Quality Control Medical Billing
Resume:
Michelle Miller
**** * ******** ********, ** ****1
ad0jj2@r.postjobfree.com
Skills
Extensive medical billing background, Solid communication skills, Proven problem solving skills, Strong organization skills, Excellent multi-tasking skills, Strong work ethic, Positive attitude, Willingness to learn new tasks, Dedicated with strong work ethic, Flexible/adaptable, Ability to work under pressure, Experience in a fast paced environment, CPT, HCPCS, Revenue codes, ICD9/10, Quality control specialist, Excels with Microsoft office, Worked with Medicare, Medicaid, and Commercial insurance INN and OON patient policies, Medisoft, Eclinicalworks, Centricity, Health Infusion, Hybrid, Imagine and Several clearing houses
Experience
September 2019-Current
TriWest, Phoenix, AZ – Claims Reviewer
●Accurately review claims for billing accuracy including CPT, HCPS, ICD-10 according to standard billing guidelines
●Research and analyze complex claims/ priority group projects
●Research and analyze legal department claim request
●Training new hires
●Audit /provide feedback on audit results
February 2019-June 2019
AMMS, Phoenix, AZ - AR Specialist
●Accurately review claims for billing accuracy including CPT, HCPS, ICD-10 according to standard billing guidelines
●Research and analyze complex claims
●Payment posting
●Full cycle revenue
●Resolve patient billing issues
●Submitted corrected claims
●Submitted Appeals
●Worked denials
●Applied payments coinsurance and deductibles according EOB
August 2018 - February 2019
District Medical Group, Phoenix, AZ - Biller II
●Research and analyze complex claims
●Verified patient demographics
●Verified patient insurance and benefits
●Verify charges and entered charges
●Worked claim edits and rejections
●Met production goals as well as project deadlines
November 2017- August 2018
REV MD, Scottsdale, AZ - Claims Edit Specialist
●Worked claims edits
●Worked claim rejections from clearing house
●Submitted corrected claims
●Worked denials
●Submitted appeals
●Verified all patient demographics
●Payment posting according to EOB
March 2016-November 2017
Arizona Priority Care, Chandler, AZ - Claims Analyst II
●Accurately review claims for billing accuracy including CPT, HCPS, ICD-10 according to standard billing guidelines
●Research and analyze complex claims
●Payment posting
●Adjudicated Claims
●Obtained Prior Auths
●Met production and quality guidelines
●Preformed reversals
March 2013 -March 2016
Care1st Health Plan, Phoenix, AZ - Claims Analyst II
●Research and analyze complex claims
●Processed UB=04 claim forms
●Processed HCFA 1500 claim forms
●Processed both INN and OON claims
●Met production goals as well as project deadlines
March 2008 -March 2013
Comprehensive Medical and Dental plan, Phoenix, AZ - Encounters Specialist II
●Research and analyze complex claims
●Processed UB=04 claim forms
●Processed HCFA 1500 claim forms
●Processed Dental claims
●Processed Vision claims
●Processed both INN and OON claims
●Prepared encounter data for Ahcccs
●Prepared monthly and quarterly reports for management
●Corrected the claims edit and claim rejections
●Met production goals as well as project deadlines
Education
February 2000 = January 2001
Apollo College, Phoenix, AZ
Medical Billing and Coding
August 1998 = May 2001
Glendale Community College, Glendale, AZ
Political Science
Profession and personal references available upon request
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