RENEE C. MELTON

*** ******** *** **** ******, NC 27587 919-***-**** (HOME) adyu1p@r.postjobfree.com

INSURANCE SUPPORT SERVICES

PATIENT/MEDICAL ACCOUNT REPRESENTATIVE INSURANCE AUDITING MEDICAL CODING

AN OUTSTANDING HIGH-PERFORMER WITH OVER THIRTY YEARS OF PROGRESSIVE EXPERIENCE IN MEDICAL BILLING, AUDITING AND CODING. I AM A RESULT DRIVEN PROFESSIONAL THAT DELIVERS BOTH INDIVIDUAL AND TEAMWORK INITIATIVES WITH CROSS- FUNCTIONAL METHODOLOGIES AND SUPERIOR INTERPERSONAL EFFECTIVENESS WHILE EXCEEDING ORGANIZATIONAL GOALS AND OBJECTIVES. I AM AN EFFICIENT AND EFFECTIVE TIME MANAGER WITH STRONG ANALYTICAL CAPABILITIES, AND A METICULOUS ORGANIZER. I AM SEEKING A POSITION WHERE MY HIGH KNOWLEDGE OF INSURANCE COMPANIES AND HOW THEY OPERATE, MY

MEDICAL AND HEALTH INDUSTRY KNOWLEDGE, MY YEARS OF PUBLIC RELATIONS AND CUSTOMER SERVICE SKILLS AND MY STRONG ANALYTICAL SKILLS, WILL BENEFIT AN ORGANIZATION.

KNOWLEDGE & COMPETENCIES

ICD.10

POWER MHS

LFRP

EPIC

MEDNAX

EXCELENT ORAL & WRITTEN SKILLS

EXPERIENCE IN HIGH CALL/CLAIM/AUTHORIZATION

ENVIRONMENT

MED-SUITE

HEALTH-CHOICE

MED-DATA

EMDEON

HIPPA LAWS

35+ YEARS OF INSURANCE EXPERIENCE

COMPUTER SAVVY

PATIENT APPEAL PROCESS

PROFESSIONAL EXPERIENCE

DETAIL ORIENTED

TEAM PLAYER

COMMUNITY OUTREACH

PUBLIC PRESENTATIONS

CUSTOMER SERVICE

MEDICAL TERMINOLOGY

RALEIGH ORHTOPEDIC

2020- 5/2022, AUTHORIZATION SPECIALIST

MAJOR CONTRIBUTIONS: SERVES AS THE AUTHORIZATION SPECIALIST FOR THE RALEIGH ORTHOPAEDIC OFFICE. POSITION IS RESPONSIBLE FOR ALL ASPECTS OF THE PRIOR AUTHORIZATION PROCESS. PROVIDES THE HIGHEST LEVEL OF CUSTOMER SERVICE TO INTERNAL AND EXTERNAL CLIENTS.

PERFORMS DAILY ACTIVITIES OF BILLING AND AUDITING OF ACCOUNTS TO ENSURE ACCURATE CLAIMS SUBMISSIONS AND TO OPTIMIZE REIMBURSEMENT FOR PATIENT TREATMENT FROM CLIENTS, PAYERS AND PATIENTS.

OBTAINS PRE-AUTHORIZATION AND DOCUMENTS ACCOUNT ACTIVITY/ELIGIBILITY AND AUTHORIZATION INFORMATION FROM INSURANCE COMPANIES IN ACCORDANCE WITH ESTABLISHED GUIDELINES FOR PATIENT INSURANCE COVERAGE.

RESEARCH PATIENT ACCOUNTS DUE TO INVALID AND/OR MISSING AUTHORIZATION INFORMATION AND CORRESPONDS WITH CLIENTS, INSURANCE COMPANIES, PATIENTS, SALES REPRESENTATIVES TO OBTAIN THE NECESSARY INFORMATION TO ENSURE ACCURATE, TIMELY AND COMPLETE CLAIMS SUBMISSIONS.

PROACTIVELY MANAGES AND MAINTAINS ALL OUTSTANDING AUTHORIZATION ACCOUNTS TO INCREASE BILLING OF CLEAN CLAIMS.

UPDATING PATIENT PROXIES AND SCHEDULES APPOINTMENTS.

CALLING PATIENTS AND GOING OVER THEIR BENEFITS WITH THEM.

EFFECTIVELY PRESENT INFORMATION AND RESPOND TO QUESTIONS FROM MANAGEMENT, CLIENTS, AUDITORS, AND INTERNAL STAKEHOLDERS.

IDENTIFY AND REPORT TRENDS AND PRIOR AUTHORIZATION ISSUES RELATING TO BILLING AND REIMBURSEMENT.

•WELCOMES PATIENTS TO OFFICE AND COMPLETE THE CHECK IN PROCESS.

•INTERACTS WITH PATIENTS/STAFF/DOCTORS EFFECTIVLEY AND EFFICIENTLY.

•DEVELOP EXCELLENT WORKING RELATIONSHIPS W/MANAGEMENT/PROVIDERS/DOCTORS.

MEDNAX

2016-2020, BILLING SPECIALIST

MAJOR CONTRIBUTIONS: PROMOTES THE EFFICIENT PROCESSING OF CLAIMS AND CLAIMS PRODUCTIVITY BY: VERIFYING AND ENTERING PATIENTS DEMOGRAPHIC AND INSURANCE INFORMATION INTO MANAGEMENT SYSTEM; OBTAINING ACCURATE IDENTIFICATION NUMBERS AND ELIGIBILITY INFORMATION FROM INSURANCE CARRIERS, INVESTIGATES ERRORS GENERATED FROM ELECTRONIC CLAIMS SUBMISSION.

COMMUNICATES WITH PROVIDERS REGARDING VERIFICATION OF PATIENT AND INSURANCE DEMOGRAPHIC INFORMATION.

INVESTIGATES AND RESPONDS TO ERRORS GENERATED FROM ELECTRONIC CLAIMS SUBMISSIONS.

ASSISTS IN RESEARCHING ELIGIBILITY SUBMISSION PROBLEMS/NEW CLIENT SUBMISSIONS.

INTERFACES WITH OTHER DEPARTMENTS, EXTERNAL PROVIDERS OR CLIENTS, AS MAY BE REQUIRED, TO RESOLVE ERRORS.

INITIATES VERBAL AND WRITTEN CORRESPONDENCE TO INTERNAL AND EXTERNAL SOURCES TO VERIFY PATIENT AND

CLAIM INFORMATION.

VERIFIES PATIENT INFORMATION.

COORDINATES ACTIVITIES WITH OTHER TEAM MEMBERS TO INSURE TIMELY DISTRIBUTION OF WORK TO OUTSIDE LOCATIONS.

REMAINS KNOWLEDGEABLE AND CURRENT ON THIRD PARTY REQUIREMENTS, AND REGULATORY GUIDELINES AT THE FEDERAL, STATE, AND LOCAL LEVELS.

QUALITY ASSURANCE OF CASES SUSPENDED DUE TO MISS KEYED INFORMATION OR INSURANCE ERROR.

VERIFIES WORKMAN COMPENSATION AND AUTO ACCIDENT CASES.

REVIEW, RESEARCH AND UPDATE MED DATA CASE INQUIRIES FROM CUSTOMER SERVICE.

RECOMMENDS NEW APPROACHES, POLICIES, AND PROCEDURES TO EFFECT CONTINUAL IMPROVEMENTS IN EFFICIENCY OF DEPARTMENT AND SERVICES PERFORMED.

PERFORMS DUTIES NECESSARY TO ENSURE THE TEAM'S PROJECTS/GOALS ARE COMPLETED.

TAKES OWNERSHIP OF SPECIAL PROJECTS, RESEARCH DATA AND FOLLOWS THROUGH WITH DETAILED ACTION PLANS.

ACTIVELY PARTICIPATES IN PROBLEM IDENTIFICATION AND RESOLUTION AND COORDINATES RESOLUTIONS

BETWEEN APPROPRIATE PARTIES.

PERFORMS OTHER RELATED DUTIES AS REQUIRED AND ASSIGNED.

ADREIMA

2015-2016, PATIENT ACCOUNT REPRESENTATIVE

MAJOR CONTRIBUTIONS: THIS POSITION SERVED AS A COLLECTIONS REPRESENTATIVE LIAISON BETWEEN THE PATIENT, INSURANCE COMPANIES AND DOCTORS OFFICE.

REVIEWED PATIENT ACCOUNTS AND BACK UP DOCUMENTATION TO DETERMINE THE NATURE AND EXTENT OF PROBLEM AND ANY ACTIONS TAKEN BY PATIENT OR THIRD-PARTY PAYERS.

COMMUNICATED WITH PATIENTS BY PHONE AND PROVIDED TIMELY AND ACCURATE INFORMATION TO PATIENTS IN A CLEAR AND CONCISE MANNER MEETING DAILY, WEEKLY AND MONTHLY DOLLAR AND DIALER GOALS.

NEGOTIATED REASONABLE PAYMENT PLANS WITH PATIENTS. THIS INVOLVED ADDING, SUBTRACTING AND CALCULATING PERCENTAGES OF THE DEBT.

PROVIDED TIMELY AND ACCURATE INFORMATION TO PATIENTS. WORKED CLOSELY WITH TEAM LEADERS, CLIENT SUPERVISOR, CREDIT DEPARTMENT, INSURANCE DEPARTMENTS, ETC. TO RESOLVE INSURANCE

AD AND INTERPRETED PATIENT INFORMATION CONTAINED IN SYSTEM NOTES.

OBTAINED CUSTOMER FEEDBACK.

HANDLED IRATE PATIENTS IN A PROFESSIONAL MANNER.

COMPLETED APPROPRIATE FORMS.

PERFORMED FILE MAINTENANCE FOR CORRECTIONS AND ADDITIONS TO PATIENTS FILE.

RESPONSIBLE FOR RETRIEVAL OF PATIENT ACCOUNT INFORMATION FROM VARIOUS DATABASES AND APPLICATIONS.

WORKED WITH OTHER FUNCTIONAL GROUPS TO ENSURE CUSTOMER SATISFACTION.

PERFORMED RELATED DUTIES AS ASSIGNED OR REQUESTED.

ENSURED ADHERENCE’S TO ESTABLISHED POLICIES AND PROCEDURES.

BLUE CROSS/BLUE SHIELD

1986-2015, NEW BLUE OPERATION SPECIALIST

MAJOR CONTRIBUTIONS: THIS POSITION SERVED AS AUDITOR FOR INSURANCE/MEDICAL CLAIMS THAT WERE SUBMITTED TO BCBS

FROM MEDICAL OFFICES AND HOSPITALS FOR PAYMENT.

EXPERT IN QUICKLY AND THOROUGHLY ANSWERED QUESTIONS RELATED TO RE SOLVING INQUIRIES REGARDING BILLING CLAIMS.

EXPERT IN CROSS-FUNCTIONAL SUPPORT FOR ALL OPERATIONAL FUNCTIONS WHICH INCLUDED AUDITING ONE ON ONE TRAINING AND/OR ROOT CAUSE ANALYSIS.

ASSISTED IN TRAINING PARTNERS IN WINSTON SALEM, NC WITH POWER MHS AND LFRP SYSTEMS.

REVIEWED, PREPARED AND MAINTAINED SPREADSHEETS FOR ALL AUDITS.

RESTORED CREDIT MEMOS REGARDING OVER-PAYMENT OF BILLS.

TRAINED STUDENTS ON PROPERLY ENTERING BILLING CODES, SOLVING BILLING INQUIRY CLAIMS.

REVIEWED ALL CLAIM FORMS THAT WERE MISFILED BY HEALTH INSURANCE COMPANIES.

RE-DIRECTED PROCESSING CLAIMS TO PROCESSING DEPARTMENT FOR CORRECTIONS.

EDUCATION

ARMSTRONG TECHNICAL COLLEGE DEGREE: CERTIFICATE, DENTAL ASSISTANT-1974

REFERENCES

JANICE RAINES, BILLING SPECIALIST, MEDNAX- 919-***-****

THERESA SWINDLE, SUPERVISOR, ADRIEMA- 919-***-****

LAURUNATTA BOONE, MANAGER-EXTENDED BUSINESS OFFICE- 919-***-****

EMILY FRANCIS, BCBS- 919-***-****

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