Melinda Barrett
Port St Lucie,FL
Summary
Highly motivated Senior Claims Auditor/Configuration Specialist. Detail oriented, results driven professional with more than 20 years’ experience in healthcare operations. Energetic self-starter with excellent analytical, organizational, and resource management skills. Seeking a challenging senior level position in claims that offers opportunity to contribute skills, experience and talent to the furtherance of an organization’s mission, vision, and operational goals. Tenacious Claims Auditor with understanding of researching claims processing errors and determining appropriate resolutions. Data-driven Configuration Specialist with exceptional skills in auditing and testing all configuration elements.
Overview
23
23
years of professional experience
1
1
Certification
Work History
Claims Quality Auditor
Integrated Home Care Services
11.2021 - Current
- Prepare audit reports recommendations for management
- Research claim processing problems and errors
- Perform routine to complex audits on claims for payment integrity
- Process and close high dollar claims
- Review and close adjudication run daily
- Process Medicare, Medicaid and Commercial claims (UB-04 & CMS 1500)
- Work special projects
- Load Fee Schedules & Benefits
- Assist Providers with claim denials and disputes
- Process DME & Home Health Claims
- Conduct compliance Audits to identify potential errors & trends
- Work Provider Portal Claim rejects
- Collaborated with cross-functional teams to ensure proper implementation of configuration changes.
- Analyzed existing systems and databases and recommended enhancements to solve business needs
Sr. Claims Examiner/Configuration Specialist
Premier Eye Care
08.2015 - 11.2021
- Process Medicare and Medicaid Vision & Medical Care claims
- Audit and monitor claim errors for quality assurance
- Process claims adjustments for overpayment and underpayment
- Responsible for handling escalated Provider claim disputes
- Update authorizations
- Load benefits and Fee Schedules
- Load New Providers
- Process coordination of benefits and tertiary claims
- Process CMS 1500 and UB-04 claims
- Review claims for proper payment
- Review claims reject reports
- Work SDS reject claims
- Reviewed questionable claims by conducting agent and claimant interviews to correct omissions and errors.
Claims Supervisor
University of Miami Behavioral Health/Concordia Behavioral Health
06.2011 - 07.2015
- Manage claim examiners daily process
- Audit and monitor incoming calls, claims and adjustments
- Responsible for training new employees
- Responsible for printing EOB’s and Provider checks
- Prepare and load member authorization
- Process 837 files to Avmed and Medicaid
- Responsible for check tracer
- Responsible for handling escalated Provider disputes and Appeals.
Senior Integrated Services Specialist
Coventry Health Care/Aetna
11.2000 - 04.2011
- Process all Lines of Business for Medical claims
- Data enter claims for payment
- Applied Provider specific contract agreement
- Reviewed claims for errors
- Responsible for special projects
- Responsible for training new employees
- Processing Medical claims.
- Examined claims forms and other records to determine insurance coverage.
Education
Associate of Arts - Computer Software And Media Applications
ITT Technical Institute
Plantation, FL07.2014
Skills
- Microsoft Word
- Excel
- PowerPoint
- IDX
- Plexis
- Amisys
- Encoder Pro
- Adobe
- Access
- SDS
- Outlook Express
- Remarkable experience in processing Mental Health, Medical Health, Routine Vision & DME Healthcare Claims
- Experience working with ICD-9, CPT-4 and/or HCPCS coding systems
- Experience loading benefits & fee schedules
- Proficiency with coordination of benefits and tertiary claims
- Extensive knowledge in claim adjustments, underpayment and overpayment
- Knowledge of understanding Provider contracts, LOA and SCA
- Knowledge with Medicare, Medicaid, and Private Insurance
- Experience with claim audits and/or peer to peer review
- Knowledge of EDI, Smart Data Solutions, and Availity
- Knowledge of HIPAA Compliance Privacy Act
- Experience with Plexis, Amisys System and VisibilEDI
- Strong customer service orientation
- Experience with loading Provider Contract rates
- Maintain quality and productivity standards
Certification
Notary Public
Timeline
Claims Quality Auditor
Integrated Home Care Services
11.2021 - Current
Sr. Claims Examiner/Configuration Specialist
Premier Eye Care
08.2015 - 11.2021
Claims Supervisor
University of Miami Behavioral Health/Concordia Behavioral Health
06.2011 - 07.2015
Senior Integrated Services Specialist
Coventry Health Care/Aetna
11.2000 - 04.2011
Associate of Arts - Computer Software And Media Applications
ITT Technical Institute
Notary Public
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