Customer Service Medical

Marvette N. McClendon

**** ************ ***, *********, ** 37027 Phone: {615} 406-5369 Email: ***********@*****.***

SUMMARY OF QUALIFICATIONS

• Experience in AR resolution, root-cause analysis, and over/under payment identification.

• 9+ years experience in high-volume operations environments.

• Extensive knowledge with Medicare Regulations, Guidelines and billing practices.

• Comprehensive background in all aspects of medical billing procedures.

• Proven success working with CPT/ICD-9 Codes, medical terminology and medical insurance.

• Experience/knowledge with Medicare, Medicaid, Workers Compensation, and Commercial.

• Strong customer service skills.

• Accounting Experience.

• Human Resource Experience

PROFESSIONAL EXPERIENCE

AIM HEALTHCARE SERVICES INC., FRANKLIN, TN 6/2002 – Current

Coordination of Benefits Specialist/Recovery Specialist

• Audited medical claims within the client system to ensure proper coordination and payment.

• Explained medical benefits to members and providers.

• Review/Resolve credit balances for governmental and non-governmental payors.

• Prepare/analyze reports detailing current and historic credit balances, identifying trends, variance aberrant data and other information as needed.

• Perform root-cause analysis on reoccurring credit balances; drive/maintain resolution with payors.

• Track refund requests, recoupment requests and adjustment requests.

• Identify and resolve errors in coverage/contract to ensure correct handling of future claims.

• Supports team strategic functions through proper capture of payor and claims information.

• Liaison between contracted MCO’s and providers/members.

Accomplishments: Consistently met discovery quota of 250K- 400K monthly

CNA Insurance Company, BRENTWOOD, TN 1997– 2002

Case Manager Specialist

EDUCATION

Bachelor of Science, Business Administration/Management & Marketing, Human Resource emphasis, Middle Tennessee State University, Murfreesboro, TN

SKILLS

Medical Terminology Payment Posting/ Charge Entry Microsoft Word

Microsoft Excel Medicare Guidelines/Regulations Microsoft Access

NAIC Guidelines ICD-9, CPT and HCPCS Codes Data Entry

PowerPoint 10-Key by Touch FACS System

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