PAMELA GUNTER

*** ******** **** ***** *** **** Houston, Texas77090 832-***-**** adr9ce@r.postjobfree.com

PROFESSIONAL SUMMARY

Highly trained customer oriented professional with over ten years of successful experience in managing patient accounts and claims seeking an opportunity as a certified medical billing and coding specialist. Experience in customer service and support with recognized strengths in account maintenance,

problem-solving and troubleshooting, collections, and insurance verifications.

SKILLS

● CPT and ICD Coding

● HIPAA, OSHA

● CMS-1500/UB-04

● Local State Health Laws

● Microsoft Office

● Claims Submission

EMPLOYMENT HISTORY

Miscellaneous Commercial Collector 10/2019-present

City Ambulance Services/Viking Enterprises

- Responsible for following up on miscellaneous commercial medical claims with various carriers and analyzed the incoming explanation of benefits

- Forwarded claims for refund analysis and/or processing appeals depending on the nature of the account

- Negotiated payments discounts for commercial accounts

- Process secondary billing for all insurance carriers for the payment of any copay and or deductible

- Examine and resolve internal and external inquiries on accounts

- Quickly and effectively solve customer challenges

- Documenting incoming EOBs, and identify various discrepancies and forward to the proper department for resolution

Certified Billing and Coding specialist for Lyme Disease, Labs, and Radiology and IV Solutions. 12/2017-03/2020(part time)

Medical Bill Gurus, Houston TX

- Responsible for creating medical claims by way of Superbills from different clinics and using the CPT, ICD10, and HCPCS, manuals as references to ensure proper coding and billing for charges.

- Submitted claims whether EDI or printed to insurance companies and making necessary corrections for resubmitting claims

- Updated patient list for each clinic

- Created new patient’s charts and cases by patient’s demographics, insurance and illness

Managed Care/Worker’s Comp Collector 05/2007-03/2019

St Joseph Medical Center, Houston, Texas

- Responsible for all managed care and worker’s comp accounts which include payment discrepancies, adjustments, appeals and patient demographic updates

- Examine and resolve internal and external inquiries on accounts

- Quickly and effectively solve customer challenges

- Documenting incoming EOBs, and identify various discrepancies and forward to the proper department for resolution

- Maintaining the daily quota given by the manager for 80 accounts per day

- Familiar with insurance carriers, member medical plans, and state Medicare/Medicaid benefits

- Process incoming calls for patient accounts

- Process secondary billing for all insurance carriers for the payment of any copay and or deductible

Texas Medicaid Collector 03/2004-05/2007

Twelve Oaks & Austin Surgical Hospitals, Houston, Texas

- Responsible for following up on Texas medical claims with various carriers and analyzed the incoming explanation of benefits

- Forwarded claims for refund analysis and/or processing appeals depending on the nature of the account

- Supplied implant invoices for claims to be filed with insurance companies

- Provided excellent customer service for internal and external concerns relating to accounts

- Assisted managers with special projects and reports

- Analyzed medical claims for discrepancies, billing, payments, adjustments, and or procedure code

- Negotiated payments discounts for commercial accounts by remittance of managed care products such as HMO and PPO for adjustments

- Analyzed aged accounts to ensure accurate write off amounts deemed necessary

Customer Service Representative/Front Desk

Park Plaza Hospital, Twevle Oaks Hospital, & St. Joseph Hospital 07/1995-03/2004

- Responsible for answering all incoming calls and assisting vendors, attorneys and other medical providers with requested information using HIPPA guidelines and policies. Assisting walk in customers with request and patients that are needing copies of their itemization statements and or medical records using their proper identification and taking payment information for billings and balances owed on their accounts.

EDUCATION

Brightwood Business College Houston, Texas 2017-2018

- Major : Medical Billing and Coding, and Healthcare insurance

Southern University A&M College Baton Rouge, LA 1990

- Major: Business Administration

- Minor: Economics

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