Medical Billing and Coding Professional

Eva Adams

*** ***** ****** ******, ** *****

864-***-**** **********@*****.***

PROFESSIONAL SUMMARY

Well-rounded professional backed by management, medical claims, healthcare industry, accounts receivable, administrative, call center, and customer service experience. Able to provide timely and accurate data to ensure reimbursement for patient services. Follow policies, procedures, and guidelines to ensure consistent quality. Maintain and assure patient privacy and confidentiality.

Ultimate Medical Academy – HIPAA Essentials for Healthcare Professionals Certificate.

Strong time management skills with ability to establish priorities to meet timelines.

Function independently with minimal direction and guidance.

Communication skills necessary to effectively deal with patients and healthcare providers.

Electronic Medical Records (EMR) – Citrix.

Revenue Cycle Management Software – Availity.

Microsoft Office Applications – Word, Excel, Outlook, and PowerPoint Type 40 WPM with 10-key data entry skills.

Tri-Country Technical College Certifications

Phlebotomist, Nursing Assistant, Electrocardiogram Technician, Medical Terminology, and Biology

KEY QUALIFICATIONS

Medical Billing Accounts Receivable Collections Co-Pay Deductibles Co-Insurance EOBs

Revenue Cycle Management Posting Payments Government (Medicare & Medicaid) Third Party Payers

Electronic Health Records (EHR) Electronic Medical Records (EMR)

Managed Care (HMO PPO POS) Workers Compensation Insurance Verification Insurance Claim Processing

CMS 1500 CMS 1450 (UB-04) Medical Terminology Anatomy & Physiology HIPAA Compliance

Medical Coding (ICD-10-CM HCPCS CPT) Front Office Operations Medical Office Procedures Scheduling

EDUCATION

Ultimate Medical Academy Associate of Science Degree – Medical Billing and Coding, 2025

Ultimate Medical Academy Diploma – Medical Billing and Coding, 2024

PROFESSIONAL EXPERIENCE

Med SR – Belton, SC 11/2024 – Present

Refund Analyst

Maintain a minimum productivity of 5 claims an hour and 40 account worked per day.

Address inquiries via inbound and outbound calls, through email, and written request submitted to inbox.

Work assigned work queue, attach supporting Explanation of Benefits (EOBs) and documentation to refund letter, and save in designated folder on the T drive to be attached to refund check for mailing.

Review accounts that require research, correction, or explanation regarding the payment posting.

Make necessary corrections to claim balance control, undistributed and distribute payments to correct CPT, move payments to correct guarantor and invoice, credit balance transfers, recoups-recoveries, and transfer payments from voided invoice to corrected and rekeyed invoices.

Meet established and agreed upon goals within 90 days of continuous employment.

Keep management informed of client problems in communication and correspondence.

Document in a clear and concise manner when completing refund slip within EPIC.

Accenture Centene Corporation – Belton, SC 03/2024 – 07/2024

Process Improvement Specialist – Remote

Accountable for analyzing, designing, and implementing process improvements within clinical settings.

Used data and experience to shape public policy efforts to help healthcare become accessible for members.

Verified insurance coverage and eligibility of a member and updated medical insurance policies.

Adhered to schedule in deadline-driven environment and completed with policies, procedures, and core values.

GC Services Inc EnTergy – Belton, SC 06/2023 – 10/2023

Customer Service Representative – Remote Call Center

Handled large volume of inbound calls, greeted customers, addressed inquiries, and provided accurate responses.

Handled collections, accounts receivable, utility sales, and lead generations and assisted during power outages.

Provided assistance with electronic billing issues, collected payments, and documented call activity.

Worked efficiently and strove to meet productivity and quality standards.

Kept sensitive and confidential information private.

Staffmark, Inc Kravet, Inc – Anderson, SC 10/2017 – 05/2018

Administrative Assistant

Started as a Temporary Employee and was hired through Kravet, Inc. 12/2017.

Performed administrative duties assigned by supervisor and manager in a timely manner.

Organized and maintained files and processed purchase orders using Oracle Application.

Cross Country Home Services – Anderson, SC 04/2011 – 08/2018

Corporate Trainer – Call Center

Ensured high-quality training for new and existing employees in customer service roles, including role-playing and informal coaching.

Processed payroll and attendance using UltiPro, and handled necessary forms for new hires, terminations, and absences.

Managed claims, identified and resolved warranty service issues, completed audits, and handled process improvement and quality assurance results.

Maintained training curriculum and database to track statistics, generated and managed claims using Oracle systems, monitored performance, and ensured accuracy in financials and reports.

Retained professional knowledge through workshops, networking, and cross-functional training, and traveled to train Outsource Business Partners.

The Hook Seafood and Oyster Restaurant – Anderson, SC 07/2005 – 04/2023

Assistant Manager / Customer Service

Oversaw full operation of the restaurant and bar, opened and closed restaurant, created schedules, and monitored service levels, cash, and inventory.

Recruited service and kitchen staff and screened and hired outstanding talent for the organization.

Greeted customers, coached employees, and ensured quality customer service.

Drove sales initiatives for specials and promotional items, set goals, and monitored sales performance of staff.

Provided leadership designed to deliver a high quality of service to customers within the framework of established company expectations.

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