Open To Work
Claudia Medeiros
San Marcos,CA
Work Preference
Summary
Organized Medical Biller thoroughly versed in medical coding and HIPAA requirements. Personable professional with several years of hands-on experience claiming refunds, reviewing claims, and maintaining billing reports. Accommodating and helpful team player proficient in job-related billing software.
Overview
11
11
years of professional experience
Work History
Medical Billing Specialist
Advantage Ambulance
Escondido, California
06.2021 - 06.2022
- Processed medical claims for ambulance services using specialized billing software.
- Verified and coded ambulance charges to ensure accurate billing to insurance companies.
- Coordinated with insurance companies to resolve claim discrepancies and denials.
- Verified patient eligibility using the various insurance portals
- Reviewed patient information for accuracy and completeness before submission.
Medical Billing Specialist
CHMB
San Diego, CA
03.2017 - 04.2019
- Prepared, reviewed and transmitted claims using billing software, including electronic and paper claims processing.
- Followed up on unpaid claims to ensure timely resolution within standard billing cycle.
- Verified insurance payments for accuracy and compliance with contract terms.
- Contacted insurance companies regarding any discrepancies in payments.
- Identified and billed secondary or tertiary payers.
- Researched and appealed denied claims to recover lost revenue.
- Verified patient eligibility for insurance benefits to ensure coverage.
- Checked if necessary referrals were obtained for proper patient care.
- Investigated and handled refund requests to ensure timely resolution.
Claims Resolutions Specialist II Liability
Millennium Health
San Diego, CA
06.2014 - 03.2016
- Researched claim denials for resubmittal or filing of an appeal.
- Researched claim denials to facilitate resubmittal or appeal process.
- Initiated and maintained follow-up for timely claims and appeals filing.
- Verified fee schedules to ensure compliance with payer requirements.
- Evaluated patient accounts for existing insurance coverage.
Medical Billing Specialist
Sequenom Center for Molecular Medicine
San Diego, CA
07.2013 - 03.2014
- Verified insurance for all carriers.
- Investigated denied claims to identify denial reasons and facilitate resolution.
- Submitted first and second level appeals for claims to ensure proper review.
- Verified accuracy of procedure codes billed to ensure compliance and minimize claim rejections.
Medical Claims Processor
Sharp Healthcare
San Diego, CA
11.2011 - 12.2012
- Processed HMO and commercial insurance plans to ensure timely reimbursements.
- Verified authorizations and confirmed current eligibility to reduce claim denials.
- Verified that needed authorizations were on file and eligibility was current.
- Managed processing of 250 claims daily, maintaining accuracy and compliance.
Education
Carlsbad High School
Carlsbad, CASkills
- Claims processing
- Insurance claims processing
- Claim submission
- Claim resubmission
- Claim resolution
- Denial management
- Authorization
- Patient billing
- Insurance verification
- Eligibility verification
- Eligibility checks
- Accurate data entry
- Medical coding
- Medicare/Medi-Cal
- ICD coding
- ICD-10 knowledge
- Billing software
- Billing compliance
- EOB analysis
- Accounts Receivable
- Collections
- Account management
- Account resolution
- Procedure documentation
- CMS-1500 billing forms
- HMO/ PPO
- Workers Compensation
- Medicare/Medi-Cal
- HIPAA compliance
- Verification processes
- Effective communication
- Problem solving
- Attention to detail
- Time management
- Multitasking and organization
- Team collaboration
- ICD coding
- Procedure documentation
- Claim reimbursements
- Insurance claims processing
- Claims submission
- ICD-10
- CMS-1500 billing forms
Skill Sets
- Multi-Specialty
- Multi Carrier
- HMO/ PPO
- Workers Compensation
- Medicare/Medi-Cal
- HIPPA
- CPT & ICD9/10
- EOB’s
- Patient Registration
- Accounts Receivable
- Collections
- Ins Verification
- Eligibility
- Account Resolution
- Authorizations
Timeline
Medical Billing Specialist
Advantage Ambulance
06.2021 - 06.2022
Medical Billing Specialist
CHMB
03.2017 - 04.2019
Claims Resolutions Specialist II Liability
Millennium Health
06.2014 - 03.2016
Medical Billing Specialist
Sequenom Center for Molecular Medicine
07.2013 - 03.2014
Medical Claims Processor
Sharp Healthcare
11.2011 - 12.2012
Carlsbad High School