Insurance Medical

Melissa E Golden 737-***-****

**** **** **** ****, ***** Rock, TX 78664 ***********@*****.***

Professional Profile

Medical billing specialist who has also worked as a re-pricing analyst. I have experience compiling and submitting claims to insurance companies and then subsequently billing patients. I have worked very close to almost every type of healthcare facility including hospitals, doctor’s office. I have over 10 years experience in coding for family practice and will be taking my coding certification next month. Day-to-day responsibilities vary from location to location but often include:

Using coded data to produce and submit claims to insurance companies.

Working directly with the insurance company, healthcare provider, and patient to get the claim processed and paid.

Reviewing and appealing unpaid and denied claims.

Verifying patients’ insurance coverage.

Answering patients’ billing questions.

Handling collections on unpaid accounts.

Managing the facility’s account receivable reports.

Able to code the claim and understand the coding process.

Understand the Medicare rules and guidelines for billing.

Spanish speaking and translator.

Professional Experience

Little River Healthcare, Round Rock, TX

July 2015-Present

Billing Specialist II

Responsibilities:

Billing all commercial insurance payers, including all government payer such as Tricare South, TriWest, VA, and CHAMPUS.

Correctly coded and billed professional and institutional claims, 1500 and UBs.

Worked system and clearinghouse edits to ensure claims are billed clean, accurately and timely.

Identify and resolve billing issues.

Accurately post payer adjustments accordingly.

Research CPT-10 coding discrepancies for compliance.

Verify patient’s active coverage and claim status as needed.

Bill out late charges with correct information from previous EOBs.

Texas Tech University Health Science Center, Amarillo, TX

Dec. 2014 – April 2015

Coding & Billing Specialist

Responsibilities:

Translated patient information and into alphanumeric medical code.

Submitted claims to insurance.

Maintained strict confidentiality.

Coded patient services and enter into computer.

Ensured healthcare facilities are reimbursed for all procedures.

Handled information about patient treatment, diagnosis, and related procedures to ensure proper coding.

Used computers and read and organized charts

Followed up on submitted claims.

Investigated rejected claims to resolve denial reasoning.

OccuNet, Amarillo, TX

April 2013 – July 2014

Review Analyst

Responsibilities:

Completed line-by-line analysis of hospital bills utilizing CompIQ and OccuNet’s internal software system for alignment and internal and external policies and procedures.

Applied judgment (in conjunction with review algorithms) to determine how to proceed with a claim.

Collaborated with the analyst team to apply review findings as line-item edits.

Generated reporting and supporting documents for insurance companies and medical facilities to support line-item edit rationale.

Performed self-quality checks on reports, including verification of formulas and adherence to internal and external policies and procedures.

BSA Provider Network, Amarillo, TX

June 2007 - April 2013

Billing Supervisor / Biller

Responsibilities:

Trained and/or instructed employees in job duties or company policies.

Posted charges, payments, and adjustments.

Performed all billing aspects including but not limited to verifying insurance eligibility & benefits, billing insurance, claims follow up, appeals, collections, and account audits.

Answered billing correspondence and telephone calls regarding applicable accounts.

Supervised a team of 6-7 billing clerks

Balanced electronic EOBs at the end of day and ensured that all were posted correctly for seven clinics and facility patient accounts.

I prepared individual deposits for each of the seven clinics and maintained accurate financial reports on a daily, weekly and monthly basis.

I evaluated patent financial status and established budget payment plans as needed.

Prepared information of delinquent accounts and reported to collection agency.

I maintained strict confidentiality of patient information and followed all HIPAA guidelines/regulations.

BSA Urgent Care, Amarillo, TX

June1999 – June 2007

Office Clerk III

Responsibilities:

Answered main office phone line. Directed calls to appropriate sections for assistance. Took messages as required.

Obtained updated and filed medical records as needed.

Obtained documentation as requested by healthcare providers (test results or documentation not yet filed in the records).

Performed other administrative and clerical duties in support of the medical care and operational support.

Conducted end-of-day process at close of business and resolved any delinquent or pending appointments in computer system.

Coded fee tickets for outpatient procedures.

Posted physician’s charges to patient account.

Education

American InterContinental University, Online

Associates in Business Administrative Management

March 2010

Amarillo College, Amarillo, TX

Medical Data Specialist Certification

May 1999

Other

I have experience using Centricity, NextGen, Cerner, NetAccess, Mysys Tiger, Mysys, and Cerner.

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