Medical Billing & Collections Specialist
Resume:
Maureen Mcclendon
Medical Billing Specialist
**** ********* ***** - ***** *******, MO 63303
********@*****.*** - 314-***-****
WORK EXPERIENCE
Medical Billing /Collection Specialist II
Numotion - Hazelwood, MO - September 2012 to Present
Responsibilities
• Performs manual or electronic processing of reimbursement claims.
• Performs billing and collections of Medicare, Medicaid and private insurances billing and collections.
• Maintains accurate and complete records concerning billing activity.
• Posts cash to billing system.
• Work denials thoroughly. Completes Claim Tracking Detail report once a month for the division
fordivisionassigned
• Appeal procedures or claims that have denied inappropriately within 72 hours of receipt of denial notification
• Answer patient calls regarding their balance, problems with their claims, or insurance questions
• Follow-up on unresolved billing issues for patient
• Setup payment plans for patients as needed/requested
• Work with physician and/or Office Manager to resolve billing disputes
• Apply account credits appropriately when observed
• Write up researched refund requests and submit to the Refund Coordinator
• Correct coding errors are observed so that they can be addressed and corrected
• Call insurance companies to determine status on all accounts more than 90 days old
• Sends any necessary supporting documentation required by insurance companies within one week of
receiving the request
• Note contact with the patient or an insurance company on the patient's account in Greenway
• can mail; run deposit total tape for all daily payments
Accomplishments
AR account was 1 of the top 3 accounts Collected on bringing in the most revenue on a monthly basis.
MANAGER OF RETAIL STORE
PURPLE PEARL BOUTIQUE - July 2010 to April 2013
Organizing and supervising all the daily activities of a retail outfit. Overseeing the inventory of the store and
accordingly placing replenishment orders. Strategizing and planning the achievement of organizational goals
and objectives, Planning event and promotional campaigns for boosting sales. Evaluating and surveying the
market and incorporating new ideas and plans into retail chain, Negotiating and dealing with suppliers and
vendors for product procurement, Finance and budget planning of the store. Ensure customer satisfaction by
maintaining quality and standards of retail outlet. Upload new product and delete old product from website.
Process and ship out all Orders In timely manner from website.
Provider Service Rep
UNITED HEALTH GROUP - Maryland Heights, MO - July 2005 to March 2012
Responsible for efficiently navigating claim processing systems to complete all closed and denied, simple
adjustments, and the majority of complex adjustments (out of scope high dollar and inpatient). Provided
quality service to Providers through real time and accurate resolution of closed and denied claims, simple
adjustments and escalated claim issues. Perform all types of complex adjustments and closed, denied, and
simple adjustments. Meet Quality, Productivity and Attendance requirements. Ensure Provider Satisfaction
through. Maintaining accurate documentation in ORS. Providing assistance to Providers with status updates.
Being responsible for any follow-up work needed for resolving and closing issues. Identifying and resolving
anticipated Provider issues to prevent future calls. Maintain proficiency in all technical applications (technical
skills and system knowledge). Comply with all current policies, procedures and workflows.
Human Resource Assistant
GRAND MANOR NURSING HOME - St. Louis, MO - August 2002 to June 2005
Staffing • Work with the Administrator and Manager to develop hiring strategy to ensure staffing levels are
maintained and to minimize hourly turnover • Source, screen and interview applicants using the competency
based interview guidelines found in hiring guide and through the group interview process as well as conduct
background checks and drug screening for all employees and new hires • Review and maintain Applicant
tracking system • Regularly schedule external recruiting in various selling oriented organizations to attract top
talent • Maintain nurse staffing to numbers required by facility staffing model Development: • Conduct on-board
orientation of new Team Members. Ensure use, execution, maintenance and administration of the on-boarding
process through the learning management system. • Lead the training and development of all Team Members
to ensure compliance to the company's service/product knowledge of skills training standards • Deliver and
follow-up on various product knowledge learning initiatives rolled out throughout the year • Responsible for the
tracking of all required training through the Learning System Legal compliance: • Ensure Tax Credit compliance
is 100% for all hires as well as adhering to all state and federal regulatory employment requirements inclusive
of I-9 compliance, work permits and payroll practices, and Company minor regulations. • Set up and maintain
all new hire paperwork and Team Member files by following company family guidelines as well as maintaining
confidentiality of these items • Maintain employment posters • Conduct routine HR assessment • Assist with
unemployment claims • Ensure compliance with all government regulations and paperwork Team Member
data management in HR: • Assign, maintain and monitor Single Sign On access and licenses • Punch Edit
Log Management • HRIS System Maintenance Team Member satisfaction and engagement: • Communicate
Company benefit programs • Monitor break room standards • Assist with Team Member satisfaction surveys
• Monitor execution of Team Member Recognition policy. Assist Phone Operator when needed.
House Keeping / Front Desk Clerk
RENAISSANCE HOTEL - Saint Ann, MO - January 2000 to September 2002
Started in Housekeeping. Cleaning Guest Rooms. Assist in Laundry when needed. Serves guests by
completing registration; controlling room assignments. Night audit and p.m. shift. Welcomes guests by
greeting them; answering questions; responding to requests. Registers guests by obtaining or confirming room
requirements; verifying preregistration; assigning room; obtaining information and signatures; issuing door
cards. Establishes credit by verifying credit cards or obtaining cash. Directs guests to room by showing location
on hotel map; calling bellhop. Conveys information to guests by receiving and transmitting messages, mail,
facsimiles, packages, etc. Provides information to guests by answering inquiries regarding hotel and other
services guests may require, such as entertainment, shopping, business, and travel. Maintains records by
entering room and guest account data. Collects revenue by entering services and charges; computing bill;
obtaining payment. Makes hotel and other reservations by entering or telephoning requirements; checking
availability; confirming requirements. Secures guests' valuables by placing valuables in safe deposit box.
Contributes to team effort by accomplishing related results as needed. Close out all end of day and complete
daily postings. Assist PBX operator of duties when needed.
EDUCATION
PARKWAY SOUTH HIGH SCHOOL BALLWIN MO UNITED STATES - Ballwin, MO
ADDITIONAL INFORMATION
• I am able to communicate effectively in person, over the phone and via email and chat rooms. I actively listen
to the customer. This means asking clarifying questions to ensure that I understands the customer's issue and
restating the customer's problem to inform the customer that I am listening. I have problem-solving skills and
gather information, create solutions, communicate the solutions to the customer and assist in implementing
those solutions. I am familiar with basic computer use, Zirmed, AR, Availity, Microsoft Office, including
Word, Excel, PowerPoint, Outlook and SharePoint. I know and have the everyday needs to run an office.
Customer Service, People Skills, Quality Focus, Professionalism, Energy Level, Multi-tasking, Dependability,
Thoroughness, Phone Skills, Data Entry Skills, Listening.
Contact this candidate