Loddie M Gillespie

678-***-****

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

Ste 145-1706

Atlanta Ga 30326

advv67@r.postjobfree.com

Summary

I have 20+ years of experience, including as a Medical Billing Specialist in pediatrics, as a Finance Analyst and as a Patient Access Representative in industries including Health Services, Wholesale Trade Durable Goods and Business Services. Most recently, I have been working as a Medical Billing Specialist at Washington University from July 2019 to October 2019. My skills and experiences include: File Management, Human Resources, Medical Terminology, Policy Analysis. I hold an Associate of Business Administration (ABA) degree in Pediatrics from Missouri College and was currently going to school for my Bachelor of Arts degree in Psychology from Webster University but had to stop due to the Pandemic.

Experience

Anthem Co, Stone mountain, GA Aug. 2021 to Feb. 2022 Provider Services

Used software tools including: Solutions central...work force management Spoke with customers by phone. Received and processed incoming phone calls from customer or client base. Recorded details of customer transactions, inquiries. Prioritized data entry daily to ensure customers' needs were met. Ensured that appropriate changes were made to resolve customer concerns. Effectively identified customer concerns over the phone. Determined charges for services requested. Referred unresolved customer grievances for further investigation. Determined whether losses were covered by insurance. Performed office duties such as data entry, word processing, filing, copying. Washington University, St louis, MO July 2019 to Oct. 2019 Medical Billing Specialist

Processed Government claims, insurance follow up, authorizations, precerts, insurance follow up and provider calls Robert Half/Peoples Healthcenter, St louis, MO Feb. 2018 to Feb. 2019 Finance Analyst

Worked Nextgen and Epic systems by processing corrected and rebilled rejected claims, credit card payments, posting insurance and patent sliding fees, bankruptcy data, insurance verification, pre certifications, authorizations, provider calls, lawyer request, meeting patients one on one to print and discuss itemized bills, faxing, filing and performing other clinical standards as needed.

BJC/Northwest Health Care, St louis, MO Nov. 2016 to Jan. 2018 Patient Access Representative

To ensure prompt and efficient access by providing exceptional service to customers with effective communication with patients and guest ꞏ Registered patients for outpatient services such as Mammograms, CT's, X rays, Ultrasounds, MRI's and Lab orders ꞏ Accurately collecting co pays/co insurance payments with cash or card information for clinical care and the initiation of legal medical record and financial data ꞏ Updated Medicare/Medicaid, Commercial and private pay insurances for proper billing Robert Half/Dohmen Services, St louis, MO June 2016 to Aug. 2016 Liaison Analyst

Performed duties of providing Authorizations and Pre Certifications for Carticel Knee Surgery Patients ꞏ Insurance Follow Up/Verification for billing purposes ꞏ Pre certification and authorizations follow up for future surgery dates ꞏ Busy phone duties to providers discussing problem solving issues Parallon Health Solutions, St louis, MO July 2015 to Sept. 2015 Appeals Analyst

Processed Appeals to completion on commercial and government insurances ꞏ Generated letters of Appeal approvals or denials to patients on claims that were medically and non medically necessary ꞏ Worked Appeal accounts on date prioritized ꞏ Worked on Aged Trial Balance Report to reflect back on timely filing claims ꞏ Busy phone duties to and from providers discussing problem solving issues Conifer Health Solutions, St louis, MO Apr. 2015 to July 2015 Claims Analyst

Processed Medicare/Medicaid, commercial and private pay claims ꞏ Insurance Follow Up/Verification ꞏ Checked for authorizations and pre certifications on claims in hold up status ꞏ Worked Timely Filing Reports to completion. United Seating and Mobility, St louis, MO Jan. 2015 to Apr. 2015 Data Analyst

Processed claims for authorizations and pre cert purposes ꞏ Insurance follow up/verification on patients that received Durable Medical Equipment ꞏ Busy phone duties to providers in getting authorizations extended on equipment SSM Corporate Office Medicare Government Follow Up, St louis, MO July 2011 to Dec. 2014 Government Clerk

Reviewed insurance policies to determine coverage ꞏ Processed and recorded new insurance policies and claims ꞏ Prepared insurance claim forms or related documents, adjustments and review them to completeness ꞏ Pre Certifications, Authorizations, Appeals and Referrals ꞏ Worked with the Social Security Administration processing inmate claims ꞏ Provided customer service such as limited instructions on proceeding with claims or referrals to providers, organized work with detailed office or records. Perot Systems, St louis, MO Aug. 2008 to June 2011 Claims Analyst

Investigate, evaluated and settled claims ꞏ Applying technical knowledge and human relations skills to effect fair and prompt disposal of cases and to contribute to a reduced loss ratio ꞏ Medicare/Medicaid and Commercial Claims processing, Adjustments, Reimbursements, insurance verification/follow up, per certifications, authorizations, referrals ꞏ Busy phone duties to providers discussing unresolved claim issues ꞏ Adjust reserves or provide reserve recommendations to ensure that activities are consistent with corporate policies ꞏ Resolved complex claims using high service oriented file handling and processed claims with designated authority level. St. John's Mercy Health, St louis, MO July 2006 to Aug. 2008 Senior Claims Analyst

Verify accuracy of processing Medicare/Medicaid, Commercial Insurances and Private Pays Claims ꞏ Followed up on claims processing for payment ꞏ Phone calls to liaisons discussing correct updated codes for proper billing ꞏ Revised any claims errors, prepare itemized statements, bills or invoices, insurance verification, authorizations, pre certifications, appeals and referrals ꞏ Worked accounts from Aged Trial Balance (ATB) report for timely filing purposes ꞏ Lead over 47 team members and trained new employees

Skills

Balance, Billing, Copy, Credit, Customer Relations, Customer Service, Data Entry, Fax, File Management, Financial, Forms, Government, Human Resources, Insurance, Languages, Legal, Letters, Medical Terminology, Microsoft Access, Microsoft Office, Policy Analysis, Problem Solving, Programming, Telephone Skills, Word Processing Licenses

Missouri, Regular Driver's License

Education

Unfinished degree or diploma. Not currently enrolled 1996 Missouri College, St. Louis, MO

Associate of Business Administration (ABA): Pediatrics Course Work Completed : Associates Certification ꞏ Medical Assistant/Billing and Coding/Pediatrics, GPA: 4.0 Page 1 / 2

Skills

Balance, Billing, Copy, Credit, Customer Relations, Customer Service, Data Entry, Fax, File Management, Financial, Forms, Government, Human Resources, Insurance, Languages, Legal, Letters, Medical Terminology, Microsoft Access, Microsoft Office, Policy Analysis, Problem Solving, Programming, Telephone Skills, Word Processing Licenses

Missouri, Regular Driver's License

Education

Unfinished degree or diploma. Not currently enrolled 1996 Missouri College, St. Louis, MO

Associate of Business Administration (ABA): Pediatrics Course Work Completed : Associates Certification ꞏ Medical Assistant/Billing and Coding/Pediatrics, GPA: 4.0 Webster University, St louis, MO

BA: Psychology

Loddie Gillespie

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