, authorization, length of stay and timely filing issues.

Claims Analyst

Processed Medi - San Ramon, CA - September 2008 to September 2010

Cal and Commercial claims for a number of Health Plans,

Adjudicated Professional and Facility claims according HPMG, DOFR guidelines and

Compliance rules and regulations.

• Followed up on pended claims using morning report, verified eligibility of members, researched Health Plan

websites for pertinent information while

maintaining productivity and accuracy goals made up by company.

Customer Service Rep (Contract)

Nichols Research - Fremont, CA - June 2008 to September 2008

Responsible for calling people in our data base designed to find qualified

Participants to participate in focus groups.

Patient Acct Rep (Contract)

UCSF - San Francisco, CA - April 2008 to May 2008

Responsible for verifying client data for completeness and accuracy as well as verification of current insurance

carriers.

• Following up on past due accounts for collection. Editing of electronic and hardcopy claims for submission

to various insurance carriers including

government, managed care and commercial.

Medical Claims Processor

SCF Arizona - Phoenix, AZ - February 2006 to February 2008

Medical Review Representative responsible for inputting workers compensation

claims medical billing data from images to company computed systems for adjudication.

• Vast knowledge of medical terminology, coding, understand and determine

physician contract terminology.

• Read and decipher network hospital and durable medical equipment bill types.

Identify appropriate charges for accurate payments.

Customer Service Rep

Mckesson Pharmaceutical - Phoenix, AZ - January 2006 to February 2006

Phoenix, AZ

• Responsible for answering inbound calls from medical professionals interested in purchasing newly approved

medication by FDA for Rheumatoid Arthritis.

Medical Claim Processor

Alameda Alliance for Health - Alameda, CA - November 2004 to August 2005

Alameda, CA

• Responsible for processing all Medi-Cal incoming claims and ensuring claims

were processed and adjudicated in date order and claim type as directed by

Claims Manger and Supervisor.

• Maintained acceptable quality of a maximum 3% error ration.

EDUCATION

Associated in Medical

Heald College Hayward - Hayward, CA

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