Medical Billing Manager
Resume:
Melissa J. Clark
Rancho Cucamonga, CA 91739
661-***-**** - cell
**********@*****.***
Software: MS Word, MS Excel, MS Access, MS Outlook, MS PowerPoint, MediSoft, Peachtree, QuickBooks, RIMS, ADS, Art Explosion, Lytec, NextGen, MS Visio, MS Project, Health Connect, Lotus Notes, Image Silo
Robert Half Management Resources Pasadena, CA
Credit Resolution Supervisor (Contract at Kaiser Permanente) 2009 – 2009
supervised staff of 9 Credit Resolution Processors, 8 Document Prep Assistants, 1 Charge Poster, and 3 MFA Processors - implemented several processes for improved work flow – executed multi processes to catch-up backlog to within the guidelines of department policy & procedures – fielded phone calls regarding refund checks – completed HR paperwork to create new staff position – assisted in yearly review of ASU staff – assisted in creation of new computer work queues – completed time keeping for payroll
Orthopaedics International Valencia, CA
Billing (AR) Manager 2007–2008
manage the billing of all physician treatments - post all incoming cash - negotiating payoff w/ attorney offices for worker’s compensation or personal injury law suit settlements - assist with patient care - schedule appointments - call pharmacy w/ refill approvals – obtain approvals for workers compensation patients - responsible for monthly A/R reconciliation – responsible for year-end A/R reports – processed all refunds
Care Level Management Woodland Hills, CA
Billing (AR) Manager 2006–2007 managed team of 11 - wrote weekly statistics report and analyzed trends - authored month-end closing reports - assisted in claim billing - implemented several processes for improved collection - appealed Medicare denials - completed the Billing Department financial budget for the year 2007 - member of leadership team that reviewed and wrote company procedure policies/guidelines – forecast monthly receipts - wrote policies and procedures for the billing department - all incoming patient billing issue calls until customer service position was created - regularly met w/ executives and owners – responsible for monthly A/R reconciliation – responsible for year-end A/R reports – reconciling accounts receivable accounts with the general ledger - processed all refunds – completed all special contract billings - insurance follow-up.
First Health Priority Woodland Hills, CA
Lead Review Analyst 2005-2006
assess needs for future medical treatment - financial analysis of Worker’s Compensation related medical records – assign cost for future medical treatment
Orthonet White Plains, NY
Claims/Re-Audit Manager 2002-2004
managed team of 20 - created presentations of analyzing claim submissions to reimbursement - created processes for better communication between departments - formatted multiple types of spreadsheets and graphs - created guidelines for claim processing to reduce claim backlog - over saw daily system issues for staff – managed staff of claim processors for PT and OT workers compensation claims
Radiologix New City, NY
Reimbursement Analyst 2001-2002
closed all monthly reports in system - converted all monthly reports to Excel and formatted for Accounting - updated ICD-9 and CPT codes into billing system - negotiation of network contract fees
Chartwell Indiana – Indianapolis, IN
Reimbursement Manager 1999-2001
managed team of 8 - wrote weekly statistics report - authored month-end closing reports - assisted in claim billing, incoming referrals, and cash posting - trained incoming temporary employees - implemented several processes for improved reimbursement collection - attended fair-hearings to dispute Medicare refunds - negotiated insurance treatment contract fees - assisted General Manager in completing the yearly budget for the reimbursement department - member of leadership team that wrote the company two-year business plan
Tufts Health Plan Waltham, MA
Front End Supervisor 1997-1998
managed team of 14 full-time and up to 26 temporary employees - assisted in claims processing, referrals, and overtaxing - trained incoming temporary employees - coordinated improvements of referral process with medical directors
Maxicare Insurance Indianapolis, IN
Medical Claims Examiner/Customer Service Substitute 1993-1997
processed medical HMO claims - investigated conflicting claim information via telephone with doctors, pharmacies, and hospitals - processed Medicaid dental claims - loaded ADA coding into system - processed medical PPO claims - directed incoming calls to customer service representatives
Adminastar Federal, Inc. Indianapolis, IN
Customer Service Representative 1991-1993
researched and adjusted Medicare claims - notified beneficiaries of incorrect information on forms - contacted doctor's offices to obtain missing information from claims
Education
Indiana State University Terre Haute, Indiana
Degree: BA Business Administration
Martinsville High School Martinsville, Indiana
Certification
CPC – April 2007
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