Medical Coding & Billing Specialist
Resume:
MELINDA BRUECHER
850-***-**** • ************@*****.*** • Fountain, FL
Summary
Detail-oriented Medical Coder and Billing Expert with over 18 years of experience optimizing healthcare revenue cycles. Expert in ICD-10-CM and CPT coding, facility charging, and modifier assignment to ensure accuracy and regulatory compliance. Proven track record in maintaining high productivity standards while adhering to NCCI edit policies and Medicare LCD/NCD guidelines to improve health outcomes and system efficiency.
Work Experience
Claims research specialist January 2025 – Present
SARNOMA DIGITECH, REMOTE
• Identify and assign batches of claims to proactively resolve all denials and ensure facility charging accuracy.
• Maintain a daily quota of 60 to 65 claims while meeting rigorous coding quality and productivity standards. Adhere to MMA dual plan regulations while filing strategic appeals and reconsiderations for complex medical claims.
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Participate in direct collaboration with provider representatives to correct systemic errors and reduce the volume of claim denials.
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Understand and optimize account workflows to reduce time between processed accounts through efficient multitasking.
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Lead Medical billing and specialist- Credentialing specialist January 2014 – January 2025 MEDICAL INSURANCE SERVICES, PANAMA CITY, FL. REMOTE Identified and recorded essential clinical data for insurance claims, specializing in ICD-10, HCPCS, CPT treatment codes, and modifier assignment.
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• Adhered to facility services guidelines to ensure 100% accuracy and completeness of submitted medical claims. Maintained proactive follow-up with insurance carriers on rejected claims, resolving coding issues using Microsoft Excel for data tracking.
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Managed provider credentialing for major networks including BCBS of FL and Medicare 1st Coast Service Options, ensuring compliance with Medicare NCD.
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Directed EDI agreements and ERA applications for a large Mental Health practice, optimizing facility coding quality for 8 providers.
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Medical Billing January 2007 – January 2011
ASSURANCE HEALTH CARE, PANAMA CITY, FL
Processed insurance claims by identifying patient insurance, diagnosis codes, and necessary CPT modifiers for outpatient coding.
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• Maintained high accuracy standards for facility charging to minimize audit risks and ensure regulatory compliance.
• Followed-up on unpaid claims and resubmitted corrections based on Medicare LCD and NCCI edit policies.
• Utilized medical claim billing software for account reconciliation and electronic payment posting. Server/Bartender January 1995 – January 2006
SPICY NOODLE CAFÉ, PANAMA CITY BEACH, FL
Maintained expert-level knowledge of service offerings while upholding high professional standards and service excellence.
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• Managed inventory logistics and stocked service areas to ensure continuous operational flow and productivity. Education
Associate of Science in Medical Billing and Coding June 2014 ULTIMATE MEDICAL ACADEMY, TAMPA, FL
Medical Billing and Coding Diloma in Medical Billing and Coding December 2013 ULTIMATE MEDICAL ACADEMY, TAMPA, FL
Additional Skills
Core Medical Coding & Compliance: ICD-10, CPT, Medical Coding, Facility Charging, Modifier Assignment, NCCI Edit Policies, Medicare LCD, Medicare NCD, Outpatient Coding, Ambulatory Payment Classification
(APC), HCPCS, HIPAA Compliance
Software & Tools: Microsoft Excel, EMR proficiency, Athena, Allscripts E-Clinical, Greenway Prime Suite EMR, Medisoft, Tract Net practice fusion, Total MD, Ambulance Commander Revenue Cycle & Facility Services: Medical Claims Process, Remittances & Denials, Explanation of Benefits
(EOB), Account reconciliation, Insurance Verification, Medicare, Medicaid, Tricare, CMS 1500, UB-04 (CM 1450), Managed Care (HMO, PPO, & POS), Workers’ Compensation Operations & Administration: Facility Services, Health Equity, Data Entry & 10-Key Skills, Typing Speed: 75 WPM, Appointment scheduling, Medical Office Management Certifications
• Medical Billing and Coding Diploma - Ultimate Medical Academy (December 2013)
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