Melanie Cimino
Enfield, CT ****2
acz3iu@r.postjobfree.com
WORK EXPERIENCE
Accretive Health - Jupiter, fl
Medical Billing and Collections Specialist
Responsibilities:
Under payments, collections, Appeals, Primary, Secondary, Government and Commercial, payments as well as verify coverage, Update insurance information, excel reports, email, Traditional Medicare Reconsideration, Medical record requests, analysis, medical necessity research
Accomplishments
I have met and exceeded company as well.as personal goals, currently studying for medical coding
Skills Used Excel, underpayment expertise, insurance knowledge, contract knowledge, sequestration rates, Appeals, Ethics, Effective Communication, Government and Commercial Payers
Patient Service Representative
Stuart Surgery Center April –
Stuart, FL - May 2014 to May 2014
Ophthalmologist General GI Anesthesiologist Patient Charts (Filing, Creating, Updating), Surgery Scheduling, Insurance Verification, Co Pay, Medicare, BCBS (all Commercial Insurance), Tricare, Deposits, Email Correspondence, Avality, BCBS Portal, Filing, HIPPA Compliance, Account Reconciliation, Account Receivable Posting, Deposits, Multi phone Lines, Ordering Supplies, Physician Credentialing, Follow up with patients after care
Reference:
Sokum Avalia - 772-***-****
Medical Data Systems - Vero Beach, FL - June 2013 to March 2014
Medical Billing Specialist
Responsibilities
Insurance Discovery, Appeals, Claims CMS1500/UB40, Denials Coverage and Benefits, Medicare/Medicaid, Tri Care, CHAMPVA Commercial Insurance, Government, State Patient Interaction Programs, Insurance Verification, EOB and COB Knowledge, Account Receivable posting, Account Reconciliation, Claim Follow Up, Insurance Verification and COB Avality, New Collections, ADP, BCBS Portal,Citrex Claim Management,McKesson,State Medicaid /Medicare Hospital Host Systems
Reference:
Taryn Hafner /Supervisor 719-***-****
Journal Inquirer - Manchester, CT
District Sales Manager/\
Zone Supervisor
September 1998 to March 2010
A/R & A/P, Data Entry, Word, Excel, Inter office Email, Scheduling, Time Management, Project Completion, 6 line Phone System ( Avia ) Bonus Programs and Incentives, Billing and Payments, Staff Payroll, Managed Employees, Filing, Paperwork, Memos, Oversee Staff (6 District Managers and 300+ carriers, Training Staff, Hiring, Payment posting, Customer base increase, Sales
Reference:
Patrick McCue/Zone Supervisor / 860-***-****
Administrative Assistant
Journal Inquirer - Manchester, CT - October 1994 to January 1998
Assisted Zone Supervisor in daily duties, Meetings, Memos, Filing, Phones and much more Sales Consultant /Customer Care Representative Answered Multi- Phone lines directed to appropriate Department, Billing and payment questions as well as Email Return Customer Service Professional Answered High Volume of Escalation calls, Customer Inquiries, Payments, Appointment Setting, Credit and Collections Payment Arrangements, Up Sells, Demonstrates excellent Customer Support and Service
EDUCATION
Medical Coding
Penn Foster - Pennsylvania 2015 to 2016
Medical Billing and Claims
US Career Institute 2009 to 2010
Enfield High School 1988 to 1991
Skills:
Investigate, recover, and resolve all types of claims as well as recovery and resolution for health plans, commercial customers, and government entities
Up Initial /follow phone calls to members, providers, and other insurance companies to gather coordination of benefits
Investigate and pursue recoveries and payables on subrogation claims and file management.
Process recovery on claims
Ensure adherence to state and federal compliance policies, reimbursement policies, and contract compliance
Perform other duties as assigned
Investigate claims to identify fraudulent claim submissions or aberrant billing practices
Effectively handle caseload, monitor mandated and internal turn-around time requirements
Document in accordance with investigative standards, all investigative activity and findings in proprietary database
Follows Department Standards Operating Procedures and Corporate Policies
Perform Telephonic Interviews
Client Communication
Communicate Claim Processing instructions
Conduct Internet research
Perform analysis of claim data as needed
Provide comprehensive report of investigative findings when required
Monitor the effectiveness of the investigative findings, for their Regions, making recommendations for flag addition, removal, or revision., to include Provider Education,
Recovery or referral to GCA when appropriate
Ability to work in a production environment as well as home office and meet stated production goals
CPT or Diagnosis code experience also experience using claims platforms Working knowledge of medical terminology and claim coding
Strong analytic and problem solving skills
ability to work in a team environment
Proficient with personal computers, including word-processing and spreadsheets
Strong written and verbal communication skills
Analyze and investigation experience
Provides explanations and interpretation within my area of expertise
Program Experience
Epic, Centrix, Parathon, Mckesson,Sorian,Claims Logic, Emomed,
Medifax,Commercial and Government Contract/Portals/EOB,COB IVR’s, Experience, Avality, Navinet,
Personal Accomplishments
I have Excelled in the Medical Billing Field, I learned hands on how to do Appeals and Denials, Analysis as well as Insurance payment follow up collections and much more, I continue to move up the ladder to several different positions and skills. I continue to learn new skills and programs everyday
Medical Billing, Hospital Host Systems, Avality, All commercial Insurances as well as Government Insurance, Patient Liaison, Medicaid/Medicare Contract Experience, Workman’s Compensation, Dedication to the job at hand, Perseverance, Time management, I feel I am a great asset to any company if hired I will give 110%