Melesha Brown
Bronx,New York
Summary
Experienced health service professional with a demonstrated history of working in the hospital/healthcare industry. Skilled in Electronic Medical Record (EMR), insurance verification, Medical Billing and Coding and has a strong background in revenue cycle management. seek a position in which my skills and experience can be maximized to its highest potential.
Overview
7
7
years of professional experience
1
1
Certification
Work History
Financial Investigator
Bronx Care Health Systems
04.2017 - Current
- Verification of medical insurance such as Medicaid, Medicare, and other commercial insurance
- Make timely notification to insurance company
- Obtain authorization for elective or inpatient stay from insurance companies
- Interview patients to verify and correctly update demographics
- Make necessary corrections to accounts as advised by quality assurance supervisor.
Claims Specialist
Westchester Medical Center
05.2021 - 03.2022
- Reviews claims in which a denial has been received from the payer
- Identifies the root cause of the denial and addresses the denial issue with the appropriate department (i.e., Billing, CDM, Clinical Documentation, Coding, etc.)
- Utilizes available resources to effectively research claims and complete steps to submit information necessary to process or appeal claims
- Communicates trends in the claim denial populations to the leadership team
- Investigates and ensures that questions and requests for information are responded to in a timely and professional manner to ensure resolution of outstanding claims
- Completes and requests adjustments to a claim, as appropriate
- Organizes work/ resources to accomplish objectives and meet deadline.
Patient Access Coordinator
Nyack Hospital
09.2016 - 07.2017
- Completes registration of all incoming patients via ambulance entrance
- Conducts interviews to gather accurate demographic information
- Ensures compliance with HIPAA regulations and hospital policies
- Verification of medical insurance such as Medicaid, Medicare, and other commercial insurances
- Collection of copays
- Refer patients to appropriate insurance resources.
Education
B.S.- Health Services Administration -
Lehman College
A.A.S-Accounting -
Monroe College
Skills
- Claims Investigation
- Microsoft Office
- Policy Interpretation
- Claims Processing
- Claims analysis
- Data Entry
- Insurance Coverage Verification
- Understanding of medical terms
- Account Management
- Prior authorization processing
- Medicaid knowledge
- Regulatory Compliance Adherence
Certification
- Certified Billing and Coding Specialist
- Data Entry Management
- Medical Terminology
- Advanced Hospital & CCS Prep
- Microsoft excel
- Word
- PowerPoint
- QuickBooks
Timeline
Claims Specialist
Westchester Medical Center
05.2021 - 03.2022
Financial Investigator
Bronx Care Health Systems
04.2017 - Current
Patient Access Coordinator
Nyack Hospital
09.2016 - 07.2017
B.S.- Health Services Administration -
Lehman College
A.A.S-Accounting -
Monroe College
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