Medical Billing Manager

Terrence J. Moore

*** ********* *****, *********** ** 30281 Tel: 678-***-**** E-mail:**********@***.***

Objective

To obtain a position in the Healthcare Industry

Skills

Over 20 years experience in the HealthCare Industry

Strong background in medical claims processing and examining

Extensive knowledge of medical terminology, CPT and ICD9 Codes

Excellent computer skills along with knowledge of Microsoft Word and Excel

Work History

Reimbursement Specialist, Gentiva, Atlanta, GA (June 2009 – June 2010)

Adjusted claims, processed adjustments, denials and cash transfers through the Mesta System.

Processed denial claims using denial codes through the Mesta and Intact System.

Performed various administrative functions.

Claims Examiner, Intracorp, Norcross, GA (April 2004 – January 2009)

Examined, processed and adjusted claims through Smart Advisor System and Audit Plus System.

Processed pay code and Medrisk claims.

Indexed workman compensation claims through Audit Plus System.

Claims Examiner, Elderplan, Brooklyn, NY (April 2002 – March 2004)

Examined and determined payment of claims through the Amisys claims processing system.

Processed and adjusted claims to determined payment to providers.

Reviewed claims for correctness and applied guidelines for payment determination.

Handled claims requiring investigation to determine coverage, liability and adjustments.

Documented correspondence on claims and prepared agenda for resolving issues.

Claims Processor, Partners in Health, Bronx, NY (February 2000 – April 2002)

Examined and determined payment of claims through the Amisys claims processing system.

Processed and mailed payments to providers; researched and resolved claims adjustment discrepancies.

Performed various administrative functions; answered claims questions from providers and members.

Pre-Code Medical Claims Examiner, Empire Blue Cross/Blue Shield, New York, NY

(February 2000 – April 2002)

Examined medical claims through the FEPR claims processing system.

Checked corporate membership file for subscriber information and the corporate provider file (IDMS) for provider information; Entered data from claims forms for all medical claims accounts.

Identified whether investigation was needed for worker’s compensation or no fault benefits.

Assisted Supervisor in processing special claims.

Education

Clayton State University

Medical Coding Specialist Certificate Program

Completion Date: 11/2010

Interests

Sports, Chess, and Fitness

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