Frank Marchese
Coram,NY
Summary
A highly motivated professional, pursuing a stimulating full-time opportunity that will leverage my experience, reliability, people skills and personal motivation for success. Able to lead a staff of medical professionals. Experienced in recouping old denied claims and getting them paid. Understanding in why claims deny and how to rectify the problems. Focused and reliable in the medical and professional billing cycle. Able to train and motivate individuals in being a billing professional. Microsoft Office ICD-9&10 Coding Insurance confirmation CPT Coding Payment posting Billing best practices Monthly billing management Billing reconciliation Financial reporting Self-motivated Medical Biller and Coder, brings proven leadership, organizational and customer relations skills. Independently solves problems and keeps teams on task to handle diverse business requirements. History retaining clients and talented staff.
Overview
15
15
years of professional experience
1
1
Certification
Work History
Director of HMO Billing
Medford Multicare Center
05.2017 - 10.2022
- HMO
- Handles provider/member correspondence regarding medical claims
- Observes all HIPAA guidelines in claim processing
- CPT and ICD coding for claims adjudication
- Process voids and adjustments
- Communicates effectively with management and co-workers alike
- Codes procedures and diagnosis correctly from doctors' abstracts
- Posts entries, charges, payments, and adjustments as professional services are rendered
- Reconcile and recoup issues for Provider inquiries
- Leads team huddles for daily processing updates
- Reviewed historical records, current operational data and forecasting information to identify and capitalize on system enhancement opportunities.
Medical Coder/Biller
TOC Eye Center
11.2016 - 05.2017
- Performed on-site coding audits to determine accuracy and compliance with coding guidelines.
- Followed up with medical staff regarding missing information in patient records.
- Assisted in preparation of medical reports for external parties.
- Reviewed patient charts to better understand health histories, diagnoses, and treatments.
- Researched and resolved medical record discrepancies.
- Communicated effectively with staff, patients, and insurance companies by email and telephone.
- Generated reports to identify coding trends and discrepancies.
- Responded to inquiries from healthcare providers regarding prior authorization requests.
Senior Claims Examiner
Emblem Health
02.2013 - 11.2016
- Reviewed and analyzed suspicious and potentially fraudulent insurance claims.
- Researched claims and incident information to deliver solutions and resolve problems.
- Managed large volume of medical claims on daily basis.
- Generated reports on medical claims processing activities and results.
- Verified patient insurance coverage and benefits for medical claims.
- Maintained claims data in EmblemHealth's Q-care systems.
- Evaluated medical claims for accuracy and completeness and researched missing data.
Billing Account Manager
PC Advantage
07.2010 - 02.2013
- Created and maintained up-to-date patient medical records to enable tracking history and preserve consistent information.
- Transcribed and entered patient medical information into electronic medical records systems.
- Sorted and distributed incoming and outgoing medical records.
- Correctly coded and billed medical claims for various hospital and nursing facilities.
- Verified accuracy of patient information in medical records.
- Applied official coding conventions and rules from American Medical Association and Centers for Medicare and Medicaid Services to assign diagnostic codes.
- Assisted in preparation of medical reports for external parties.
Billing Account Manager
MBS Billing Services
08.2009 - 06.2010
- Maintained accuracy, completeness, and security for medical records and health information.
- Created and maintained up-to-date patient medical records to enable tracking history and preserve consistent information.
- Transcribed and entered patient medical information into electronic medical records systems.
- Communicated effectively with staff, patients, and insurance companies by email and telephone.
- Verified accuracy of patient information in medical records.
- Applied official coding conventions and rules from American Medical Association and Centers for Medicare and Medicaid Services to assign diagnostic codes.
- Communicated with insurance companies to research and resolved coding discrepancies.
Medical Office Assistant
North Shore Orthopedics
03.2008 - 08.2009
- Adhered to strict HIPAA guidelines to protect patient privacy.
- Performed various administrative tasks by filing, copying and faxing documents.
- Greeted visitors and initiated triage processes for clients to streamline patient flow.
- Prepared patient charts by gathering and organizing medical records ahead of appointments.
- Managed office bookkeeping with insurance billing and patient payments.
- Managed office logistics by scheduling appointments, maintaining files and collecting payments.
- Conducted patient intake interviews, recording and documenting relevant information.
Education
Medical Office Administration Diploma -
Hunter Business School
High School Diploma - High School Curriculum
William Floyd HS
Mastic Beach, NY06.1987
Skills
- Medical Terminology
- Insurance Claims Analysis
- Medical Claims Coding
- Medical Billing Code Accuracy
- ICD-10 (International Classification of Disease Systems)
- Insurance Procedures
- Billing Procedures
- Electronic Health Records Systems
- Accounts Payable and Accounts Receivable
- Benefits Verifications
- Health Insurance Plan Knowledge
- Authorizations
Certification
- Former CPC - Certified Professional Coder from 2013-2017.
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Timeline
Director of HMO Billing
Medford Multicare Center
05.2017 - 10.2022
Medical Coder/Biller
TOC Eye Center
11.2016 - 05.2017
Senior Claims Examiner
Emblem Health
02.2013 - 11.2016
Billing Account Manager
PC Advantage
07.2010 - 02.2013
Billing Account Manager
MBS Billing Services
08.2009 - 06.2010
Medical Office Assistant
North Shore Orthopedics
03.2008 - 08.2009
Medical Office Administration Diploma -
Hunter Business School
High School Diploma - High School Curriculum
William Floyd HS
- Former CPC - Certified Professional Coder from 2013-2017.
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