Melissa Earl
Brick,NJ
Summary
Professional with strong expertise in medical billing, prior authorizations, bringing reliable and adaptable approach to navigating evolving needs. Proven track record in team collaboration and achieving results through effective communication and problem-solving. Skilled in coding, claims processing, and patient account management, with keen eye for accuracy and compliance. Known for dependability and focus on efficiency, ready to contribute to streamlined billing operations.
Overview
10
10
years of professional experience
Work History
Prior Authorization Specialist/Medical Biller
Jasper Spine Institute
02.2024 - Current
- Collaborated with physicians to obtain necessary clinical information for prior authorization submissions.
- Maintained thorough knowledge of insurance plan requirements, facilitating accurate and timely completion of authorization forms.
- Tracked referral submission during facilitation of prior authorization issuance.
- Reviewed appeals for prior authorization requests and communicated with payers to resolve issues.
- Researched denied claims and contacted insurance companies to resolve these issues.
- Reviewed and collected outstanding balances and owed by patients; initiated collection actions if necessary resulting in improved account recovery efforts.
- Expedited billing processes by correctly coding services performed for insurance claims submission.
Prior Authorization Specialist
Caduceus Health
03.2020 - 06.2023
- Analyzed medical records and other documents to determine approval of requests for authorization.
- Reduced turnaround time for prior authorization requests by utilizing electronic submission methods.
- Monitored pending cases closely, proactively following up on outstanding documentation needed for successful approval outcomes.
- Achieved high success rate in obtaining authorizations by effectively demonstrating medical necessity through comprehensive documentation and clear communication with insurance companies.
- Answering incoming phone calls
Receptionist
Jersey Coast Family Medicine
06.2015 - 06.2019
- Greeted incoming visitors and customers professionally and provided friendly, knowledgeable assistance.
- Confirmed appointments, communicated with clients, and updated client records.
- Handled cash transactions and maintained sales and payments records accurately.
- Streamlined front desk operations for increased efficiency by effectively managing phone calls, emails, and walk-in clients.
- Was in charge of office authorizations and referrals to outgoing services.
Education
No Degree - Nursing/Billling
Ocean County College
Toms River, NJHigh School Diploma -
Brick Memorial HIgh School
Brick,NJ06-2007
Skills
- Medical terminology
- Medical appeals handling
- Multitasking
- Patient referrals
- Data entry
- Electronic health records proficiency
- Insurance verification
- Effective communication skills
- Authorizations
- Billing procedures
- Claims processing experience
- Medical coding
- HIPAA compliance
Timeline
Prior Authorization Specialist/Medical Biller
Jasper Spine Institute
02.2024 - Current
Prior Authorization Specialist
Caduceus Health
03.2020 - 06.2023
Receptionist
Jersey Coast Family Medicine
06.2015 - 06.2019
No Degree - Nursing/Billling
Ocean County College
High School Diploma -
Brick Memorial HIgh School
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