Melissa Tovar
Houston,TX
Summary
Medical billing professional with experience in insurance verification and claim processing across healthcare settings. Supports revenue cycle operations through denied claim resolution, accounts receivable follow-up, and provider communication. Improves reimbursement accuracy, clean claim records, and patient billing outcomes.
Overview
1
1
Certification
13
13
years of professional experience
Work History
Medical Biller and Coder & Prior Authorization Sp
Houston Nephrology PA
Houston, Texas
01.2025 - 10.2026
- Verified insurance details to ensure accurate billing submissions and minimize claim rejections.
- Processed nephrology claims and patient care service records with accuracy and efficiency.
- Worked with providers to fix billing discrepancies quickly.
- Monitored accounts receivable and proactively followed up on outstanding claims to expedite resolution.
- Resubmitted denied claims to insurance carriers for review.
- Clarified billing questions and payment options for patients to enhance understanding and satisfaction.
- Updated electronic health records to maintain complete service documentation.
- Supported rollout of new billing software to improve workflow efficiency.
Medical Billing Manager
Medical, North Star Medical Group
Houston, TX
02.2016 - 01.2025
- Managed insurance claims, ensuring prompt reimbursement and contributing to revenue growth.
- Submitted claims electronically through Navicure and resolved denials and billing discrepancies.
- Checked patient insurance eligibility daily, collaborating with relevant parties to ensure accurate billing.
- Reviewed Medicaid claims and patient accounts before monthly statement submission.
- Prepared detailed reports on billing inquiries and reconciled transactions to improve financial accuracy.
- Collaborated with team members to identify and implement process improvements for operational efficiency.
- Built five years of experience in medical billing and collections within healthcare settings, strengthening revenue cycle management.
- Maintained confidentiality of patient records while handling sensitive billing information.
Medical Referral Coordinator & Medical Records
Raul Rivera
Pasadena, TX
12.2013 - 01.2016
- Scheduled patients based on availability, urgency, and insurance authorization guidelines.
- Verified benefits eligibility for scheduled patients daily to support smooth service delivery.
- Collaborated with multidisciplinary staff to improve patient care and reduce response times.
- Prepared patients and equipment for lumbar injections; documented vitals, complaints, and medications in EMR.
- Provided pre- and post-operative care to support patient comfort and recovery.
- Collected blood, urine, and saliva specimens for testing to support accurate results and timely diagnosis.
- Checked expiration dates for supplies and medications to ensure safety and compliance. for supplies and sample medications to maintain compliance.
- Maintained organized spreadsheets for payments and collections updates to improve financial tracking and reporting.
Education
Master of Science - Nursing Administration
Universal of Houston
Houston, TX01-2027
Master of Health Science - Medical Assistance & Medical Billing & Coding
Fortis College
Houston, TX05-2012
Master of Health Administration - Accounting
Houston Community College
Houston, TX09-2009
High school diploma - Data Science
Sam Houston High School
Houston, TX06-1993
Skills
- Billing and coding
- Inpatient coding
- Claims processing efficiency
- Revenue cycle management
- Invoice processing and posting
- Patient account tracking
- Patient data identification
- EHR systems
- Electronic health record systems
- Recordkeeping
- Security compliance
- Patient data
Certification
- Dialysis prior authorization and medical billing, MEDICAL RECORDS (10+ years), DATA ENTRY (10+ years), CMA (5 years), Phlebotomy (10+ years), Bilingual (10+ years), Billing and Coding (5 years), Referral Coordinator (5 years), Injections (10+ years), HIPPA regulations (10+ years), Insurance Verification (10+ years), Medical Receptionist (10+ years), EMR system (10+ years), Patient Care (10+ years), Medical Terminology (10+ years), eClinicalWorks, Certified Medical Assistant (AAMA) January 2012 to Present, CPR Certification May 2020 to May 2023, Certified Billing and Coding Specialist March 2007 to Present, BLS Certification, AHIMA, RHIA, January 2018 to June 2024
LANGUAGES
- English - Fluent, Spanish - Fluent
- English: Professional, Spanish: Professional
Timeline
Medical Biller and Coder & Prior Authorization Sp
Houston Nephrology PA
01.2025 - 10.2026
Medical Billing Manager
Medical, North Star Medical Group
02.2016 - 01.2025
Medical Referral Coordinator & Medical Records
Raul Rivera
12.2013 - 01.2016
Master of Science - Nursing Administration
Universal of Houston
Master of Health Science - Medical Assistance & Medical Billing & Coding
Fortis College
Master of Health Administration - Accounting
Houston Community College
High school diploma - Data Science
Sam Houston High School