Rolande Dely

** ******* ******, ******, ** ***** Cell: 617-***-**** adl5q6@r.postjobfree.com

SUMMARY

Enthusiastic Medical claims analyst and Billing specialist with excellent skills and dedicated work ethic. Experienced in hospital inpatient/outpatient surgery coding, ICD-9 and ICD-10. Familiar with commercial and private insurance carriers. Desire a position in the Veterans Health Care Systems. Seeking a fast-paced position in a hospital.

SKILLS

• ICD-9 coding

• CPT and HCPCS coding

• HIPAA compliance

• Physician billing

• Claims appeal procedures

• Insurance processing

• Medical billing

• Customer service-oriented

• Scheduling

• Claims Processing

EXPERIENCE

09/16/2019 to Present- Medical Billing Specialist

VA Hospital- Bedford, MA

• Customer Service: receive calls from Veterans and solve their issues.

• Process billing first and third-party claims, Mental Health, and Prosthetics claims as well. Validate claims for billing purposes insuring eligibility for review.

• Responsible for the verification of Veteran’s insurance coverage for inpatient and outpatient services. Verify benefits, policy number and precertification.

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• Apply payments to the appropriate bill or refunds to the applicable party.

8/06/2018 to 09/13/2019- Direct Nursing Care

VA Hospital- Bedford, MA

• Provided direct nursing care to medical and/or psychiatric Veterans who require the use of a wide range of complex treatments and procedures ONLY under the direct supervision of nursing staff; this includes assisting Veterans to eat and bathe.

• Provided a safe and supportive environment each Veterans, as needed.

• Maintained emotional control, function effectively in stressful situations, and is supportive to staff, families, and Veterans.

• Safely performed supportive duties that include monitoring of patient status, reporting and recording deviations, and providing continuing emotional support during treatments.

• Demonstrated the ability to successfully use CPRS, VATAS, Outlook, and VISTA, as needed.

12/07/2018- Certification: CPR (American Heart Association)

• VA Hospital- Bedford, MA

Rolande Dely

34 Lothrop Avenue, Milton, MA 02186 Cell: 617-***-**** adl5q6@r.postjobfree.com

10/2011-01/2017-Billing Specialist/Claims Analyst II

• Public Consulting Group- Boston, MA

• Accurately applied payments to member’s accounts. Researched and resolved incorrect payments. Reviewed billing edits and provided insurance providers with corrected information. Analyzed and processed member’s billing in a

• Analyzed and processed member’s billing in a timely manner. Processed revenue reports with accuracy. Provided tenacious follow-up to ensure proper payments were fully collected.

• Worked on UB hospital claims, CPT surgical codes, ICD9, used modifiers, worked on HCFA claims, reviewed, analyzed, processed, adjusted, priced and released claims. Checked fee schedule on Medicare or Medicaid webpage, checked members and provider's eligibility, and checked authorization. Trained team.

03/1997-08/2010- Administrative Assistant

Edgar's Electrical Services- Milton, MA

• Managed the receptionist area, including greeting visitors and responding to telephone and in-person requests for information.

• Performed a full range of payroll duties by processing pay, leave, and benefits requests. Reviewed a variety of personnel and payroll records and documents.

• Provided information regarding payroll policies and procedures.

• Assisted in providing responses to all complicated cases by resolving time, leave and benefits issues.

EDUCATION

01/2005-09/2005- Medical Coding and Billing Specialist

Clark University Computer Career Institute- Braintree, MA

• USA Intensive, 385-hour, instructor lead, hands-on training and curriculum focused on CPT- and ICD-9 CM coding skills, obtained the fundamentals of medical insurance, insurance terminology, products, contracts and general procedures, obtained knowledge of the body systems, their structures and functions. Gained firm understanding of HIPAA privacy regulations. Practices and liability.

09/2011-05/2012- Radiology

Bunker Hill Community College- Charlestown, MA

• Pre-requisites classes for radiology.

09/1990-05/1992-Computer Programming

Roxbury Community College- Roxbury MA

• Studied programming languages and learned how to solve issues.

TRAINING

09/2005-10/2005- Externship for Medical Coding and Billing

Goddard Hospital- Stoughton, MA

• Responsible for entering patient demographics. Reviewed and coded records using ICD-9 and CPT surgical codes. Assisted in submitting payment entries and claims on paper and electronically. Trained to schedule appointments and identify all the UB 92claim form blocks, as well as coding for the facility.

Computer Skills: Microsoft Word, Excel, Outlook and Power Point.

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