LETCHRIE MCCULLOUGH
Rowlett,Tx
Summary
Detail-oriented and results-driven professional with experience in health insurance claims processing and medical billing. Skilled in accurately processing and adjudicating health insurance claims while ensuring compliance with regulatory guidelines and company policies. Adept at verifying claim information, resolving discrepancies, and providing exceptional customer service to members and providers. With a keen eye for detail and a commitment to accuracy, excelling in managing fluctuating workloads and ensuring timely claims processing.
Overview
12
12
years of professional experience
Work History
MEDICAL CLAIMS PROCESSOR
RX Compass
01.2020 - Current
- Review and verify patient information, insurance coverage, and medical codes to ensure accuracy.
- Adjudicate medical claims based on insurance policy terms, medical necessity, and regulatory guidelines.
- Validate diagnosis and procedure codes (ICD-10, CPT/HCPCS) submitted on claims for accuracy.
- Investigate and resolve claim discrepancies, coding errors, and billing issues through communication.
- Analyze claim denials and appeals, identify root causes, and take corrective actions to resubmit or appeal.
- Maintain accurate records of claims processing activities, generate reports on claim status, payment trends, and denial rates, and document audit trails for compliance purposes.
REIMBURSEMENT SPECIALIST
SCP Health
11.2018 - 12.2019
- Analyze reimbursement rates, fee schedules, and payer contracts to ensure accurate reimbursement.
- Monitor payer contracts, fee schedules, and reimbursement policies to ensure compliance.
- Manage the revenue cycle process, including claims submission, payment posting, & denial management.
- Conduct coding audits and reviews of medical claims to ensure coding accuracy.
- Track and analyze key performance indicators (KPIs) related to reimbursement.
- Provide education and training to healthcare providers and staff on coding best practices, documentation requirements, and reimbursement policies to support accurate claims submission and maximize reimbursement potential.
HEALTHCARE BILLING SPECIALIST
Conifer Health
11.2013 - 12.2018
- Prepare and submit medical claims, invoices, and billing statements to insurance companies.
- Enter charges for medical services rendered into billing systems accurately, ensuring alignment.
- Verify insurance coverage, eligibility, and benefits for patients, confirming authorization requirements.
- Process payments received from insurance companies, patients, and third-party payers.
- Assist patients with understanding their medical bills, insurance coverage, and financial assistance options, providing guidance and support in navigating the billing process and resolving billing disputes.
Education
High School Diploma - undefined
W.T. High School
05.1989
Skills
- Claims Processing
- Medical Billing
- Adjudication of Claims
- Knowledge of Health Insurance Policies
- Claims Processing Software
- Ethical Conduct
- Technical Proficiency
- Accuracy in Data Entry
- Complex Problem Solving
- Communication Skills
- Prioritization of Tasks
- Adaptability to Changing Priorities
- Critical Thinking
- Multi-tasking
- Familiarity with Medical Terminology
- Electronic Claims Processing
- Time Management
- Customer Service
- Documentation Review
- Analytical Skills
- Continuous Learning & Development
- Conflict Management
- Compliance Monitoring
- Understanding of HIPAA Guidelines
- Medical Record Review
Timeline
MEDICAL CLAIMS PROCESSOR
RX Compass
01.2020 - Current
REIMBURSEMENT SPECIALIST
SCP Health
11.2018 - 12.2019
HEALTHCARE BILLING SPECIALIST
Conifer Health
11.2013 - 12.2018
High School Diploma - undefined
W.T. High School