MELISSA DAVIS
Medtronic MiniMed
Corpus Christi,TX
25
Years of experience
Experienced Healthcare Revenue Cycle Professional with 17 years in medical claims processing and reimbursement. Expertise in managing claims from submission to resolution, including denial resolution and appeals. Skilled in reviewing EOBs, maintaining electronic medical records, and communicating with stakeholders to optimize reimbursement. Over three years of remote work experience, maintaining productivity and compliance with quality standards.
Work History
Patient Financial Services Representative
8 Years 6 Months- Oversaw medical claims from initial review and submission to payer follow-up, denial resolution, appeals, and final reimbursement to ensure accurate and timely processing.
- Placed outbound calls to insurance payers to obtain claim status, resolve denials, verify reimbursement, and facilitate claim resolution.
- Managed prior and retrospective (retro) authorization requirements, reviewed authorization status and payer criteria, and obtained supporting documentation to facilitate claim payment and reimbursement.
- Utilized Availity, Quantum Health, eviCore, BCBS and Anthem provider portals, NaviNet, Kaiser, and Optum for payer follow-up, authorization research, claim status, denial review, and reimbursement resolution.
- Liaised with insurance carriers, provider offices, and internal teams to resolve reimbursement issues, facilitating timely claim payments.
- Executed work remotely from home, ensuring consistent productivity and adherence to company standards. for approximately three years while consistently meeting productivity, quality, and HIPAA compliance standards.
- Investigated payer rejections and recoupments, identified root causes, and escalated accounts to appropriate departments to enhance resolution efficiency.
- Researched denials related to prior authorization, medical necessity, coding, eligibility, and payer policies.
- Prepared and submitted approximately 10-15 insurance appeals daily.
Medical Billing Specialist
1 Year- Managed medical billing processes, including insurance claims follow-up, payment posting, and accounts receivable management, to ensure timely revenue collection.
- Reviewed and resolved insurance claims discrepancies and researched claim denials to facilitate accurate billing and enhance reimbursement outcomes.
- Verified insurance coverage and communicated with providers, patients, and insurance carriers to support timely reimbursement.
- Verified insurance coverage and coordinated communication with providers, patients, and insurance carriers to expedite reimbursement processes.
Medical Billing Specialist
1 Year- Processed medical billing, insurance claims, and payment posting, ensuring timely accounts receivable management.
- Worked with physicians, insurance companies, and patients to resolve reimbursement and billing issues.
- Reviewed Explanation of Benefits (EOBs) and resolved insurance claim discrepancies.
- Collaborated with physicians, insurance companies, and patients to resolve complex reimbursement and billing issues, enhancing overall satisfaction.
Medical Billing & Collections Specialist
3 Years- Managed physician claims end to end, including claim review and submission, insurance follow-up, claim status research, denial resolution, claim corrections and resubmissions, appeals, reimbursement follow-up, and final resolution.
- Reconciled insurance and patient payments, corrected posting discrepancies, and maintained accurate account balances to ensure financial integrity.
- Processed lockbox and facility deposits, performed billing adjustments and write-offs, and corrected accounts in accordance with established procedures to maintain operational compliance.
- Executed month-end reconciliation by balancing account activity, reconciling payments, reviewing postings for accuracy, correcting discrepancies, and ensuring precise account balances at close.
Medical Billing Specialist
3 Years- Managed end-to-end medical claims, overseeing claim review, submission, insurance follow-up, denial resolution, corrections, appeals, and reimbursement follow-up to ensure timely payments.
- Reviewed insurance claims and processed reimbursements, effectively resolving billing issues to maintain cash flow.
- Reviewed insurance claims, processed reimbursements, and resolved billing issues.
- Coordinated with providers and insurance companies to facilitate timely resolution of claims, enhancing overall claim processing efficiency.
Medical Billing Specialist
2 Years- Submitted insurance claims and managed medical billing for multiple provider accounts, ensuring timely reimbursements.
- Performed payment posting, followed up on claims, resolved denials, and managed reimbursement activities to optimize cash flow.
- Maintained accurate patient billing records and supporting medical documentation to enhance compliance and audit readiness.
- Maintained patient billing records and supporting medical documentation.
Medical Assistant
1 Year- Assisted physicians during patient examinations and clinical procedures to ensure accurate diagnosis and effective treatment.
- Prepared patients for examinations, documenting vital signs to provide physicians with critical health information.
- Educated patients on treatment instructions and follow-up care.
- Educated patients on treatment instructions and follow-up care to promote adherence and improve health outcomes.
Medical Receptionist
3 Years- Coordinated front office operations, patient scheduling, and appointment coordination to ensure seamless patient flow.
- Verified insurance coverage and processed patient registrations to facilitate accurate patient information management.
- Maintained medical records and patient documentation while ensuring confidentiality.
- Resolved patient billing inquiries and communicated with providers and insurance carriers to clarify account details.
Education
Bachelor of Science - Business Administration, Healthcare Management
- Delta Mu Delta International Honor Society
- GPA: 3.99
Associate of Science - Business Administration
Graduated with High Honors
Associate of Applied Science - Medical Practice Management
Medical Office Specialist Certificate
Medical Assistant Diploma
Skills
Revenue Cycle Management
Insurance Appeals
Denial Resolution
Medical Billing
Claims Resolution
Accounts Receivable
Reimbursement Recovery
Insurance Follow-Up
Payment Posting
Prior Authorization
Commercial Insurance
EOB analysis
Payee Follow-Up
HIPAA Compliance
Medical claims processing
Claims resolution
Athenahealth | Centricity | Salesforce | Availity | Quantum Health | eviCore | BCBS Provider Portals | Anthem Provider Portals | NaviNet | Kaiser | Optum | One Health Port | Zelis | Microsoft Excel | Microsoft Office Suite | EMR/EHR
Work Preference
Work Type
Full Time
Location Preference
Remote
Minimum Desired Compensation
$23/hr
Timeline
Patient Financial Services Representative
Medtronic MiniMed
01.2018 - 07.2026Read More
Medical Billing Specialist
Corpus Christi Eye Specialists
01.2017 - 01.2018Read More
Medical Billing Specialist
CHRISTUS Health
01.2016 - 01.2017Read More
Medical Billing & Collections Specialist
Corpus Christi Pain Medicine
01.2012 - 01.2015Read More
Medical Billing Specialist
South Texas Brain & Spine
01.2009 - 01.2012Read More
Medical Billing Specialist
Jennings & Jennings Billing
01.2007 - 01.2009Read More
Medical Assistant
Urology Group
01.2005 - 01.2006Read More
Medical Receptionist
Respiratory Center of South Texas
01.2002 - 01.2005Read More
Colorado Technical University
Bachelor of Science from Business Administration, Healthcare Management
12.2026Read More
Colorado Technical University
Associate of Science from Business Administration
01.2024Read More
Kaplan College
Associate of Applied Science from Medical Practice Management
01.2012Read More
Southern Careers Institute
Medical Office Specialist Certificate
01.2004Read More
Southern Careers Institute
Medical Assistant Diploma
01.2002Read More