Edie Melendez
Philadelphia,PA
Summary
Accomplished Medical Biller with over 25 years of experience in healthcare administration. Proven expertise in claims processing, accounts receivable follow-up, team management, and electronic health record systems.
Overview
28
28
years of professional experience
Work History
Medical Billing Manager
CORA Services
Philadelphia, Pennsylvania
04.2021 - 05.2024
- Posted payments and reviewed claims for accuracy and compliance.
- Maintained excel reports detailing daily numbers for CFO.
- Managed claims and contracts for CBH efficiently.
- Updated provider profiles with commercial payers regularly.
- Maintained EHR fee schedules, CPT codes, ICD-10 codes, and clinician profiles.
- Submitted 837 files through clearing house or CBH portal.
- Tracked denial trends and communicated findings to department heads.
- Uploaded 835 and 277N files into EHR for streamlined processing.
Payment Specialist
Children Hospital of Philadelphia
Philadelphia, Pennsylvania
09.2017 - 03.2020
- Payment posting
- Balancing daily
- Meeting month end deadlines
- Maintain excel reports for CFO of daily numbers and eft
Medical Biller promoted to Billing Supervisor
Orthopedic Surgery and Rehab Associates
Philadelphia, Pennsylvania
08.2013 - 09.2017
- Charge Entry
- Accounts Receivable
- Payment posting and denial management
- Prepare monthly and quarterly reports for accountant
- Scheduled appointments
- Legal liaison between physicians and work compensation attorneys
- Scheduled depositions and collected legal fees
- Submitted claims to various insurance companies and followed up on denials.
- Coordinated with healthcare providers to ensure accurate coding and documentation.
- Resolved billing inquiries from patients and addressed discrepancies promptly.
- Maintained organized records of billing transactions and patient information.
- Trained new staff on billing procedures and software systems used in practice.
- Submitted electronic claims to various insurance carriers.
- Verified medical codes for diagnosis, treatments, procedures and supplies using ICD-10 coding system.
- Researched discrepancies between billed charges and payments received from insurance companies or other third party payers.
- Answered incoming calls regarding billing inquiries from patients and and or providers in a professional manner.
- Reviewed patient insurance information to ensure accuracy and completeness of claims submission.
Physicians’ Billing Supervisor
Mercy Health System CBO
01.2007 - 01.2012
- Managed a team of seven staff. Was responsible for the timely and efficient charge entry process for the physician component for all Pathology, EKG, and Psychology consult charges.
- In addition, I supervised the Health District’s claims processing department for Mercy Health System facilities. My responsibilities as the supervisor of the Health District Claims processing team included:
- Liaison between the City of Philadelphia and Mercy Health System facilities.
- Direct point of contact for providers with Health District Issues.
- Manage the efficient and timely processing of Health District Claims.
Medical Assistant
Dr. Hyunki Shin Practice
Philadelphia, Pennsylvania
09.1996 - 04.2006
- Front Desk and back office duties
- Scheduled surgeries, pre-certified all operating room cases and deliveries
- Scheduled Level II ultrasounds and home visiting nurses
- Charged entry and payment posting
- Accounts receivable
- Was promoted to Billing Supervisor within few years of employment.
Billing Supervisor
Gabay Ent & Associates/Philadelphia Surgi-Ctr
Philadelphia, Pennsylvania
01.2000 - 01.2004
- Charge Entry
- Accounts receivable
- Payment posting and denial management
- Generate monthly reports for Physician and Surgical Center Director meetings
- Covered the front desk when needed
- Scheduled surgery and testing for ENT and cosmetic patients
- Vein puncture, suture removal, wound care, and assisted with excisions (clinical)
Education
Certificate of Technical Studies - Medical Assistant
Delaware Valley Academy of Medical Assistant
Philadelphia, PA05-2033
Some College (No Degree) - Health Care Administration
Community College of Philadelphia
Philadelphia, PASkills
- Medical billing
- A/R follow-up
- Claims management
- Insurance verification
- Excel reporting
- Coding accuracy
- Payment posting
- Account reconciliation
- Cash posting
- Billing cycle management
Timeline
Medical Billing Manager
CORA Services
04.2021 - 05.2024
Payment Specialist
Children Hospital of Philadelphia
09.2017 - 03.2020
Medical Biller promoted to Billing Supervisor
Orthopedic Surgery and Rehab Associates
08.2013 - 09.2017
Physicians’ Billing Supervisor
Mercy Health System CBO
01.2007 - 01.2012
Billing Supervisor
Gabay Ent & Associates/Philadelphia Surgi-Ctr
01.2000 - 01.2004
Medical Assistant
Dr. Hyunki Shin Practice
09.1996 - 04.2006
Certificate of Technical Studies - Medical Assistant
Delaware Valley Academy of Medical Assistant
Some College (No Degree) - Health Care Administration
Community College of Philadelphia