Martin Melchor
Lakeside,CA
Summary
MEDI-CAL MANAGED CARE SPECIALIST
Over 15 years experience. Medi-Cal guidelines, Medi-Cal Fee schedule, DRG, DRG Pricing calc, Contracting, COB, website navigation, experienced in Epic, Microsoft office, Excel, Cirius, Onbase, File CD, and Microsoft Teams.
Corrected claims, Underpayments, denials, appeals, adjustments and refunds. Also experienced in commercial claims.
Highly motivated employee with desire to take on new challenges. Strong work ethic, adaptability, and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills.
Overview
12
12
years of professional experience
Work History
Account Specialist
Scripps Healthcare
San Diego, CA
04.2013 - Current
- Researched and resolved billing discrepancies with insurance companies.
- Verified eligibility of third-party payers to ensure timely reimbursement of claims.
- Collaborated with other departments to resolve complex issues related to billing or payments.
- Interpreted healthcare policies, contracts, and fee schedules when determining reimbursement amounts.
- Processed payments from patients and insurance companies accurately and efficiently.
- Developed strategies to improve revenue cycle operations including billing policies and procedures.
- Conducted audits of patient accounts to identify errors or inconsistencies in charges or payments.
- Maintained compliance with HIPAA regulations by safeguarding confidential information.
Skills
- Claim processing
- Policy interpretation
- Audit procedures
- Data analysis
- Problem solving
- Attention to detail
- Friendly, positive attitude
- Relationship building
- Multitasking
- Organizational skills
- Research
- Dependable and responsible
- Quality assurance
- Remote office availability
- Analytical and critical thinking
- Computer skills
Affiliations
I have always exceeded productivity requirements and my quality audits are consistently above average. I am proud to be a resource for my team, I work well with others and also take direction well. I am a fast learner and a problem solver. My focus is to close my accounts in the shortest amount of time possible, and at the maximum reimbursement. I am great at finding underpayment causes both from the payor and internally.
References
References available upon request.
Timeline
Account Specialist
Scripps Healthcare
04.2013 - Current
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