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Claims Examiner, Auditor, Customer Service,Medical Assistant Insurance

Location:
Spring, TX
Posted:
July 22, 2020

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Resume:

Pamela J. Edwards

***** ******** ******* ****

Spring, TX 77373-8164

832-***-****/ader04@r.postjobfree.com

Education

Ashford University

Bachelor of Arts in Health Care Administration, 2010

Houston Training Schools

Diploma with Honors in Medical Assisting, 1991

Phillis Wheatley Senior High School

Honors Program, 1989

Certifications

Certified Clinical Medical Assistant

National Healthcareer Association – December 2015 to Present

Certified Billing and Coding Specialist

National Healthcareer Association – August 2014 to Present

National Registration as a Certified Medical Assistant (NR-CMA):

Administrative and Clinical Competencies

National Association for Health Professionals - 1991 to Present

Computer Software

Microsoft: Word, Excel, Powerpoint, Access, Publisher, Lotus Notes

Medical facility/billing: Medisoft, MDServe, SMS, CMS, FMS, IDX, CUBS

Claims examination/adjustment: ACT, EZ-Cap, HSD Diamond, Payorsoft

Experience

Lone Star College System – Montgomery Campus

Adjunct Instructor, October 2010 to Present

Teach courses in medical office administration.

Advanced Revenue Management

Accounts Receivable Representative, April 2012 to October 2015

Insurance follow-up and appeals on medical accounts, payment

adjustments and posting.

Community Healthcare Systems/Tomball Regional Hospital

Patient Accounts Representative, April 2011 to April 2012

Insurance verification and billing, follow-up on accounts

billed to insurance, submit adjustment reports for posting.

Professional Careers Institute

Instructor, May 2010 to May 2011

Taught adult students in the administrative medical assistant and

billing and coding programs; coordinated and proctored career

certification testing; evaluated externship students and sites.

Memorial Hermann Healthcare Systems- Corporate Office

Claims Examiner/Adjuster, November 2007 to May 2010

Adjudicated and adjusted PPO and EPO claims according to established provider contracts.

Texas HealthSpring/GulfQuest, L.L.P.

Medical Claims Examiner, February 2006-November 2007

Adjudicated commercial and Medicare HMO claims.

Insurance Overload Systems

Administrative Medical Contractor, May 2005-February 2006

Adjudicated and audited health, P&C, life claims for Travelers, American General and Gulfquest.

The University of Texas M.D. Anderson Cancer Center – Corporate Office

Patient Business Services Analyst, July 2003-May 2005

Insurance benefit and patient demographic verification/system update, patient and financial data analysis, insurance billing and follow-up; team leadership and unit training.

References

Available upon request.



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