Medical Billing Data Entry

MARLENE F. MATHIS

Royersford, PA ***** **********@***.***

610-***-**** linkedin.com/in/marlene-mathis-72079913/

TEST ENGINEER MEDICAL BILLING SPECIALIST

Accomplished Test Engineer Medical Billing professional with progressive experience in a regulated environment. Proven success performing analysis and tests to ensure optimal medical billing processes. Earned reputation for being detailed oriented with a strong work ethic and focus on achieving organizational goals.

Healthcare Information Technology Data Analysis Integration Systems Analysis Managed Care

Healthcare Industry Training Medical Billing

EXPERIENCE

Quest Diagnostics 1988 – 2022

Senior Test Engineer

Developed test plans based on the Billing Requirements Document.

•Ensured billing compliance when submitting patient claims to Government and Third-Party Payors.

•Provided status updates to the project team.

Senior Business Analyst

Supported the transition to production for billing projects.

•Provided a high level of business partner satisfaction by serving as the liaison between IT and Revenue Services to define customer requirements.

Account Manager, National Managed Care Payor Relations

Reviewed national contracts to assure compliance with third party billing requirements and documented all billing concerns to Managed Care Sales as well as Legal.

•Analyzed and updated billing information throughout all billing systems to ensure accuracy and consistency.

•Performed reimbursement analysis to ensure payers were paying in accordance with contractual agreements, considering fee schedules and medical necessity guidelines.

Quality Assurance Analyst

Collected and analyzed monthly quality control reports from assigned Billing areas, investigated variances, and monitored corrective actions.

•Performed quality assurance audits, identified, and reported findings to functional Billing managers and followed-up with resolution for any findings.

•Provided process knowledge of quality assurance, standards, tools, and methods for assigned areas of the Billing organization.

Billing Data Entry Supervisor

Interacted with external Clients and Sales to resolve complex billing issues by responding to billing concerns in a timely manner.

•Monitored Awaiting Billing file to achieve productivity goals set for the department.

•Trained a staff of 25 full time employees and 8 temporary employees on all new Legal Compliance and Billing Policies.

EDUCATION PROFESSIONAL DEVELOPMENT

Associates Degree Business Management, Peirce College

Managing IT Projects, The George Washington University

Introduction to Business Analysis, The George Washington University

Software Testing for Better Project Management, The George Washington University

Associate’s Certificate Project Management, The George Washington University

Negotiation Skills for Project Management, The George Washington University

Certified Tester Foundation Level, International Software Testing Qualification Board (ISTQB)

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