Open To Work
MELISSA HUDSON
West Haven,CT
Work Preference
Summary
Detail-oriented individual with exceptional communication, customer service, insurance, billing and posting management skills. Proven ability to handle multiple tasks effectively and efficiently in fast-paced environments. Successful at efficiently handling patient inquiries, obtaining Tricare authorizations, insurance, billing, posting and administrative tasks. Familiar with contracts and other documents affecting billing processes. Productive and diligent with passion for resolving discrepancies through attention to detail and creative problem-solving. Passionate about perpetuating company values through impeccable work ethic and drive.
Overview
17
17
years of professional experience
Work History
Billing Payment Poster
Orthopaedic Specialty Group
02.2024 - Current
- Manually and electronically posts 100s of thousands of dollars for Anthem BCBS (Tuesdays), and private, third party, Medicare, Medicaid, Champva, Tricare, Humana, MVA, Skilled nursing, HSA on a daily.
- Supported audits by providing detailed records of all posted payments and adjustments upon request.
- Stayed informed of industry changes and updates by participating in relevant training sessions, utilizing new knowledge to enhance job performance.
- Proactively identified potential underpayments from insurers and took appropriate actions to rectify discrepancies swiftly.
- Increased accuracy of patient account balances by diligently applying payments according to insurance guidelines.
- Maintained compliance with HIPAA regulations while handling sensitive patient information during payment posting tasks.
- Assisted colleagues with complex or challenging cases, fostering a collaborative work environment focused on problem-solving and continuous improvement.
- Served as a key liaison between billing and collections departments, facilitating timely communication around patient account issues.
- Processed payments that had been received from insurance companies and Medicare.
- Identified overpayments and processed refunds for insurance carriers and patients.
- Contributed to improving departmental workflows by regularly sharing insights and feedback on processes with management.
- Consistently maintained high levels of productivity, exceeding departmental goals each month.
- Submitted cash and check deposits and generated cash receipts to record money received.
- Audited and corrected billing and posting documents for accuracy.
- Utilized various software programs to process customer payments.
- Handled account payments and provided information regarding outstanding balances.
- Used data entry skills to accurately document and input statements.
- Responded to customer concerns and questions on daily basis.
AR Billing Specialist
CPA Medical Billing LLC
07.2022 - 02.2024
- Posts patient payments or adjusts claims based on insurance explanation of benefits and Federal contractual agreements
- Adapts to daily work changes or for individual customer/patient/medical practice need
- Creates individual insurance batches and posts payment according to the contractual agreement
- Sends claims to Coding when discrepancies or missing information needs to be updated for a corrected claim submission
- Corrects payment batch errors to balance claims t9 submit to secondary or tertiary payers
- Obtains Explanation of benefits, ERAs, check/receipt of payments to balance or post previous paid claims but never received correspondence of payment
- Completes work in a timely fashion to meet deadlines
- Organized and documents all work completed
- Supports coworkers and management needs (team player)
- Customer service via telephone, in person, utilizes Teams for certain communication while practicing privacy and HIPAA laws to protect patients privacy
- Willingness to learn and teach others of new procedures
- Submits claims and corrected claims when Information on a claim has been edited and now claim needs to be reprocessed
- Verifies and confirms providers credentials such as NPI and Taxonomy when providing various care for patients making sure they're the correct provider for all medical encounters for clean claim submission
- Confirms with insurance companies that claims are being processed for in network providers as well as out of network providers when some providers are new and waiting for official contractual agreements.
- Utilizes NPPES when verification is needed for certain medical providers and to confirm we have the correct tax identification numbers, national provider identification and taxonomies on file for appropriate medical specialty
- Claim follow up -corresponding with Insurance companies to have claims reprocessed when denied in error.
- Follows all HIPAA/Privacy rules and regulations when discussing, working or handling sensitive information
- Verifies and adds new insurance Information to patients accounts and Submits claims to the correct insurance carrier for processing and reimbursement
- Answers telephone and assist on helping and resolving patient Inquires and issues in a pleasant very respectful manner
- Updates patient accounts with newly obtained information for accurate billing
- Documents and records all actions between patients and insurance companies
- Communicates with registration department for the purpose of obtaining patients insurance information directly from the patient upon check in so they can correct/add or update the patients insurance files due to insurance carrier denied claims and needs the verification of coordination of benefits, new subscribers identification numbers, verification of Date of Birth or other information needed to adjudicate the claim
- Communicates with Coders for claims that need to be reviewed due to insurance denied for example: use of wrong CPT codes, missing modifiers, diagnosis, or additional Information is needed such as progress notes/medical provider documentation for specific dates of service
- Completes special or assignments in a timely manner and if can't complete, immediately communicates with my Supervisor to explain why for example: waiting on documents or documentation to complete billing and claim submission because without I can't fulfill request and or process claim(s) until information is obtained
- Communicates with all commercial insurance companies, Champva, Tricare for determining factors for claim or procedure denials and dispute claims when denials were incorrect and request claims to be reprocessed or will have appeals filed for the reimbursement of claims denied in error
- Start: 7:00am-9:00am End: 3:30pm-5:30pm, M-F
- Supervisor: Israelis Febres (954)415-7409
- 40 Hour work week
FR Program Specialist, GS 7, Step 8
North East Centralized Patient Account Center(NECPAC) – Veterans Health Administration
08.2020 - 12.2021
- Used Huron work tools to review medical encounters for identification of dual eligible veterans, Champva recipients, Active Duty service members, collateral of veterans, workers compensation recipients.
- Obtained referrals and prior authorizations using Tricare (Humana Military) website for Tricare spouses and Active duty service members.
- Customer service; called ADSM to advise and remind the service member of their need for authorizations & referrals when seeking care at any VA and the importance of contacting their MTF commander or PCP in order to obtain for all upcoming medical visits prior to scheduling appointments to avoid potential billing to them for not having authorizations or referrals prior or to be seen at the VA for upcoming medical encounters
- Liaison between billing department and Human resources for Workers compensation inquiries and concerns
- Updated and inserted new information regarding workers compensation cases and new authorization / referral numbers on to a spreadsheet and uploaded documents within SharePoint
- Identified appointment types and collaborated with scheduling departments via email or phone for updates and or corrections to appointments types, appointment status (Normal-Tricare-Active duty) or to have appointments cancelled for Active duty service members that are not eligible for (example; community care visits- these visits are only for Veterans) or do not have authorization on file for the scheduled visit
- Contacted insurance supervisors and billers to inform them of expired/termed/updated group types or cancelled Tricare or insurance policies so patient insurance files can be updated appropriately to avoid billing discrepancies
- Reviews appointments to determine whether a high or low dollar appointment, all high dollar appointments were sent to Utilization review
- Determined if dual eligible veteran (example; Service connected and has Tricare eligibility) and verified if an affirmation form (consent to bill Tricare) is on file within SharePoint and if not sent all encounters to the financial representatives for that specific VA facility for VISNS 1&2 (North Hampton, Connecticut, Boston, Erie, Providence, White River Junction and more)
- Used Eligibility Status (ES) to update Tricare or Active duty status in eligibility screens
- Collaborated and communicated with eligibility department via email, phone, messenger in regards to updating patient information cancelling upcoming appointments and transitioning out Champva recipients that are no longer eligible to be seen at the VA due to having Medicare benefits.
- Utilized Talent Management System to complete all required educational, official job and mandated VA training
- Removed encounters that were untimely or could not be billed due to being out of scope for retrieval of affirmation forms (veteran consent to bill their Tricare benefits) and contacted patients when no authorization or referrals for Tricare recipients were not on file and contacted patients to advise they need to obtain authorization or referrals from their primary care providers or military treatment facilities where applicable
- 40 Hour work week, 8am-4:30pm - Remote Mon/Wed/Fri on Duty StationTue/Thursday
- Supervisor: Jacqueline McNeill
Program Support Assistant(Biller) GS 7 Step 7
VA Connecticut Healthcare System
05.2008 - 08.2020
- Utilizes VISTA software packages, Microsoft Office, internet,TPJI (third party joint inquiry), ICB(Insurance Card Buffer), SharePoint, Spreadsheets and all Office equipment, email, telephone
- Subject matter expert for Tricare / Champva/ OWCP/ Third party Billing Department
- Outpatient Pharmacy Electronic Claims Coordinator (Rx OPECC)
- Listens attentively to evaluate and recognize potential miscommunication or misunderstandings to reconcile problems and or issues effectively and in a swift manner
- Anticipates problems and identifies and evaluates potential sources of information and generates alternatives to solve problems
- Demonstrates a positive and helpful attitude and supports management performance goals
- Thorough when performing work and conscientious about attention to detail.
- Resolves employee related software, computer issues and hardware problems
- Provides great friendly customer service no matter the issue or problem
- Demonstrates a positive and helpful attitude, while supporting management performance goals
- Provides prompt and courteous service to staff, visitors and patients both on the phone and in person, despite any difficult communication situation and demonstrates competency in interpersonal interventions
- Analyzes information and makes decisions that may have significant ramifications
- Identifies, researches and breaks down problems using structured problem resolution approaches
- Communicates, explains or defends complex situations, new data, and or information and adapts to the audience's level of knowledge, especially when training new employees
- Monitors and supports staff with information that is entered onto spreadsheets for billing of multiple services
- Reviews moderately complex data from multiple sources and determine relevant information to a given situation
- Performs patient account management to ensure no duplicate encounters have been billed or entered within billing menus
- Provides training amongst peers and various customer support
- Provides prompt courteous feedback within a timely manner
- Anticipates problems and identifies and evaluates potential sources of information and generates alternatives to solve problems
- Maintains relationships with Veterans, Staff, outsiders and customers with diverse needs in order to meet expectations
- OERR, Quadra Med, Copier/Fax machines, Microsoft Suite and Microsoft Windows and other various communication and programs on a daily basis
- Utilizes knowledge and education to understand medical terminology and the usage of personal information in a health care environment including signs, symbols and abbreviations to accurately decipher handwritten progress notes. I recognize disease processes that are involved with legal cases, and determining if the relationship between the service connected disabilities and procedure(s) that were provided to the patient(s) are billable for Workers Compensation cases
- Collaborates with healthcare teams to accomplish specific goals for patients
- Promotes and maintains effective working relationships with other personnel both within and outside of the medical center
- Daily usage of CPT-4(Current Procedural Terminology), ICD-9, ICD-10 and HCPCS (Health Care Procedure Coding Systems) manuals to accurately determine if the diagnosis, modifier and procedure codes are accurately compatible for billing and in compliance with Medicare's rules, regulations and requirements
- Abides and follows all rules and regulations regarding release of information including Privacy Act 1974, Freedom of Information Act, for the accurate handling of sensitive information (e.g. HIV, AIDS, Sickle Cell, Alcohol / Drug Abuse) in addition to VISTA Security
- Practices HIPAA (Health Information Portability and Accountability Act) guidelines to always protect personal identifiable information and or sensitive information when collaborating or communicating with other department staff to accurately update patient charts and claim information
- Coordinated and completed multiple tasks for multiple people in urgent or emergent situations
- Completed all annual and mandatory training requirements
- Completed assignments and assigned reports (e.g. entered not reviewed, claim status awaiting resolution(CSA), etc), within one day of assignment or entry
- Produces quality work while consistently treating veterans with compassion and respect and in a timely fashion
- Reviews all encounters to ensure that billing is appropriate and timely
- Insured the Billing department was running smoothly by assuring fellow co-workers (e.g. contract or new billers) have their daily workloads
- Communicated by written, verbal, Electronic and or telephone communication to individuals at all levels, to include: supervisors, co-workers, lawyers, veterans and / or family members, insurance agents and many more customers
- Consulted Veteran and Active Duty patients regarding Tricare and Champva eligibility benefits, Tricare cost-shares, and veteran copayments where applicable
- Researched and rectified errors or inconsistencies regarding patient Veteran accounts, and non-veteran accounts (eg ChampVa, Workers Compensation)
- Collaborated with the Pharmacy supervisor(s) to resolve prescription rejections so veterans and Champva recipients can receive their meds in a timely manner
- Obtained prior authorizations for prescriptions when medication has been rejected within the prescription ECME (electronic claims management engine) database and was determined a medical necessity
- Obtained certification(s) for medical necessity for prescriptions as needed to process rejected Champva medication distributions
- Verified new insurance entities and eligibility benefits, such as: Medicare, Champva, third party carriers (e.g. BCBS, AETNA etc) and various Tricare Branches with in the Insurance Card Buffer and updated accordingly
- Reviewed and verified inpatient and outpatient insurance policy information by accessing the computer database (VISTA) or ICB (Insurance Card Buffer) for correctly determining if there are exclusions prior to billing the patients encounter(s)
- Appended deductibles, Tricare cost-shares, co-insurance and copayment charges when applicable after reimbursement for claims have been received and payment has been posted
- Verified validation of prior authorization or pre-cert for the billing of Inpatient admissions or North Region DoD (Department of Defense IDES (Intergraded Disability Evaluation System) claims for active duty recipients getting ready for discharge
- Organized, gathered, compiled and filed patient information before and after processing Tort Feasor (legal cases), Workman's Compensation, Compensation and Pension (disability examinations) Prosthetics (durable medical equipment), inpatient, Fee Basis, and all outpatient or specialty claims
- Researched and validated Tricare/Champva recipient's coverage to create claims determining the type of treatment provided, pre-certification requirements, the patient's rank and co-pay amount due
- Maintained accurate documentation for billing all specialty claims (e.g. Torts, PT, OT (physical/occupational therapy) prosthetics(DME))
- Created manual claim(s) to be billed, if not already in the database
- Maintained accurate Release of Information database and pre-certification/coordination of benefits file
- Verified of Explanation of Benefits (EOB) and insurance eligibility form direct contact with patient's insurance carriers
- Used the Audit Compliance Module and the Integrated Billing Module(IB) to review and or cancel patient encounters that were entered by the clinics or providers that may or may not be billable or covered dates of service
- Used claim scrubber, insuring accurate clean claims are submitted to Medicare and other third-party insurances for reimbursement
- Retrieved information using QuadraMed/Citrix Nuance software to thoroughly complete the Bill me, Code me, ENR (entered not reviewed), NILCO (new Insurance late check out) and Labs over 65 reports
- Runs specialized reports to retrieve and review patient information or daily encounters to determine the status, and the level of medical necessary for a clean claim reimbursement
- Manually runs Labs using the Audit PCE compliance module within the QuadraMed /Citrix Nuance when scheduled report fails to run
- 40 Hour Work Week, (Remote M-F(2019-2021))
- Supervisor: RoseMarie Fish
- (203)932-5711 ex 3517
Education
High School Diploma -
Adult Education
New Haven, CT2000
Health Claims Specialist
Branford Hall Career Institute
Branford, CT2004
Department Of Veteran Affairs
West Haven, CT2016
Skills
- Expertise in HIPAA compliance
- Insurance verification
- Tricare Authorizations/Referrals
- Healthcare Billing Accounts Receivables and Payment posting
- Strong attention to detail and analytical problem-solving
- Strong verbal and written communication
- Experienced with Microsoft Office applications
- Customer service excellence
- Data entry and management
- Billing dispute resolution
- Teamwork
Section name
Covid-19 Vaccinated: Healthcare Professional Clinic Site VACT; Pfizer-BioNTech Covid Vaccine 1st Dose: Lot#ER8731 Date:04/27/2021, 2nd Dose: Lot#ER8727 Date: 05/17/2021
Timeline
Billing Payment Poster
Orthopaedic Specialty Group
02.2024 - Current
AR Billing Specialist
CPA Medical Billing LLC
07.2022 - 02.2024
FR Program Specialist, GS 7, Step 8
North East Centralized Patient Account Center(NECPAC) – Veterans Health Administration
08.2020 - 12.2021
Program Support Assistant(Biller) GS 7 Step 7
VA Connecticut Healthcare System
05.2008 - 08.2020
High School Diploma -
Adult Education
Health Claims Specialist
Branford Hall Career Institute
Department Of Veteran Affairs
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